Quality Measurement and Improvement in the Cardiac Catheterization Laboratory
2012; Lippincott Williams & Wilkins; Volume: 125; Issue: 4 Linguagem: Inglês
10.1161/circulationaha.111.018234
ISSN1524-4539
AutoresPaul Frey, Ann Connors, Frederic S. Resnic,
Tópico(s)Healthcare cost, quality, practices
ResumoHomeCirculationVol. 125, No. 4Quality Measurement and Improvement in the Cardiac Catheterization Laboratory Free AccessBrief ReportPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessBrief ReportPDF/EPUBQuality Measurement and Improvement in the Cardiac Catheterization Laboratory Paul Frey, MD, MPH, Ann Connors, RN and Frederic S. Resnic, MD, MSc Paul FreyPaul Frey From the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA. , Ann ConnorsAnn Connors From the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA. and Frederic S. ResnicFrederic S. Resnic From the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA. Originally published31 Jan 2012https://doi.org/10.1161/CIRCULATIONAHA.111.018234Circulation. 2012;125:615–619Case Presentation: A 46-year-old man with a past medical history significant for morbid obesity (body mass index of 66), hypertension, tobacco use, and dyslipidemia presented to an outside hospital with a non–ST-segment elevation myocardial infarction and was transferred for coronary angiography. Femoral arterial access was obtained for an uncomplicated percutaneous intervention (PCI) with the use of unfractionated heparin and a glycoprotein IIB/IIIA inhibitor. After successful PCI of the right coronary artery with drug-eluting stent implantation, the femoral arteriotomy was closed without complication. Two hours after the completion of the procedure, the patient experienced ventricular fibrillation and respiratory arrest requiring prolonged resuscitation with a subsequent hematocrit level noted to be 12.5%. The patient was resuscitated with fluid and blood products. Emergent angiography showed no active iliofemoral contrast extravasation and a widely patent coronary stent. An abdominal CT scan without contrast confirmed the diagnosis of a retroperitoneal hemorrhage. Unfortunately, the patient experienced recurrent ventricular fibrillation, and he died despite additional resuscitative efforts.BackgroundCardiac catheterization is one of the most common invasive procedures performed in the United States.1 Although the benefits of cardiac catheterization remain great, the large number of procedures performed coupled with infrequent but potentially significant complications make the cardiac catheterization laboratory an important environment in which to constantly strive to improve quality. Although optimal patient outcomes remain paramount, state and national regulatory requirements, public reporting, and payers' interests in both outcomes and cost raise the importance of quality measurement and improvement in the cardiac catheterization laboratory.2Minimal Requirements for Quality Monitoring and Societal RecommendationsMinimal requirements for quality monitoring in the cardiac catheterization laboratory vary with individual state regulatory practices. As an example, in Massachusetts, data elements are collected and reported as mandated by the Massachusetts Department of Public Health, The Joint Commission, Centers for Medicare & Medicaid Services, and mandated participation in the American College of Cardiology National Cardiovascular Data Registry (ACC-NCDR). The Table provides examples of the multiple data elements and organizations to which information is submitted by catheterization laboratories in Massachusetts.Table. Examples of Groups and Types of Data Collected and Reported by Cardiac Catheterization Laboratories in MassachusettsData Element GroupData Requirement ExamplesOrganization Reporting*DefinitionChallengesProcessDoor-to-balloon timeDPHST-segment elevation or new LBBB hospital arrival to primary PCI 35. Each member of the healthcare team, from nursing staff to physicians, is charged to help identify the patients who are most vulnerable. This initiative has resulted in a significant increase in radial access for those most at risk of complication (Figure 2).Download figureDownload PowerPointFigure 2. Percentage of left heart catheterizations by radial approach at Brigham and Women's Hospital in patients with body mass index >35 with line representing clinical case of retroperitoneal hemorrhage (RPH).DisclosuresNone.FootnotesCorrespondence to Frederic S. Resnic, MD, MSc, Division of Cardiovascular Medicine, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115. 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Bradley S, Chan P, Spertus J, Kennedy K, Douglas P, Patel M, Anderson H, Ting H, Rumsfeld J and Nallamothu B (2012) Hospital Percutaneous Coronary Intervention Appropriateness and In-Hospital Procedural Outcomes, Circulation: Cardiovascular Quality and Outcomes, 5:3, (290-297), Online publication date: 1-May-2012. January 31, 2012Vol 125, Issue 4 Advertisement Article InformationMetrics © 2012 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.111.018234PMID: 22294706 Originally publishedJanuary 31, 2012 PDF download Advertisement SubjectsEthics and Policy
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