Accreditation Identifies and Supports a Quality Culture in the Catheterization Laboratory

Background:
Accreditation improves processes and quality. Accreditation for Cardiovascular Excellence (ACE) has reviewed 75 organizations since 2010. During the initial review at each institution, a total of 5337 randomly selected cardiac catheterization cases were reviewed. This analysis analyzed the factors related to obtaining initial accreditation.

Methods:
Each facility undergoes a site visit performed by an experienced cath lab nurse where each standard is scored. In addition, a random sample of cases are reviewed by highly experienced, blinded, independent operators. Data are recorded for both reviews on a standard web-based case report form and downloaded for analysis (JMP 14.2, SAS Institute Cary NC).

Results:
In the 75 facilities reviewed, 60 facilities initially achieved accreditation and 15 did not. For the site visit parameters, 28 variables were identified as being significantly different between the 2 outcomes. These included a listing of procedures, leadership structure, nursing personnel, reporting, consent, performance standards, quality assurance and radiation safety. On multivariate analysis, only 3 variables remained significant. These included having a nursing supervisor (94.4% vs. 58.3%, p<0.0001) staff nurse background (94.4% vs. 75.0%, p<0.0001) and anticoagulant protocol (73.2% vs. 41.7%, p<0.0001). Ten variables demonstrated significant differences on univariate analysis in the case reviews. This included AUC and pre-procedural ischemia (related to documentation), angiographic quality, extent of disease, final results and an overall performance. Eight variables remained significantly different including those related to documentation (p<0.0001), angiographic quality (p<0.0001), AUC (diagnostic p<0.0001 and revascularization p<0.003) and overall procedural assessment (p<0.0001)

Conclusions:
The robust, standardized application of standards differentiates between facilities with a culture of quality and those where significant gaps exist. All facilities that were initially deferred ultimately achieved accreditation. The ACE accreditation process is successful in bridging quality gaps as evidenced by the high rate of conversion from deferred to accreditation.