PROTOCOLS & RECOMMENDATIONS
At the Virginia Cardiac Services Quality Initiative, we are committed to advancing the standards of cardiac healthcare across Virginia and beyond. This section of our website is dedicated to providing you with comprehensive and meticulously developed protocols and guidelines. These resources are designed to assist healthcare professionals in delivering consistent, high-quality cardiac care that is informed by the latest clinical evidence and best practices.
Explore Our Resources
Our protocols and guidelines cover a broad spectrum of cardiac care topics, each carefully crafted by experts in cardiology, cardiac surgery, and patient care management. Whether you are looking for innovative approaches to treatment, wanting to refine your existing practices, or seeking insights into complex clinical decisions, you'll find invaluable information here to guide you.

Your feedback is invaluable. We invite you to:
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Share Your Insights: If you have suggestions for improvements, or if there’s additional content you’d like to see, please let us know.
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Join Our Community: Participate in discussions, workshops, and forums to collaborate with other professionals dedicated to improving cardiac care.
Tailored for Your Needs
We understand that each healthcare setting may have unique needs and challenges. That’s why our resources are designed to be adaptable:
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Customizable Protocols: While our protocols are based on robust clinical data and expert consensus, we encourage healthcare providers to modify them as needed to enhance patient care in their specific contexts.
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Up-to-Date Information: The field of cardiac care is ever-evolving. Our protocols are regularly reviewed and updated to reflect the latest research findings and technological advancements, ensuring you have access to the most current information.

Your Role in Shaping Cardiac Care
By utilizing these protocols and guidelines, you are joining a community of professionals dedicated to the highest standards of cardiac health services. Together, we can achieve better patient outcomes, reduce complications, and enhance the quality of life for those we serve.
Complete this form to download any of our protocols.
VCSQI Protocols
Data Managers FTE Recommendations
The Data Manager FTE Recommendations offers strategic guidance on allocating Full-Time Equivalents (FTEs) across cardiac data registries statewide. Based on detailed analysis of abstraction time and related tasks, these recommendations aim to balance workloads, enhance data quality, and support staff well-being.
RBC Protocol
The VCSQI RBC Protocol is a statewide guideline to reduce unnecessary blood transfusions in cardiac surgery. It provides clear, evidence-based transfusion triggers, post-op care recommendations, and a 9–12 point blood conservation plan—cutting transfusion rates from 70% to as low as 12%. The protocol also highlights gender differences in outcomes, helping teams deliver safer, more efficient care.
Readmission Protocols & Calculator
The VCSQIVHAC Readmission and Calculator is a user-friendly tool developed by VHHA and VCSQI to help cardiac teams predict readmission risks following Coronary Artery Bypass Grafting (CABG). By combining clinical, organizational, and socioeconomic data, the calculator delivers personalized risk scores that guide post-op care planning.
Designed to support better outcomes and reduce readmissions, this tool empowers providers to take a more holistic, data-driven approach to patient recovery. The document offers a step-by-step guide for effective use—an essential resource for improving CABG patient management.
Readmissions Protocol
The VCSQI Readmissions Protocol is a practical guide to reducing hospital readmissions after cardiac surgery. Developed by VCSQI experts, it outlines targeted strategies across three phases—before surgery, after surgery, and after discharge—to address risk factors and improve outcomes.
Key elements include proactive discharge planning, patient and family education, post-op monitoring, and post-discharge support like home monitoring and cardiac rehab. Standardizing these practices helps reduce care variability, enhance recovery, and lower costs.
Prolonged Ventilation
The VCSQI Prolonged Ventilation protocol provides actionable guidance to reduce prolonged ventilation (over 24 hours) in cardiac surgery patients—a key factor in improving outcomes, optimizing resources, and lowering hospital costs. Developed by VCSQI, this evidence-based guideline explains the STS-defined threshold, shares outcome data, and outlines practical strategies like proactive extubation planning and team-driven improvement goals.
Ideal for clinical teams focused on quality care, this guide supports safer, faster recoveries and better performance metrics in cardiac surgery.
VCSQI Atrial Fibrillation Prophylaxis Protocol
The VCSQI Atrial Fibrillation Prophylaxis Protocol is a structured, evidence-based guide to preventing post-op atrial fibrillation in cardiac surgery patients. Developed by VCSQI, the protocol covers pre-op to post-discharge care, focusing on medication strategies like Amiodarone and Lopressor with clear dosing and exclusion criteria.
It includes guidance on prevention, treatment of breakthrough AFib, heart rate management, and use of pacing and anticoagulation. A vital resource for cardiac teams, it helps reduce complications, shorten hospital stays, and improve patient recovery.
VCSQI AKI Reduction Recommendations and Suggestions for Care
The VCSQI AKI Reduction Recommendations and Suggestions for Care is a comprehensive set of guidelines developed by the VCSQI AKI Workgroup to help reduce the risk of Acute Kidney Injury (AKI) in cardiac procedures. Originally released in January 2022 and revised in January 2023, the document provides actionable preoperative, intraoperative, and postoperative strategies for cardiology and surgical teams. Recommendations include managing nephrotoxic risks, optimizing fluid and contrast use, and closely monitoring kidney function—all aimed at improving patient outcomes.
Strategies for Change
"Strategies for Change" is a pivotal initiative by the Virginia Cardiac Services Quality Initiative (VCSQI) aimed at highlighting best practices in healthcare. This program fosters collaboration among providers, researchers, and policymakers to identify and implement evidence-based solutions that improve patient outcomes, reduce costs, and promote health equity. By focusing on real-world strategies that drive measurable change, this initiative empowers healthcare professionals to adopt innovative practices that advance the quality of care and optimize healthcare delivery across diverse populations. Join us in shaping the future of healthcare by learning, sharing, and implementing the best practices that make a lasting impact.
We Are Here to Support You
If you have questions or require further assistance regarding the application of any protocols, do not hesitate to contact us. Our team is here to support you in providing exceptional care to your patients.