New Mandates For AUC, Clinical Decision Support Tools, Innovation In Pediatric/Congenital Heart Disease

Why wouldn't you use it? SCAI's easy-to-use coronary revascularization AUC app simplifies the 25-page AUC document into simple drop-down menus. With a few mouse clicks, real-time information helps interventional cardiologists determine whether a PCI is appropriate.

This app is part of SCAI's Quality Improvement Toolkit (SCAI-QIT). SCAI's goal is to allow clinicians to assess the appropriateness and risks associated with a procedure accurately and consistently to improve the quality of care delivered.

In 2011, Baptist Health looked at initial AUC scores and realized that it had big quality improvement opportunities, and that the tools they needed were right at their fingertips, via SCAI-QIT. Approximately one in four of the hospital's PCI procedures was deemed appropriate. Over the next two years, Baptist Health doubled that number. The key to success was developing new cath-lab processes that seamlessly incorporate the revascularization AUC app. Today, physician assistants in patient prep complete a form with the clinical information needed for the online AUC calculator. In the cath lab, staff input the information into the AUC calculator using a hyperlink Baptist Health incorporated into the cath lab's structured reporting system. A chart-ready Revascularization AUC Data Reporting Sheet lists AUC rankings individualized for each patient. Importantly, the reporting sheet allows the team to document their rationale if they decide to perform an "inappropriate" PCI. At Baptist Health, AUC results are monitored weekly, and immediate feedback is sent to interventional cardiologists by email. Physicians also receive scorecards on their performance and for the department.

By early 2014, the Baptist program resulted in 62.1% of PCI cases rated as appropriate, as compared to the 2011 rate of 27.7%. Beth Israel Deaconess Medical Center in Boston instituted a similar procedure with cardiology fellows entering the patient's clinical information. After PCI, the angiographic findings were entered to calculate a final AUC rating. The result: 63.6% of cases were rated appropriate; 25.6%, uncertain; and 0.6%, inappropriate. Another 10.1% of cases were not rated, because the AUC did not include a suitable clinical scenario. SCAI PCI risk assessment apps can be accessed at www.SCAI.org/QIT and are available in formats compatible with smartphones, tablets, laptops and PCs. Click on "PCI Risk Assessment Tool" for the app that predicts the risk of in-hospital mortality, significant bleeding, vascular injury, kidney injury, need for dialysis, repeat revascularization, and 30-day hospital readmission.

Pediatric/Congenital Heart Disease
Great minds think alike. During SCAI 2014, the Society's Congenital Heart Disease Committee launched Pediatric SCAI-QIT, a new quality improvement toolkit designed to meet the needs of structural/congenital interventional cardiology teams and their patients. ACE followed this launch with an announcement of its own; due to rapidly increasing demand for its cardiac cath lab Accreditation and External Quality Review services, ACE is leading the way with a new accreditation service for Pediatric Congenital Heart Disease.

"Our goal is to combine the high level of rigor and ACE's proven capabilities to assist clients in reducing complexity and achieving an easy implementation of comprehensive quality programs," said Bonnie H. Weiner, MD, MSEC, MBA, FSCAI, FACC, Chief Medical Officer, ACE. "We strive to engage all caregivers, including physicians, the lab team, and facility leadership."

Pediatric SCAI-QIT modules provide a detailed bibliography of resources on pediatric care, numerous web links for easy access to online resources, information on and access to registries and benchmarking information. Pediatric SCAI-QIT can be accessed at www.SCAI.org/PEDQIT.