IMPROVING ACUTE CORONARY SYNDROME (ACS) MORTALITY AND PROCESS OF CARE: TARGETING CARDIOGENIC SHOCK (CS)

ABSTRACT

Background: Measurement of our performance with National Cardiovascular Data Registry (NCDR®) Percutaneous Coronary Intervention (PCI) Registry® reflected below national average in STEMI mortality. Targeting cardiogenic shock (CS) was key to improved care. AIM was to improve CS processes of care and STEMI mortality. Methods: Novant Health (NH) utilized a system thinking multidisciplinary approach driven by an evolving Plan-Do-Study-Act Cycle (PDSA) Model for Improvement* in combination with the Cath PCI Registry® dashboard performance measures, process and outcome metrics. Data analysis supported change recommendations to advocate for an advanced care program and future CS team. Initial review included a 9-month baseline group from Oct 01,2017 - June 30,2018 versus 7-month comparison from July 01,2018 - Jan 31,2019. Implementation of recommendations from GAP analysis Q1 2019 tracking of specific projects and initiatives Q2-Q3 2019. Outcome utilized for measuring success was Cath PCI Registry ACS STEMI mortality Metric #18 from Q3 2019 - Q1 2021. Results: NHPMC data results rolling four quarter STEMI risk adjusted mortality Metric #18 baseline percentage rate 8.28 Q3 2019 - Q1 2021 decreased to 6.34. This represented a positive Impact of our initiatives. The US Registry benchmark 50th - 75th percentile for this metric trended upward during this timeframe possibly due to the high acuity of patients impacted by the COVID pandemic. Conclusion: NH emphasis on protocol adherence, team engagement, consistency in care processes resulted in organizational learning and continued aspiration towards excellence. In review of our single-center project we improved care to our CS population and decreased STEMI ACS risk adjusted mortality. Teams continue to be engaged in strategies for effective, efficient and equitable patient centered care. Integration of CS best practices in annual nursing education with sharing of knowledge across NH footprint. In process of developing synergistic care of high-risk transferred ACS patients with CS and developing care pathways. Initiation of ECMO program in June 2021 with continued efforts to establish a structured shock team.