Abstract 348: Using the NCDR Cath/pci Registry to Identify Opportunities and to Maintain and Improve Cardiovascular Care

Abstract

Background: The NCDR Cath/PCI Registry provides standardized capture of cardiovascular and anatomic risk factors and national benchmarking of outcomes to identify quality concerns and opportunities for improvement in the quality of care by practitioner and hospital. A rolling 4 quarter analysis is provided to participants that include measures of performance, quality, appropriate use. Procedure: Two performance measures [in-hospital PCI mortality and D2B] and two quality measures [in-hospital bleeding/ transfusion post PCI and contrast nephropathy] and were selected for intensive review and process improvement. The rolling 4 quarters ending in 2018 Q3 are compared to the 209Q3 results. Drill down analysis of event contributory factors was performed in a joint practice setting to identify opportunities for improvement. Results: In hospital risk adjusted PCI mortality improved over the assessed period from 3.4 Q3208 to 1.4 Q32019 [1.27 for the 3 rd quarter of 2019]. above the 75 th percentile. Stony Brook D2B times were maintained in the desired range of < 60 minutes [58 min in 2018Q3 and 59 min in 2019Q3]. Efforts to improve field First Medical Contacts [EMS] to facilitate D2B times by field transmission and ED review of field ECG with activation of the D2B Cath team demonstrate FMC-2B times of 92.2 minutes in 2018 and 83.1 minutes in 2019; achieving and maintaining the desired range of < 90 minutes. Transport times from external hospitals were extremely variable, dependent on intake process, transport availability and distance. Rate of bleeding and transfusion post PCI were <10% outliers at 7.82% and 3.42% for 2018Q3. Both have improved but remain challenges at < 10 th percentile at 4.25% bleeding and 2.25% transfusion rate for 2019Q3. Interestingly radial operators also remain outliers, with preprocedure severe anemia, active bleeding, inappropriate transfusion thresholds have been identified as contributory concerns. Acute kidney injury [presumptive contrast nephropathy] improved from 9.57% in 2018Q3 to 6.16% [50 th percentile] 2019Q3. More aggressive hydration with the “Poseidon trial” protocol improved post procedure CIN, which is often aggravated by hypotension, aggressive diuresis, ACEI/ARB/AA medications in patients with volume overload and heart failure. Conclusions: The NCDR Cath/PCI is a valuable resource for benchmarking performance, outcomes and appropriateness on an ongoing basis. Continuing feedback has allowed us to document and sustain improvement and to evaluate the effect of interventions implemented to improve the quality of care. Analysis also demonstrated that individual operators were not identified as significant outliers for the analyzed variables suggesting that systemic process improvement should be pursued.