A Pilot Assessment of Three Point-of-Care Strategies for Diagnosis of Perioperative Lung Pathology in Cardiothoracic Surgery

Abstract

It is a statewide clinical quality registry with almost all hospitals performing PCI in Victoria contributing. VCOR provides insights into overall trends in a hospital's quality performance, with quarterly, annual and ad-hoc reporting. We undertook a detailed analysis (deep dive) of hospital performance related to PCI for acute STEMI to gain insights into factors that influence the quality of care. Methods: 13 public and 10 private hospitals contribute baseline, procedural, in-hospital and 30-day outcomes via a secure web-based system. All sites receive quarterly reports providing individualised comparative outcomes. Results: 1133 consecutive STEMI patients were treated over a 12-month period from July 2014; 39% in private hospitals. The mean age was 62 ± 12.6yrs. Females comprised 19%. Pre-hospital notification (PHN) of STEMI by faxed ECG occurred in 48%. Median door-to-balloon (DTB) time for the overall cohort was 69 min (IQR 46-100). Median compliance with DBT < 90 min was 69% (range 46%-87%). PHN improved compliance for DBT < 90 min by 34% compared with no PHN. Many health services exhibited a fall-off in performance for out-of-hours cases, with a reduction in compliance rate to 64% (range 36%-80%). Compliance with DBT < 90 min did not influence mortality or length of stay. Conclusion: Detailed analysis of performance measures for PCI for STEMI reveals variation across Victorian hospitals and compliance with door-to-balloon times < 90 min below target. Improving out-of-hrs delays and use of pre-hospital notification have measurable beneficial effects on performance.