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Morbidity and Mortality Conference for Percutaneous Coronary Intervention
- Source :
- Circulation. Cardiovascular quality and outcomes. 10(8)
- Publication Year :
- 2016
-
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.
- Subjects :
- Male
medicine.medical_specialty
Cardiac Catheterization
Quality management
Time Factors
medicine.medical_treatment
Best practice
Clinical Decision-Making
030204 cardiovascular system & hematology
Risk Assessment
Decision Support Techniques
Workflow
03 medical and health sciences
0302 clinical medicine
Percutaneous Coronary Intervention
Predictive Value of Tests
Risk Factors
medicine
North Carolina
Humans
030212 general & internal medicine
Intensive care medicine
Cardiac catheterization
Aged
Quality Indicators, Health Care
Patient Care Team
Academic Medical Centers
business.industry
Patient Selection
Process Assessment, Health Care
Percutaneous coronary intervention
Middle Aged
Quality Improvement
Benchmarking
Case selection
Female
Interdisciplinary Communication
Cardiology and Cardiovascular Medicine
business
Program Evaluation
Subjects
Details
- ISSN :
- 19417705
- Volume :
- 10
- Issue :
- 8
- Database :
- OpenAIRE
- Journal :
- Circulation. Cardiovascular quality and outcomes
- Accession number :
- edsair.doi.dedup.....a9346ddcbcac9d5f5dee69dd97ed880b