Clinical Process Optimization of Transfemoral Transcatheter Aortic Valve Implantation

Lortz, Julia; Lortz, Tobias Peter; Johannsen, Laura; Rammos, Christos; Steinmetz, Martin; Lind, Alexander; Rassaf, Tienush; Jánosi, Rolf Alexander

doi:10.2217/fca-2020-0010

Cited by 3 publications

(10 citation statements)

References 18 publications

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“…The role of the TAVI coordinator, therefore, did not impact the rate of repeat diagnostic procedures pre- and post-implementation. TAVI coordinator implementation at another German center significantly reduced the repetition of coronary angiography and CT examinations that had been performed at other facilities, however, there was no change in TEE examinations [ 9 ]. The differences between COORDINATE and the aforementioned study may, in part, be due to center/region-specific different practices and policies.…”

Section: Discussionmentioning

confidence: 99%

“…Implementation of a TAVI coordinator could improve planning and workflow along the TAVI pathway, potentially shortening the treatment pathway [ 9 , 18 ]. The findings from the COORDINATE pilot study showed that TAVI coordinators had little impact on shortening time for diagnostics, admission, and the TAVI procedure itself.…”

Section: Discussionmentioning

confidence: 99%

“…Hospitalization with combined diagnostics and treatment are much more time efficient. Another German study showed that the introduction of a TAVI coordinator reduced the time between admission and TAVI from a median 9 (IQR 7–14) to 6 (IQR 3–10) days ( p = 0.001) [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…The length of stay in this pilot study is consistent with that reported for another German study, where the average in-hospital stay for transfemoral TAVI was 10 ± 7 days [ 11 ]. Another German study found that a TAVI coordinator program reduced the median post-TAVI hospital stay from 9 (IQR 7–15) to 7 days (IQR 6–11) ( p = 0.001) [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…A recent concept is to have a dedicated TAVI coordinator, whose role is to support both patients and hospital staff alike, achieve an efficient treatment pathway, avoid duplicate diagnostic procedures, and facilitate communication and effective decision-making processes [ 4 , 7 ]. Several local initiatives have provided evidence for the benefits of a dedicated TAVI coordinator [ 4 , 7 , 8 , 9 ], but there has been no prospective documentation of the benefits across multiple institutions. The COORDINATE registry is a pilot study to prospectively document the impact of introducing a TAVI coordinator program at three different German hospitals.…”

Section: Introductionmentioning

confidence: 99%

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The COORDINATE Pilot Study: Impact of a Transcatheter Aortic Valve Coordinator Program on Hospital and Patient Outcomes

Bohmann

Burgdorf

Zeus

et al. 2022

JCM

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The transcatheter aortic valve implantation (TAVI) treatment pathway is complex, leading to procedure-related delays. Dedicated TAVI coordinators can improve pathway efficiency. COORDINATE was a pilot observational prospective registry at three German centers that enrolled consecutive elective patients with severe aortic stenosis undergoing TAVI to investigate the impact a TAVI coordinator program. Pathway parameters and clinical outcomes were assessed before (control group) and after TAVI coordinator program implementation (intervention phase). The number of repeated diagnostics remained unchanged after implementation. Patients with separate hospitalizations for screening and TAVI had long delays, which increased after implementation (65 days pre- vs. 103 days post-implementation); hospitalizations combining these were more efficient. The mean time between TAVI and hospital discharge remained constant. Nurse (p = 0.001) and medical technician (p = 0.008) working hours decreased. Patient satisfaction increased, and more consistent/intensive contact between patients and staff was reported. TAVI coordinators provided more post-TAVI support, including discharge management. No adverse effects on post-procedure or 30-day outcomes were seen. This pilot suggests that TAVI coordinator programs may improve aspects of the TAVI pathway, including post-TAVI care and patient satisfaction, without compromising safety. These findings will be further investigated in the BENCHMARK registry.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

The COORDINATE Pilot Study: Impact of a Transcatheter Aortic Valve Coordinator Program on Hospital and Patient Outcomes

Bohmann

Burgdorf

Zeus

et al. 2022

JCM

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A streamlined pathway for transcatheter aortic valve implantation: the BENCHMARK study

Frank,

Durand,

Lauck

et al. 2024

European Heart Journal

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Background and Aims There is significant potential to streamline the clinical pathway for patients undergoing transcatheter aortic valve implantation (TAVI). The purpose of this study was to evaluate the effect of implementing BENCHMARK best practices on the efficiency and safety of TAVI in 28 sites in 7 European countries. Methods This was a study of patients with severe symptomatic aortic stenosis (AS) undergoing TAVI with balloon-expandable valves before and after implementation of BENCHMARK best practices. Principal objectives were to reduce hospital length of stay (LoS) and duration of intensive care stay. Secondary objective was to document patient safety. Results Between January 2020 and March 2023, 897 patients were documented prior to and 1491 patients after the implementation of BENCHMARK practices. Patient characteristics were consistent with a known older TAVI population and only minor differences. Mean LoS was reduced from 7.7 ± 7.0 to 5.8 ± 5.6 days (median 6 vs. 4 days; P < .001). Duration of intensive care was reduced from 1.8 to 1.3 days (median 1.1 vs. 0.9 days; P < .001). Adoption of peri-procedure best practices led to increased use of local anaesthesia (96.1% vs. 84.3%; P < .001) and decreased procedure (median 47 vs. 60 min; P < .001) and intervention times (85 vs. 95 min; P < .001). Thirty-day patient safety did not appear to be compromised with no differences in all-cause mortality (0.6% in both groups combined), stroke/transient ischaemic attack (1.4%), life-threatening bleeding (1.3%), stage 2/3 acute kidney injury (0.7%), and valve-related readmission (1.2%). Conclusions Broad implementation of BENCHMARK practices contributes to improving efficiency of TAVI pathway reducing LoS and costs without compromising patient safety.

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Same-day discharge after atrial fibrillation ablation under a nurse-coordinated standardized protocol

Espinosa,

Farrus,

Venturas

et al. 2024

Europace

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Background and aims Same-day discharge (SDD) after atrial fibrillation (AF) ablation is an effective means to spare healthcare resources. However, safety remains a concern, and besides structural adaptations, SDD requires more efficient logistics and coordination. Therefore, we implemented a streamlined, nurse-coordinated SDD program following a standardized protocol. Methods As dedicated SDD coordinator a nurse specialized in ambulatory cardiac interventions was in charge of the full SDD protocol, including eligibility, patient-flow, in-hospital logistics, patient education and discharge as well as early post-discharge follow-up by smartphone-based virtual visits. Patients planned for AF ablation were eligible if LVEF ≥35%, basic support at home and accessibility of the hospital within 60min were warranted. Results 420 consecutive patients were screened by the SDD coordinator of whom 331 were eligible for SDD. Reasons for exclusion were living remotely (29, 6.9%), lack of support at home (19, 4.5%) or LVEF <35% (17, 4.0%). Of the eligible patients 300 (91%) were successfully discharged the same day. There was no major post-SDD complication. Rates of unplanned medical attention (19, 6.3%) and 30d-readmission (5, 1.6%) were extremely low and driven by femoral access site complications. Those were significantly reduced upon introduction of compulsory ultrasound-guided puncture after the initial 150 SDD patients (p=0.0145). Standardized SDD-coordination resulted in efficient workflows and reduced the total workload of the medical staff. Conclusions SDD after AF ablation following a nurse-coordinated standardized protocol is safe and efficient. The concept of ambulatory cardiac intervention nurses functioning as dedicated coordinators may be key in the forthcoming transition of hospitals to SDD. Ultrasound-guided femoral puncture virtually eliminated relevant femoral access site complications and should be a prerequisite for SDD.

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Clinical Process Optimization of Transfemoral Transcatheter Aortic Valve Implantation

Cited by 3 publications

References 18 publications

The COORDINATE Pilot Study: Impact of a Transcatheter Aortic Valve Coordinator Program on Hospital and Patient Outcomes

The COORDINATE Pilot Study: Impact of a Transcatheter Aortic Valve Coordinator Program on Hospital and Patient Outcomes

A streamlined pathway for transcatheter aortic valve implantation: the BENCHMARK study

Same-day discharge after atrial fibrillation ablation under a nurse-coordinated standardized protocol

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