Abstract 4015: Are Evidence-Based Clinical Processes and Structures Associated with Lower Risk-Adjusted Vascular Complication Rates In Cath Labs?
Objective: This study examines the relationship between 16 Evidence-Based Clinical Processes and Structures (EBCPS) recommended for cath labs and major vascular complications (VC) among patients undergoing PCI in community hospitals.
Methods: This retrospective study is derived from HCA Heart Services Standards Database, a web-based survey of HCA hospitals concerning which EBCPS each hospital has implemented for different heart services; and HCA Casemix administrative database of all admissions to an HCA hospital. The study population consists of 95 HCA hospitals that performed at least 52 PCIs during 2005. Each hospital’s risk-adjusted VC rate for 2005 was estimated from a logistic regression model controlling for 19 demographic and co-morbid risk factors. Pearson’s product-moment correlation coefficients were estimated to determine the association between a hospital’s risk-adjusted VC rate and the presence or absence of each of the 16 EBCPS. Two of the EBCPS were excluded because all hospitals had implemented the activity.
Findings: The average risk-adjusted VC rate was 5.12% (range 0.50% to 15.3%) for study hospitals. The number of hospitals that had implemented each of the EBCPS varied significantly among the activities: 4 activities were implemented in more than 90% of study hospitals while 7 of the activities were implemented in fewer than 25% of the hospitals. The estimated Pearson’s correlation coefficient was negatively associated with the hospital’s risk-adjusted VC rate for all 14 of the EBCPS; therefore, associated with a decrease in VC. This analysis demonstrated the following: activities related to leadership (qualifications (2), p<0.05), designated post-procedure tele-unit (p<0.01), documentation (case audit methods, p<0.05 and pre-cath assessment (2), p<0.12), vascular management protocol (p<0.12), and staff orientation (activities (2), p<0.12) were all associated with a decrease in VC. Five activities related to staff education and retention were less strongly associated with a decrease in VC (p<0.30).
Conclusion: There is a strong association between implementation of EBCPS and a reduction in major vascular complications in community PCI practice, thus implementing EBCPS can significantly reduce adverse outcomes.