1. Topic: Pacemakers A device stimulating the heart to beat at the rate which is preset at the most effective for the patient who experienced bradycardia or cardiac arrest. Lead A pacemaker device: Battery +Computer +Clock Conduction system

2. Problem identification at the Cardiology Dept. Too many emergency replacement of pacemakers in 2002-03 Cardio-vascular Surgery team (Ns., Clin. Tech., MD, )

3. Pareto chart Result of cause analysis of emergency replacement of PM Technical failure in predicting life of PM battery Pt. drop out from the follow-up Lead fracture

4. Root Cause Analysis Emergency operation Patients Medical StaffDealers Pacemaker Dropout Poor KM: Mini- clinic/Programmer Poor follow-up for the Patients Few information to Doctors Poor communication Poor follow-up for the Patients Shorter battery life New PG unable to checked by Mini-clinic Lead fracture Functional modification Fishbone diagram

5. 5 Seven countermeasures were implemented. 1..Conducting Pt surveillance 2..Improvement of Pt database 3..Opening PM clinic at OPD 4..Improveent in INFO share on Pts share among the staff 5...Promoting attendance of PTs to the follow-up sessions 6..Home visit for monitoring PM 7..Improvement of health message on PM

6. Activity 1 Surveillance on PM patients registered at the Dept. using questionnaire to the patients and the family members to know the present situation

7. Improvement of the database and its utilization Activity 2

8. Activity 3 Opening PM clinic in OPD One afternoon session for PM patients in a week Using full-function programmer

9. Activity 4 Sharing INFO among staff on PM pts visiting the next PM clinic

10. Activity 5 Promoting better compliance to the recall / follow-up of the PM users by advance contact to the Pts by the staff

11. Activity 6 Conducting follow-up by house to house visit for the pts with restricted mobility With Programmer

12. Activity 7 Improvement of messages in the leaflet for PM users

13. Before TQMAfter TQM Before TQMAfter TQM Increased Attendance rate in follow-up session Increase in frequency of full-functioned program- mer for monitoring PM Outcomes of the activities

14. Rate of Emergency in PM replacement fell to be NIL (0) in 2003-04 Before TQM After TQM Courtesy to Iizuka Hospital Target was achieved

15. Person in charge Data input on pts and their PMs at discharge Operator Data input on pts’ attendance to the follow-up Dr at clinic Back-up data formulationNurse in clinic Periodical data reviewChief Dr in PM clinic 5W1H ： Why, Who, When, Where, What, How For Standardization and sustainability