Ongoing Review is Necessary for Maintaining Quality
Presenter
Bonnie H. Weiner, M.D. MSEC MBA, MSCAI, SCAI, Harvard, MA
Bonnie H. Weiner, M.D. MSEC MBA, MSCAI, SCAI, Harvard, MA, Joaquin E. Cigarroa, M.D., MSCAI, Oregon Health & Science University Hospital, Portland, OR, Michael J. Cowley, M.D. MSCAI, Virginia Commonwealth University Health, Richmond, VA and J. Jeffrey Marshall, M.D., MSCAI, Northside Hospital Cardiovascular Institute, Atlanta, GA
Keywords: Cath Lab Administration, Coronary and Quality
Background:
Accreditation (A) is an ongoing process to assist facilities in achieving and maintaining quality in the catheterization laboratory. Independent review of randomly selected cases can provide insight into changes that occur over time. The current analysis assesses the findings from serial reviews at 2 year intervals.
Methods:
Randomly selected cases from each site and at each timepoint are reviewed by blinded, independent interventional cardiologists and all data are recorded on a standard case report form. Findings from each A visit were compared to those from initial A visits as well as each previous A visit. Statistical analysis was performed using JMP pro (version 15.2.1, SAS Institute Cary NC).
Results:
17 facilities underwent initial and as many as 3 reaccreditation visits. A total of 2532 cases were reviewed. In all cases, there were significant differences between the initial reviews and the 1st reaccreditation (RA) reviews for documentation of pre procedural ischemia, diagnostic and revascularization AUC, angiographic quality, severity of disease treated, outcomes and overall assessment. Similar findings were observed for subsequent RA reviews. Although there was in general continued improvement observed between RA 1 and 2, deterioration in some characteristics were seen between #2 and #3. (Table 1)
Conclusions:
Random case reviews are a key component of a quality system. Despite internal processes to perform this activity, they may not be effective. Independent, objective external reviews further identify opportunities for improvement as well as slippage that may occur over time. 