Document Type

DNP Project

Publication Date


Degree Name

Doctor of Nursing Practice

Faculty Advisor

Rosemary Johnson, DNP, APRN, ANP-BC, DNP

Practice Mentor

RoseAnna Petonito, DNP, APRN, ANCC-BC, DNP


Background and Significance: The World Health Organization (WHO) (2021) reports that 55.4 million people died worldwide in 2019; cardiovascular diseases due to ischemic heart disease and stroke were the top two leading causes of these deaths. Experts predict that by the year 2030, more than 22.2 million people will die annually from cardiovascular disease (Ruan et al., 2018). Noninvasive cardiovascular screening tests, such as the "Pulse4Pulse" screening tool, are a way to help providers identify patients at high-risk for cardiovascular disease and initiate treatment to reduce future risk.

Purpose: To increase provider utilization of the "Pulse4Pulse" screening test in a primary care office. The outcome measures were to increase the number of completed “Pulse4Pulse” tests; increase the total number of referrals generated from those who completed the “Pulse4Pulse” test; and, increase the revenue yield from patients completing the test. The goals of this project were achieved through health education for the providers and written literature for the patients.

Methods: The Plan-Do-Study-Act (PDSA) Cycle was implemented to help guide the project. The clinical staff's knowledge was assessed through a pre-and post-test following an educational class. A one-paragraph description attached to the "Pulse4Pulse" questionnaire was distributed to each eligible patient when first placed in the examination room. Three months of data was collected. Each month the number of patients eligible for the "Pulse4Pulse" test was recorded as well as completed tests, total number of referrals, total revenue yielded, and number of referrals to specialists.

Outcome: Month 3 to month 4 portrayed a 14% increase in completed tests which met the project goal of 10%. However, the last two months (5 and 6) of the study achieved a 7% increase. Lastly, early detection of abnormalities and referrals to specialty care and revenue generated for the office also increased.

Discussion: This quality improvement project showed the intervention to improve provider and patient utilization was effective in increasing overall completion rates of the "Pulse4Pulse" screening test. The findings of this study emphasize the importance of education and implementation of a cardiovascular screening tool.


A DNP Project submitted in partial fulfillment of the requirements for the degree of Doctor of Nursing Practice, Sacred Heart University Davis & Henley College of Nursing.

Creative Commons License

Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License
This work is licensed under a Creative Commons Attribution-NonCommercial-Share Alike 4.0 International License.



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