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Blankenship JC, Doll JA, Latif F, Truesdell AG, Young MN, Ibebuogu UN, Vallabhajosyula S, Kadavath SM, Maestas CM, Vetrovec G, Welt F. Best Practices for Cardiac Catheterization Laboratory Morbidity and Mortality Conferences. JACC Cardiovasc Interv 2023; 16:503-514. [PMID: 36922035 DOI: 10.1016/j.jcin.2022.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/19/2022] [Accepted: 10/04/2022] [Indexed: 03/18/2023]
Abstract
Cardiac catheterization laboratory (CCL) morbidity and mortality conferences (MMCs) are a critical component of CCL quality improvement programs and are important for the education of cardiology trainees and the lifelong learning of CCL physicians and team members. Despite their fundamental role in the functioning of the CCL, no consensus exists on how CCL MMCs should identify and select cases for review, how they should be conducted, and how results should be used to improve CCL quality. In addition, medicolegal ramifications of CCL MMCs are not well understood. This document from the American College of Cardiology's Interventional Section attempts to clarify current issues and options in the conduct of CCL MMCs and to recommend best practices for their conduct.
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Affiliation(s)
- James C Blankenship
- Division of Cardiology, University of New Mexico, Albuquerque, New Mexico, USA.
| | - Jacob A Doll
- University of Washington, Seattle, Washington, USA
| | - Faisal Latif
- SSM Health St. Anthony Hospital, University of Oklahoma, Oklahoma City, Oklahoma, USA
| | | | - Michael N Young
- Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Uzoma N Ibebuogu
- University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Saraschandra Vallabhajosyula
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | | | - Camila M Maestas
- Virginia Commonwealth University Pauley Heart Center, Richmond, Virginia, USA
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2
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Tung ML, Nathan AS, Hirshfeld JW. Short-Term Mortality After Percutaneous Coronary Intervention-It Ain't Over When It's Over. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:100573. [PMID: 39129809 PMCID: PMC11308001 DOI: 10.1016/j.jscai.2022.100573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 12/12/2022] [Indexed: 08/13/2024]
Affiliation(s)
- Monica L. Tung
- Cardiovascular Medicine Division at the Hospital of the University of Pennsylvania, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ashwin S. Nathan
- Cardiovascular Medicine Division at the Hospital of the University of Pennsylvania, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - John W. Hirshfeld
- Cardiovascular Medicine Division at the Hospital of the University of Pennsylvania, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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3
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Naidu SS, Abbott JD, Bagai J, Blankenship J, Garcia S, Iqbal SN, Kaul P, Khuddus MA, Kirkwood L, Manoukian SV, Patel MR, Skelding K, Slotwiner D, Swaminathan RV, Welt FG, Kolansky DM. SCAI expert consensus update on best practices in the cardiac catheterization laboratory: This statement was endorsed by the American College of Cardiology (ACC), the American Heart Association (AHA), and the Heart Rhythm Society (HRS) in April 2021. Catheter Cardiovasc Interv 2021; 98:255-276. [PMID: 33909349 DOI: 10.1002/ccd.29744] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 04/23/2021] [Indexed: 12/28/2022]
Abstract
The current document commissioned by the Society for Cardiovascular Angiography and Interventions (SCAI) and endorsed by the American College of Cardiology, the American Heart Association, and Heart Rhythm Society represents a comprehensive update to the 2012 and 2016 consensus documents on patient-centered best practices in the cardiac catheterization laboratory. Comprising updates to staffing and credentialing, as well as evidence-based updates to the pre-, intra-, and post-procedural logistics, clinical standards and patient flow, the document also includes an expanded section on CCL governance, administration, and approach to quality metrics. This update also acknowledges the collaboration with various specialties, including discussion of the heart team approach to management, and working with electrophysiology colleagues in particular. It is hoped that this document will be utilized by hospitals, health systems, as well as regulatory bodies involved in assuring and maintaining quality, safety, efficiency, and cost-effectiveness of patient throughput in this high volume area.
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Affiliation(s)
- Srihari S Naidu
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - J Dawn Abbott
- Cardiovascular Institute of Lifespan, Division of Cardiology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Jayant Bagai
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James Blankenship
- Cardiology Division, The University of New Mexico, Albuquerque, New Mexico, USA
| | | | - Sohah N Iqbal
- Mass General Brigham Salem Hospital, Salem, Massachusetts, USA
| | | | - Matheen A Khuddus
- The Cardiac and Vascular Institute and North Florida Regional Medical Center, Gainesville, Florida, USA
| | - Lorrena Kirkwood
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | | | - Manesh R Patel
- Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina, USA
| | | | - David Slotwiner
- Division of Cardiology, New York Presbyterian, Weill Cornell Medicine Population Health Sciences, Queens, New York, USA
| | - Rajesh V Swaminathan
- Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Frederick G Welt
- Division of Cardiovascular Medicine, University of Utah Health, Salt Lake City, Utah, USA
| | - Daniel M Kolansky
- Division of Cardiovascular Medicine, Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Prabhu KM, Don C, Sayre GG, Kearney KE, Hira RS, Waldo SW, Rao SV, Au DH, Doll JA. Interventional cardiologists' perceptions of percutaneous coronary intervention quality measurement and feedback. Am Heart J 2021; 235:97-103. [PMID: 33567319 DOI: 10.1016/j.ahj.2021.01.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/28/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Interventional cardiologists receive feedback on their clinical care from a variety of sources including registry-based quality measures, case conferences, and informal peer interactions. However, the impact of this feedback on clinical care is unclear. METHODS We interviewed interventional cardiologists regarding the use of feedback to improve their care of percutaneous coronary intervention (PCI) patients. Interviews were assessed with template analysis using deductive and inductive techniques. RESULTS Among 20 interventional cardiologists from private, academic, and Department of Veterans Affairs practice, 85% were male, 75% performed at least 100 PCIs annually, and 55% were in practice for 5 years or more. All reported receiving feedback on their practice, including formal quality measures and peer learning activities. Many respondents were critical of quality measure reporting, citing lack of trust in outcomes measures and poor applicability to clinical care. Some respondents reported the use of process measures such as contrast volume and fluoroscopy time for benchmarking their performance. Case conferences and informal peer feedback were perceived as timelier and more impactful on clinical care. Respondents identified facilitators of successful feedback interventions including transparent processes, respectful and reciprocal peer relationships, and integration of feedback into collective goals. Hierarchy and competitive environments inhibited useful feedback. CONCLUSIONS Despite substantial resources dedicated to performance measurement and feedback for PCI, interventional cardiologists perceive existing quality measures to be of only modest value for improving clinical care. Catherization laboratories should seek to integrate quality measures into a holistic quality program that emphasizes peer learning, collective goals and mutual respect.
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Affiliation(s)
| | - Creighton Don
- University of Washington, Seattle, WA; VA Puget Sound Health Care System, Seattle, WA
| | | | | | | | - Stephen W Waldo
- University of Colorado School of Medicine, Aurora, CO; Department of Medicine, Rocky Mountain Regional VA Medical Center, Aurora, CO
| | - Sunil V Rao
- Department of Medicine, Duke University School of Medicine, Durham, NC; Durham VA Health Care System, Durham, NC
| | - David H Au
- University of Washington, Seattle, WA; VA Puget Sound Health Care System, Seattle, WA
| | - Jacob A Doll
- University of Washington, Seattle, WA; VA Puget Sound Health Care System, Seattle, WA.
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Klein LW, Dehmer GJ, Anderson HV, Rao SV. Overcoming Obstacles in Designing and Sustaining a High-Quality Cardiovascular Procedure Environment. JACC Cardiovasc Interv 2020; 13:2806-2810. [PMID: 33069644 DOI: 10.1016/j.jcin.2020.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/07/2020] [Accepted: 06/02/2020] [Indexed: 11/30/2022]
Abstract
Accurate evaluation of the quality of invasive cardiology procedures requires appraisal of case selection, technical performance, and procedural and clinical outcomes. Regrettably, the medical care delivery system poses a number of obstacles to developing and sustaining a high-quality environment. The purposes of this viewpoint are to summarize the most common impediments, followed to summarize the most common impediments, followed by the optimal ways to design and sustain a quality assurance program to overcome these barriers. A 7-step program to create and implement an effective quality assurance program is outlined.
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Affiliation(s)
- Lloyd W Klein
- University of California-San Francisco, San Francisco, California, USA.
| | - Gregory J Dehmer
- Carilion Clinic Cardiology and the Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | | | - Sunil V Rao
- The Duke Clinical Research Institute, Durham, North Carolina, USA
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Klein LW, Anderson HV, Rao SV. Performance Metrics to Improve Quality in Contemporary Percutaneous Coronary Intervention Practice. JAMA Cardiol 2020; 5:859-860. [DOI: 10.1001/jamacardio.2020.0904] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
| | | | - Sunil V. Rao
- Duke Clinical Research Institute, Durham, North Carolina
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Doll JA, Hira RS, Kearney KE, Kandzari DE, Riley RF, Marso SP, Grantham JA, Thompson CA, McCabe JM, Karmpaliotis D, Kirtane AJ, Lombardi W. Management of Percutaneous Coronary Intervention Complications: Algorithms From the 2018 and 2019 Seattle Percutaneous Coronary Intervention Complications Conference. Circ Cardiovasc Interv 2020; 13:e008962. [PMID: 32527193 DOI: 10.1161/circinterventions.120.008962] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Complications of percutaneous coronary intervention (PCI) may have significant impact on patient survival and healthcare costs. PCI procedural complexity and patient risk are increasing, and operators must be prepared to recognize and treat complications, such as perforations, dissections, hemodynamic collapse, no-reflow, and entrapped equipment. Unfortunately, few resources exist to train operators in PCI complication management. Uncertainty regarding complication management could contribute to the undertreatment of patients with high-complexity coronary disease. We, therefore, coordinated the Learning From Complications: How to Be a Better Interventionalist courses to disseminate the collective experience of high-volume PCI operators with extensive experience in chronic total occlusion and high-risk PCI. From these conferences in 2018 and 2019, we developed algorithms that emphasize early recognition, effective treatment, and team-based care of PCI complications. We think that an algorithmic approach will result in a logical and systematic response to life-threatening complications. This construct may be useful for operators who plan to perform complex PCI procedures.
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Affiliation(s)
- Jacob A Doll
- University of Washington, Seattle, WA (J.A.D., R.S.H., K.E.K., J.M.M., W.L.).,VA Puget Sound Health Care System, Seattle, WA (J.A.D.)
| | - Ravi S Hira
- University of Washington, Seattle, WA (J.A.D., R.S.H., K.E.K., J.M.M., W.L.)
| | - Kathleen E Kearney
- University of Washington, Seattle, WA (J.A.D., R.S.H., K.E.K., J.M.M., W.L.)
| | | | - Robert F Riley
- The Christ Hospital Health Network, Cincinnati, OH (R.F.R.)
| | - Steven P Marso
- HCA Midwest Health Heart and Vascular Institute, Overland Park, KS (S.P.M.)
| | - James A Grantham
- Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.G.).,University of Missouri-Kansas City, Kansas City, MO (J.A.G.)
| | | | - James M McCabe
- University of Washington, Seattle, WA (J.A.D., R.S.H., K.E.K., J.M.M., W.L.)
| | | | - Ajay J Kirtane
- Columbia University Medical Center, New York, NY (D.K., A.J.K.)
| | - William Lombardi
- University of Washington, Seattle, WA (J.A.D., R.S.H., K.E.K., J.M.M., W.L.)
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8
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Klein LW, Anderson HV, Rao SV. Proposed Framework for the Optimal Measurement of Quality Assessment in Percutaneous Coronary Intervention. JAMA Cardiol 2019; 4:963-964. [DOI: 10.1001/jamacardio.2019.3228] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Lloyd W. Klein
- Division of Cardiology, University of California, San Francisco
| | | | - Sunil V. Rao
- Duke Clinical Research Institute, Durham, North Carolina
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9
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Quality Assurance for Radiation Dose in Interventional Fluoroscopy. JACC Cardiovasc Interv 2019; 12:481-483. [DOI: 10.1016/j.jcin.2018.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 11/20/2018] [Indexed: 11/20/2022]
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10
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Klein LW. The cardiac catheterization conference: Improving its performance as a teaching tool. Catheter Cardiovasc Interv 2019; 93:451-454. [PMID: 30506917 DOI: 10.1002/ccd.28008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 10/02/2018] [Accepted: 11/04/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Lloyd W Klein
- Professor of Medicine, Rush Medical College, Chicago, Illinois
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11
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Chambers CE. Morbidity and Mortality and Beyond: Assuring Quality in Cardiac Catheterization Laboratory Quality Programs. Circ Cardiovasc Qual Outcomes 2017; 10:CIRCOUTCOMES.117.004001. [PMID: 28798018 DOI: 10.1161/circoutcomes.117.004001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Doll JA, Overton R, Patel MR, Rao SV, Sketch MH, Harrison JK, Tcheng JE. Morbidity and Mortality Conference for Percutaneous Coronary Intervention. Circ Cardiovasc Qual Outcomes 2017; 10:CIRCOUTCOMES.116.003538. [DOI: 10.1161/circoutcomes.116.003538] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 06/09/2017] [Indexed: 11/16/2022]
Abstract
Background—
Morbidity and mortality conference is a common educational and quality improvement activity performed in cardiac catheterization laboratories, but best practices for case selection and for maximizing the effectiveness of peer review have not been determined.
Methods and Results—
We reviewed the 10-year percutaneous coronary intervention morbidity and mortality conference experience of an academic medical center. Cases were triggered for review by the occurrence of prespecified procedural events. Summary reports from morbidity and mortality conference discussions were linked to clinical data from the Duke Databank for Cardiovascular Disease to compare baseline and procedural characteristics and to assess postdischarge outcomes. Of 11 786 procedures, from 2004 to 2013, 157 (1.3%) were triggered for review. The most frequent triggering events were cardioversion/defibrillation (72, 0.6%), unplanned use of mechanical circulatory support (64, 0.5%), and major dissection (41, 0.3%). Selected procedures were more likely to include high-risk features, such as ST-segment–elevation myocardial infarction, cardiogenic shock, and multivessel disease, and were associated with higher mortality at 30 days. Only a minority of triggering events were caused by controversial or unacceptable physician behavior.
Conclusions—
This 10-year experience outlines the processes for conduct of an effective percutaneous coronary intervention morbidity and mortality conference, including a novel approach to case selection and structured peer review leading to actionable quality interventions. The prespecified clinical triggers, captured in the natural workflow by laboratory staff, identified complex cases that were associated with poor patient outcomes.
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Affiliation(s)
- Jacob A. Doll
- From the Section of Cardiology, VA Puget Sound Health Care System, Seattle, WA (J.A.D.); Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA (J.A.D.); Duke Clinical Research Institute, Durham, NC (R.O., M.R.P., S.V.R.); and Division of Cardiology, Department of Medicine, Duke University School of Medicine, NC (M.R.P., S.V.R., M.H.S., J.K.H., J.E.T.)
| | - Robert Overton
- From the Section of Cardiology, VA Puget Sound Health Care System, Seattle, WA (J.A.D.); Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA (J.A.D.); Duke Clinical Research Institute, Durham, NC (R.O., M.R.P., S.V.R.); and Division of Cardiology, Department of Medicine, Duke University School of Medicine, NC (M.R.P., S.V.R., M.H.S., J.K.H., J.E.T.)
| | - Manesh R. Patel
- From the Section of Cardiology, VA Puget Sound Health Care System, Seattle, WA (J.A.D.); Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA (J.A.D.); Duke Clinical Research Institute, Durham, NC (R.O., M.R.P., S.V.R.); and Division of Cardiology, Department of Medicine, Duke University School of Medicine, NC (M.R.P., S.V.R., M.H.S., J.K.H., J.E.T.)
| | - Sunil V. Rao
- From the Section of Cardiology, VA Puget Sound Health Care System, Seattle, WA (J.A.D.); Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA (J.A.D.); Duke Clinical Research Institute, Durham, NC (R.O., M.R.P., S.V.R.); and Division of Cardiology, Department of Medicine, Duke University School of Medicine, NC (M.R.P., S.V.R., M.H.S., J.K.H., J.E.T.)
| | - Michael H. Sketch
- From the Section of Cardiology, VA Puget Sound Health Care System, Seattle, WA (J.A.D.); Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA (J.A.D.); Duke Clinical Research Institute, Durham, NC (R.O., M.R.P., S.V.R.); and Division of Cardiology, Department of Medicine, Duke University School of Medicine, NC (M.R.P., S.V.R., M.H.S., J.K.H., J.E.T.)
| | - J. Kevin Harrison
- From the Section of Cardiology, VA Puget Sound Health Care System, Seattle, WA (J.A.D.); Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA (J.A.D.); Duke Clinical Research Institute, Durham, NC (R.O., M.R.P., S.V.R.); and Division of Cardiology, Department of Medicine, Duke University School of Medicine, NC (M.R.P., S.V.R., M.H.S., J.K.H., J.E.T.)
| | - James E. Tcheng
- From the Section of Cardiology, VA Puget Sound Health Care System, Seattle, WA (J.A.D.); Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA (J.A.D.); Duke Clinical Research Institute, Durham, NC (R.O., M.R.P., S.V.R.); and Division of Cardiology, Department of Medicine, Duke University School of Medicine, NC (M.R.P., S.V.R., M.H.S., J.K.H., J.E.T.)
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Naidu SS, Aronow HD, Box LC, Duffy PL, Kolansky DM, Kupfer JM, Latif F, Mulukutla SR, Rao SV, Swaminathan RV, Blankenship JC. SCAI expert consensus statement: 2016 best practices in the cardiac catheterization laboratory: (Endorsed by the cardiological society of india, and sociedad Latino Americana de Cardiologia intervencionista; Affirmation of value by the Canadian Associatio. Catheter Cardiovasc Interv 2016; 88:407-23. [DOI: 10.1002/ccd.26551] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 03/17/2016] [Indexed: 12/13/2022]
Affiliation(s)
- Srihari S. Naidu
- Division of Cardiology, Winthrop University Hospital, Mineola, New York
| | - Herbert D. Aronow
- Warren Alpert Medical School of Brown University, Cardiovascular Institute, Providence, RI
| | | | | | - Daniel M. Kolansky
- Cardiovascular Medicine Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Joel M. Kupfer
- University of Illinois School of Medicine-Peoria, Peoria, IL
| | - Faisal Latif
- University of Oklahoma and VA Medical Center, Oklahoma City, OK
| | - Suresh R. Mulukutla
- University of Pittsburgh and VA Pittsburgh Healthcare System, Pittsburgh, PA
| | | | - Rajesh V. Swaminathan
- Weill Cornell Medical College, New York-Presbyterian Hospital, Greenberg Division of Cardiology, New York, NY
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15
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Jennings HS, Rao SV, Feldman DN, Kolansky DM, Kutcher MA, Baker NC, Chambers CE, Petit CJ, Cigarroa JE. SCAI core curriculum for adult and pediatric interventional fellowship training in continuous quality assessment and improvement. Catheter Cardiovasc Interv 2015; 86:422-31. [PMID: 25950289 DOI: 10.1002/ccd.26029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 04/28/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Henry S Jennings
- Division of Cardiovascular Medicine, Vanderbilt Heart & Vascular Institute, Nashville, Tennessee
| | - Sunil V Rao
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Dmitriy N Feldman
- Division of Cardiology, Weill Cornell Medical College, New York, New York
| | - Daniel M Kolansky
- Penn Heart and Vascular Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael A Kutcher
- Division of Cardiology, Wake Forest School of Medicine, Winstom-Salem, North Carolonia
| | | | | | - Christopher J Petit
- Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Joaquin E Cigarroa
- Knight Cardiovascular Institute, Department of Medicine, Oregon Health and Sciences University, Portland, Oregon
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16
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Blankenship JC, Rosenfield K, Jennings HS. Privileging and credentialing for interventional cardiology procedures. Catheter Cardiovasc Interv 2015; 86:655-63. [PMID: 25534235 DOI: 10.1002/ccd.25793] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 12/14/2014] [Indexed: 01/28/2023]
Abstract
Local institutional-specific credentialing and privileging for procedures is an important process for ensuring the quality of care provided by interventional cardiologists. Recently revised standards for coronary intervention and the blossoming of structural heart disease programs have generated controversy over these processes. How standards are set for credentialing and privileging is poorly understood by most interventional cardiologists, including those responsible for credentialing and privileging. Requirements from The Joint Commission dictate how credentialing and privileging is performed at hospitals they accredit. Physicians must be recredentialed every 2 years at each hospital, with privileges renewed at that time. Hospitals must review quality of physicians even more frequently using Ongoing Professional Practice Evaluations. Hospitals must also evaluate the performance of physicians when they join a hospital staff or when they begin performing new procedures using Focused Professional Practice Evaluations. Cardiology department directors and catheterization laboratory directors are responsible for recredentialing and reprivileging members of their departments. Individual physicians are responsible for cooperating with these processes, and for periodic recertification with specialty boards and governmental agencies. We provide specific guidance to help physicians navigate these processes.
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Affiliation(s)
| | - Kenneth Rosenfield
- Department of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Henry S Jennings
- Vanderbilt Heart and Vascular Institute, Vanderbilt University School of Medicine, Nashville, Tennessee
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Dehmer GJ, Blankenship JC, Cilingiroglu M, Dwyer JG, Feldman DN, Gardner TJ, Grines CL, Singh M. SCAI/ACC/AHA Expert Consensus Document: 2014 Update on Percutaneous Coronary Intervention Without On-Site Surgical Backup. Catheter Cardiovasc Interv 2015; 84:169-87. [PMID: 25045090 DOI: 10.1002/ccd.25371] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 12/21/2013] [Indexed: 12/11/2022]
Affiliation(s)
- Gregory J Dehmer
- Baylor Scott & White Health, Central Texas, Temple, TX. SCAI Writing Committee Member and Chair
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Chambers CE. Mandatory Radiation Safety Training for Fluoroscopy Imaging. JACC Cardiovasc Interv 2014; 7:391-3. [DOI: 10.1016/j.jcin.2013.11.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 11/08/2013] [Indexed: 10/25/2022]
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Dehmer GJ, Blankenship JC, Cilingiroglu M, Dwyer JG, Feldman DN, Gardner TJ, Grines CL, Singh M. SCAI/ACC/AHA Expert Consensus Document: 2014 update on percutaneous coronary intervention without on-site surgical backup. J Am Coll Cardiol 2014; 63:2624-2641. [PMID: 24651052 DOI: 10.1016/j.jacc.2014.03.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Moussa ID, Klein LW, Shah B, Mehran R, Mack MJ, Brilakis ES, Reilly JP, Zoghbi G, Holper E, Stone GW. Consideration of a new definition of clinically relevant myocardial infarction after coronary revascularization: an expert consensus document from the Society for Cardiovascular Angiography and Interventions (SCAI). J Am Coll Cardiol 2013; 62:1563-70. [PMID: 24135581 DOI: 10.1016/j.jacc.2013.08.720] [Citation(s) in RCA: 485] [Impact Index Per Article: 44.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 07/13/2013] [Indexed: 12/22/2022]
Abstract
Numerous definitions have been proposed for the diagnosis of myocardial infarction (MI) after coronary revascularization. The universal definition for MI designates post procedural biomarker thresholds for defining percutaneous coronary intervention (PCI)-related MI (type 4a) and coronary artery bypass grafting (CABG)-related MI (type 5), which are of uncertain prognostic importance. In addition, for both the MI types, cTn is recommended as the biomarker of choice, the prognostic significance of which is less well validated than CK-MB. Widespread adoption of a MI definition not clearly linked to subsequent adverse events such as mortality or heart failure may have serious consequences for the appropriate assessment of devices and therapies, may affect clinical care pathways, and may result in misinterpretation of physician competence. Rather than using an MI definition sensitive for small degrees of myonecrosis (the occurrence of which, based on contemporary large-scale studies, are unlikely to have important clinical consequences), it is instead recommended that a threshold level of biomarker elevation which has been strongly linked to subsequent adverse events in clinical studies be used to define a "clinically relevant MI." The present document introduces a new definition for "clinically relevant MI" after coronary revascularization (PCI or CABG), which is applicable for use in clinical trials, patient care, and quality outcomes assessment.
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Moussa ID, Klein LW, Shah B, Mehran R, Mack MJ, Brilakis ES, Reilly JP, Zoghbi G, Holper E, Stone GW. Consideration of a new definition of clinically relevant myocardial infarction after coronary revascularization: An expert consensus document from the society for cardiovascular angiography and interventions (SCAI). Catheter Cardiovasc Interv 2013; 83:27-36. [DOI: 10.1002/ccd.25135] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 07/13/2013] [Indexed: 11/09/2022]
Affiliation(s)
| | - Lloyd W. Klein
- Division of Cardiology, Department of Medicine; Rush University; Chicago Illinois
| | - Binita Shah
- Division of Cardiology; New York University School of Medicine; New York
| | | | | | | | | | | | | | - Gregg W. Stone
- Columbia University Medical Center, New York Presbyterian Hospital and The Cardiovascular Research Foundation; New York City New York
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22
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Harold JG, Bass TA, Bashore TM, Brindiss RG, Brush JE, Burke JA, Dehmers GJ, Deychak YA, Jneids H, Jolliss JG, Landzberg JS, Levine GN, McClurken JB, Messengers JC, Moussas ID, Muhlestein JB, Pomerantz RM, Sanborn TA, Sivaram CA, Whites CJ, Williamss ES, Halperin JL, Beckman JA, Bolger A, Byrne JG, Lester SJ, Merli GJ, Muhlestein JB, Pina IL, Wang A, Weitz HH. ACCF/AHA/SCAI 2013 Update of the Clinical Competence Statement on Coronary Artery Interventional Procedures. Catheter Cardiovasc Interv 2013; 82:E69-111. [DOI: 10.1002/ccd.24985] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - John G. Harold
- American College of Cardiology Foundation representative
| | - Theodore A. Bass
- Society for Cardiovascular Angiography and Interventions representative
| | | | | | | | | | | | | | | | | | | | | | | | | | - Issam D. Moussas
- Society for Cardiovascular Angiography and Interventions representative
| | | | | | | | | | | | | | | | - Joshua A. Beckman
- Former Task Force member during the writing effort; Authors with no symbol by their name were included to provide additional content expertise
| | | | | | | | | | | | - Ileana L. Pina
- Former Task Force member during the writing effort; Authors with no symbol by their name were included to provide additional content expertise
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23
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ACCF/AHA/SCAI 2013 Update of the Clinical Competence Statement on Coronary Artery Interventional Procedures. J Am Coll Cardiol 2013; 62:357-96. [DOI: 10.1016/j.jacc.2013.05.002] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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24
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Harold JG, Bass TA, Bashore TM, Brindis RG, Brush JE, Burke JA, Dehmer GJ, Deychak YA, Jneid H, Jollis JG, Landzberg JS, Levine GN, McClurken JB, Messenger JC, Moussa ID, Muhlestein JB, Pomerantz RM, Sanborn TA, Sivaram CA, White CJ, Williams ES. ACCF/AHA/SCAI 2013 update of the clinical competence statement on coronary artery interventional procedures: a report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Clinical Competence and Training (writing committee to revise the 2007 clinical competence statement on cardiac interventional procedures). Circulation 2013; 128:436-72. [PMID: 23658439 DOI: 10.1161/cir.0b013e318299cd8a] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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25
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Smith IR, Cameron J, Mengersen KL, Foster KA, Rivers JT. Risk modelling in quality clinical registries: monitoring lesion treatment failure rate in percutaneous coronary interventions. Heart Lung Circ 2012; 22:193-203. [PMID: 23154197 DOI: 10.1016/j.hlc.2012.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 08/29/2012] [Accepted: 10/15/2012] [Indexed: 10/27/2022]
Abstract
AIMS This paper describes the development of a risk adjustment (RA) model predictive of individual lesion treatment failure in percutaneous coronary interventions (PCI) for use in a quality monitoring and improvement program. METHODS AND RESULTS Prospectively collected data for 3972 consecutive revascularisation procedures (5601 lesions) performed between January 2003 and September 2011 were studied. Data on procedures to September 2009 (n=3100) were used to identify factors predictive of lesion treatment failure. Factors identified included lesion risk class (p<0.001), occlusion type (p<0.001), patient age (p=0.001), vessel system (p<0.04), vessel diameter (p<0.001), unstable angina (p=0.003) and presence of major cardiac risk factors (p=0.01). A Bayesian RA model was built using these factors with predictive performance of the model tested on the remaining procedures (area under the receiver operating curve: 0.765, Hosmer-Lemeshow p value: 0.11). Cumulative sum, exponentially weighted moving average and funnel plots were constructed using the RA model and subjectively evaluated. CONCLUSION A RA model was developed and applied to SPC monitoring for lesion failure in a PCI database. If linked to appropriate quality improvement governance response protocols, SPC using this RA tool might improve quality control and risk management by identifying variation in performance based on a comparison of observed and expected outcomes.
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Affiliation(s)
- Ian R Smith
- St Andrew's Medical Institute, St Andrew's War Memorial Hospital, Wickham Terrace, Brisbane, Queensland 4000, Australia
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26
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Maroney J, Khan S, Powell W, Klein LW. Current operator volumes of invasive coronary procedures in medicare patients: Implications for future manpower needs in the catheterization laboratory. Catheter Cardiovasc Interv 2012; 81:34-9. [DOI: 10.1002/ccd.24366] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Accepted: 02/13/2012] [Indexed: 11/09/2022]
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27
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Naidu SS, Rao SV, Blankenship J, Cavendish JJ, Farah T, Moussa I, Rihal CS, Srinivas VS, Yakubov SJ. Clinical expert consensus statement on best practices in the cardiac catheterization laboratory: Society for Cardiovascular Angiography and Interventions. Catheter Cardiovasc Interv 2012; 80:456-64. [PMID: 22434598 DOI: 10.1002/ccd.24311] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Revised: 11/30/2011] [Accepted: 12/24/2011] [Indexed: 11/09/2022]
Affiliation(s)
- Srihari S Naidu
- Division of Cardiology, Winthrop University Hospital, Mineola, New York, USA.
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Frey P, Connors A, Resnic FS. Quality Measurement and Improvement in the Cardiac Catheterization Laboratory. Circulation 2012; 125:615-9. [DOI: 10.1161/circulationaha.111.018234] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Paul Frey
- From the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA
| | - Ann Connors
- From the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA
| | - Frederic S. Resnic
- From the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA
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