• Online AUC App Is Fast, Easy Source of Real-Time Quality Data in Cath Lab

    May 26, 2014

    “Appropriate” PCI Cases More Than Doubled, Study Shows

    Las Vegas, Nev. (May 26, 2014) — Online software that transforms a 25-page guideline on the appropriateness of percutaneous coronary intervention (PCI) into simple drop-down menus and a few mouse clicks is fast and easy to use, and provides real-time information in the cath lab that can help interventional cardiologists determine whether to proceed with angioplasty and stenting, according to two studies reported this week at the SCAI 2014 Scientific Sessions. The investigators of both studies examined how incorporating the tool into their cardiac cath labs impacted quality.

    The appropriate use criteria (AUC) online app is part of SCAI’s Quality Improvement Toolkit (SCAI-QIT), which is a key component of the Society’s national quality improvement program for cardiac cath labs. Based on a series of questions about a patient’s clinical history and the findings on diagnostic angiography, the AUC app classifies a PCI procedure as appropriate, inappropriate, or uncertain, as categorized by the ACCF/SCAI/STS/AATS/AHA/ASNC/HFSA/SCCT 2012 Appropriate Use Criteria for Coronary Revascularization Focused Update.

    “The online AUC app is great,” said Nanette Jackson, director of cardiovascular services for Baptist Health Lexington in Lexington, Ky. “You get immediate feedback and can decide where you need to go from there. The key is to come up with a process that works for you and is as seamless as possible for the physicians.”

    The process that Baptist Health Lexington came up with more than doubled the percentage of “appropriate” PCI cases over about a two-year period. In this week’s report, Ms. Jackson and co-author Julie Kirk, Baptist Health Lexington’s cardiac quality coordinator, described how that improvement was achieved.

    In 2011, with only 27.7 percent of its elective PCI procedures deemed appropriate, the cath lab began a campaign to educate physicians and staff on the AUC, including the diagnostic and treatment information needed to justify an “appropriate” PCI rating. Once the online AUC app was released by SCAI, they began to have physician assistants in the patient prep area fill out a new data form that includes all of the clinical information needed for the online AUC calculator. That form goes with the patient to the cath lab, where staff input the information into the AUC app using a hyperlink that the hospital  incorporated directly into the cath lab’s structured reporting system. They also print out for the interventional cardiologist the Revascularization AUC Data Reporting Sheet, which is created by the online app and lists AUC rankings individualized for each patient’s clinical situation.

    Final AUC ratings for each interventional cardiologist are monitored weekly, and immediate feedback is sent to the physician by email. Cardiologists also receive scorecards with information on their performance and that of the department overall. By early 2014, this program resulted in 62.1 percent of PCI cases being rated “appropriate,” more than double the 2011 starting point.

    “This process has helped strengthen the relationship between the Cardiology and Quality departments,” Julie Kirk said. “It has enabled physicians to take a stronger role and have a larger voice in quality processes.”

    Beth Israel Deaconess Medical Center in Boston instituted a similar procedure, with cardiology fellows entering each patient’s clinical information in the online AUC calculator before the cardiac catheterization procedure and posting the print-out in the cath lab. After PCI, they enter the angiographic findings to come up with a final AUC rating. However, as reported by cardiology fellow Stuart Chen, M.D., the Beth Israel Deaconess team went a step further, conducting angiographic audits of each case and analyzing pre- and post-audit appropriateness ratings.

    The analysis focused on 308 consecutive elective PCI procedures. Initially, using the AUC app and the results of angiography as interpreted in the cath lab, 63.6 percent of cases were rated “appropriate,” 25.6 percent “uncertain” and 0.6 percent “inappropriate.” Another 10.1 percent of cases were not rated, because the AUC did not include a suitable clinical scenario. The audit involved a closer review of the angiograms by a team of 3 physicians. Agreement with the original assessment was close but not perfect. As a result, 60.4 percent of PCIs were considered “appropriate,” 21.1 percent “uncertain,” 9.7 percent “inappropriate” and 8.8 percent “not rated.”

    “Our study shows that the AUC tool is valuable and essential for ensuring quality in the cath lab,” Dr. Chen said. “The angiographic audit provides extra information and adds value to the process, but it is very resource-intensive.”

    Ms. Jackson, Ms. Kirk and Dr. Chen all report no potential conflicts of interest.

    Ms. Jackson and Ms. Kirk will present the study “Incorporating the SCAI-QIT Appropriate Use Criteria Application into the Electronic Documentation Process” in a poster session on Thursday, May 29, 2014, 12:00 p.m. to 3:00 p.m. (Pacific Time).

    Dr. Chen’s study, “Utility of a Real-Time Appropriate Use Criteria Decision Support Tool for Percutaneous Coronary Interventions in Non-Acute Coronary Syndrome,” will also be presented in the same poster session.

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