How to Be a Quality and Safety Champion in the Cath Lab: Utilizing QIT, aUC, and Other SCAI Tools to Fulfill the Quality Mandate
Lyndon Box, MD, is a cardiologist and contributor to the SCAI tool kit working at the University of Florida, Jacksonville. He opened up the session on quality and safety tools by discussing his most recent experience after accepting a position as the director of a new catheterization lab. Dr Box said that there was no information technology in place at all for monitoring their results, and surprisingly, they were not even reporting their data to the NCDR (National Cardiovascular Data Registry). Dr Box would go on to design his own software for keeping track of patients’ symptoms, prognosis, treatments, outcomes, and repeated visits. While it is a constant learning process, he has discovered several key factors that should be implemented. You must have administrators participating in the process and select a committee to participate regularly. You should carefully and thoughtfully select a small area of focus to strive for specific improvement. Dr Box stressed that it is better to have a more precise focus. If things are too general, then progress can be too difficult to assess. Develop an action plan. In short, you must know your system like you would know your patient.
Next, Dr Michael Kutcher, MD, director of interventional cardiology at Wake Forest School of Medicine, discussed the use of the NCDR and CatchPCI registries to document quality of care. Percutaneous coronary intervention (PCI) quality metrics including process used, outcome, equipment utilization, data quality, time for STEMI patients, and proportions of patients with door to balloon times <90 minutes are tracked. The most controversial aspect involves the definition of “appropriate” versus “non-appropriate” procedures, given that some are not classifiable by the appropriate use and care (AUC) criteria. Dr Kutcher pointed out that electronic healthcare records serve separate but complementary functions with the NCDR. These are most useful for responding to quarterly reviews of the hospital. In short, PCI-practicing physicians should be familiar with NCDR and understand the many metrics presented in the quarterly reports. Approximately 92% of attendees of the seminar replied that they do knowingly participate in the NCDR.
Henry Jennings, MD, of Vanderbilt University has over 20 years of experience directing catheterization laboratories and serves to oversee the SCAI Quality Improvement Committee. He presented an overview of Ongoing Professional Practicing Evaluations (OPPEs) and Focused Practicing Evaluations (FPPEs). OPPE and FPPE are necessary in order to maintain accreditation. It wasn’t until 2008 that there were no exemptions or grandfathering for receiving board certification. The keys to success are to harness the competitive nature of physicians toward working together synergistically. Outstanding issues yet to be addressed include the lack of reimbursement for the time taken in addressing these issues.
One of the most useful of the new commonly used tools of the interventional cardiologist has to be SCAI Quality Improvement Toolkit. Kalon Ho, MD, of the Beth Israel Deaconess Medical Center in Boston, Massachusetts, developed this software. The simplified application helps physicians high quality assurance in their practices. The algorithms were developed after great thought from those with clinical experience. A physician can simply enter symptoms and test results to receive recommended if-then treatment approaches. AUC scores and indications are provided for consideration.
One of the most important concerns when dealing with angioplasty is quality of life (QoL). The concluding presentation, by J. Jeffrey Marshall, MD, director of the cardiac Cath Laboratory at the Northeast Georgia Medical Center, addressed QoL outcomes. Dr Marshall emphasized that “Sometimes quality of life is more important than quality.” PCI clearly provided superior QoL to CABG when end points were measured within several months. However, by 1 year’s time, CABG catches up and QoL measures are indistinguishable. Recovery to work and to life in general within their family was reportedly better in their own study of 464 patients.
In summary, there are free apps out there to assist with quality assurance, and you can even make your own. All practitioners of PCI should be participating in NCDR and should be aware of the many metrics made available by these quarterly reports including the measure of your hospital’s performance. QoL should be a major consideration in the decision process as to whether to treat with PCI or CABG.