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Introduction Patients admitted with Acute Coronary Syndrome (ACS) are at very high risk for recurrent atherosclerotic cardiovascular events. Guidelines recommend intensive lipid lowering in secondary prevention, including baseline lipid profile measurement, initiation of high-intensity statin therapy, reassessment at 4–6 weeks, and optimisation to achieve LDL-cholesterol (LDL-C) targets. The recommended LDL-C is <1.4 mmol/L for very high-risk patients, with >50% reduction from baseline. A baseline audit of local practice identified suboptimal lipid profile testing and limited documentation, hence a lost opportunity for optimisation of lipid-lowering therapy (LLT) to reduce adverse outcomes.Methods A two-cycle QIP was conducted. Consecutive patients admitted with ACS were included. Outcomes assessed included: (1) lipid profile testing within 24 hours; (2) calculation of LDL-C levels by laboratory irrespective of total cholesterol levels; (3) high intensity statin prescription at discharge; (4) discharge documentation of baseline LDL-C; and (5) explicit advice to primary care to reassess lipids at 2–3 months.Interventions between cycles included: (1) development of a set of baseline labs on the IT system labelled ‘ACS panel’, which included detailed lipid profile, troponin, HBA1c, thyroid function tests, so all tests can be requested with a single click; (2) agreement with pathology department to provide LDL-C calculations using validated formulae; (3) education of staff on lipid requesting; (4) development of a lipid management box embedded within the electronic discharge notification (EDN) detailing baseline LDL-C, target LDL-C, and follow-up actions.Results Cycle 1 included 200 patients and cycle 2 included 268 patients. Substantial improvements were observed following intervention. Lipid profile testing within 24 hours of admission improved from 62% to 84%, reaching 96% at the time of discharge. Calculation of LDL-C by the pathology department increased from 48% to 84% [ figure 1]. High intensity statins were persistently prescribed in both cycles. Documentation of LDL-C on EDN improved from 29% to 79% [figure 2], and documentation advising LDL-C reassessment increased from 5% to 79%. Upfront dual therapy (statin plus ezetimibe) was introduced for selected patients with significantly elevated LDL-C.Conclusion The ongoing application of the QIP was ensured by embedding the improvements directly into the existing clinical workflows. The ACS blood panel was permanently added to the electronic requesting system, making it a default option with a single click. The EDN template was updated to include a mandatory section for baseline lipid levels and target LDL values, ensuring continuity of care for GPs and cardiac rehab teams. The pathology department agreed to calculate LDL-C levels irrespective of total cholesterol levels. These changes were designed to be sustainable and significantly improved lipid management for ACS discharges.Abstract 484 Figure 1Lipid profile testing and LDL-C testing within the first 24 hours of admission for acute coronary syndrome (ACS). Stacked bar charts compare Cycle 1 and Cycle 2 audit results. The left panel demonstrates the proportion of patients who had a lipid profile tested within 24 hours admission, while the right panel shows the proportion of patients who had LDL-C specifically tested. Improvements were observed in Cycle 2 with lipid profile testing increasing from 62% to 84% and LDL-C testing increasing from 48% to 84%Abstract 484 Figure 2Documentation of lipid profile results in the electronic discharge notification (EDN) for patients admitted with Acute Coronary Syndrome. Stacked bar chart comparing Cycle 1 and Cycle 2 audit results. The figure shows the percentage of patients whose lipid profile was documented in the EDN at discharge versus those without documentation. Documentation significantly improved following interventions, increasing from 29% in Cycle 1 to 71% in Cycle 2