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DATA-INFORMED IMPROVEMENTS DECREASE POST-PCI BLEEDING EVENTS
September 28, 2022
Posted in Clinical Quality Analytics
ARTICLE SUMMARY
--------------------------------------------------------------------------------
Bleeding complications occur in up to 16 percent of all patients undergoing
percutaneous coronary intervention (PCI). Community Health Network (CHNw)
identified one area where it didn’t perform as well as expected for post-PCI
bleeding and found ways to improve through risk-adjusted quality metrics,
interdisciplinary teams, analytics, and smartsourced clinical chart abstractors.
CHNw’s data-informed improvement efforts are delivering the desired results.
--------------------------------------------------------------------------------
JUMP TO:
IMPROVING POST-PCI BLEEDING SAVES LIVES
EVALUATING THE RISKS
ELIMINATING THE RISKS
RESULTS
DOWNLOADS
Data-Informed Improvements Decrease Post-PCI Bleeding EventsDownload +
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SEIZING THE VALUE OF HEALTH INFORMATION EXCHANGE DATA
Featured Outcomes
* 42.3 percent relative increase in the number of PCIs performed using a radial
approach.
* $368K in annual cost savings, the result of a 40.8 percent relative reduction
in the number of patients with post-PCI bleeding events within 72 hours of
the procedure and a 5.3 percent reduction in length of stay (LOS).
IMPROVING POST-PCI BLEEDING SAVES LIVES
Bleeding is a common, costly complication of PCI. Bleeding complications occur
in up to 16 percent of all patients undergoing PCI, and bleeding severity is
related to adverse outcomes. Major bleeding events happen more frequently among
patients undergoing a femoral approach.1
EVALUATING THE RISKS
CHNw participates in the American College of Cardiology’s National
Cardiovascular Data Registry (NCDR®), enabling the organization to report and
assess the characteristics and outcomes of patients undergoing PCI. CHNw
evaluated the NCDR risk-adjusted quality metrics and identified one area where
it didn’t perform as well as expected—the risk of bleeding around the time of
coronary intervention. Aware that bleeding events increased morbidity,
mortality, LOS, and cost, the organization prioritized bleeding events for
improvement.
ELIMINATING THE RISKS
To reduce bleeding events and improve performance, CHNw needed detailed
performance data. The organization established an interdisciplinary team,
leveraging high-value data and analytics from the Health Catalyst® Data
Operating System (DOS™) platform and its smartsourced clinical chart abstractors
to understand its data and associated improvement opportunities.
The interdisciplinary team reviewed a year’s worth of bleeding event data,
conducting deep dives into the data and identifying gaps. As a result of the
detailed data review, CHNw:
* Clarified the patient population that should be included/abstracted by the
abstractors and submitted to the NCDR.
* Defined and standardized documentation and abstraction processes, including
the assessment and documentation of hematomas and bleeding events.
* Engaged with the national registry to clearly define the criteria for
bleeding events.
* Identified and resolved data differences and time capture issues related to
point-of-care testing hemoglobin (Hgb) results and lab-resulted Hgb.
* Implemented standard order sets, including an ST-elevation myocardial
infarction order set and a post-PCI same-day discharge order set, to ensure
key requirements, like a post-procedure hemoglobin, are evaluated and
documented for all patients.
CHNw evaluated benchmark data for the percentage of radial versus femoral
approach PCI and set a goal to increase the overall rate of radial PCI.
Physician leaders provided peer-to-peer education on the benefits of radial
versus femoral approach, sharing the most recent literature, best practices, and
outcomes data, engaging providers in changing to a radial-first approach.
Smartsourced clinical chart abstractors perform their work to abstract data and
help monitor performance, notifying the medical director each time a patient
does not receive the expected care. The medical director follows up with the
physicians responsible for the patient, informing them of the expected standard
and improvement opportunities.
> “Improving quality performance is complicated, and there are no quick fixes.
> By getting deep into the data, the metrics, the care system, and effectively
> engaging key stakeholders, we successfully improved performance.”
>
> Michael Robertson, MD, Interventional Cardiologist, Community Health Network
RESULTS
CHNw’s data-informed improvement efforts are delivering the desired results. The
organization has achieved:
* 42.3 percent relative increase in the number of PCIs performed using a radial
approach.
* $368K in annual cost savings, the result of a 40.8 percent relative reduction
in the number of patients with post-PCI bleeding events within 72 hours of
the procedure and a 5.3 percent reduction in LOS.
REFERENCES
1. Mason, P. J. et al. (2018). An update on radial artery access and best
practices for transradial coronary angiography and intervention in acute
coronary syndrome: a scientific statement from the American Heart
Association. Circulation: Cardiovascular Interventions. Retrieved from
https://www.ahajournals.org/doi/10.1161/HCV.0000000000000035
ADDITIONAL READING
* Data-Informed Patient Blood Management Saves $1.2M
* Closing Care Gaps at the Point-of-Care Yields 4X Value Realization
* Smartsourcing Clinical Data Abstraction Continues to Deliver Value While
Reducing Costs
* Real-Time Data Enables Improvement, Reducing Bariatric Surgery Costs by $840K
* Consistent Improvement Methodology Accelerates Healthcare Outcomes
Seizing the Value of Health Information Exchange Data
Group 37
TRANSFORMING HEALTHCARE IS OUR PASSION
Health Catalyst is a leading provider of data and analytics technology and
services to healthcare organizations, committed to being the catalyst for
massive, measurable, data-informed healthcare improvement.
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