Implementation of the Benchmark quality improvement program in 14 Canadian TAVI centers reduced mean referral-to-procedure time from 127.5 to 114.4 days and procedure time from 60.2 to 43.6 minutes.
Observational (n=14)
Yes
Does the Benchmark quality improvement program improve clinical practice metrics and streamline care in TAVI programs?
Implementation of a peer-to-peer quality improvement program in Canadian TAVI centers successfully streamlined care pathways, reducing wait times and procedure times while increasing early mobilization and next-day discharge.
Abstract Background Across international regions, transcatheter aortic valve implantation (TAVI) programmes are increasingly constrained by their limited capacity to facilitate timely, patient-centred, and efficient processes of care that reflect current evidence. Increasing demand for access to care is driven by ageing populations and new indications. There is significant evidence supporting the implementation of best practices from referral to follow-up to facilitate early and safe discharge home, and reduce health service utilisation. In clinical care, the adoption of new processes and innovative pathways can face challenges that may hinder the implementation of fully optimised programmes. This is particularly salient in TAVI programmes that have evolved from earlier maximalist approaches to more minimalist and streamlined contemporary practices. Purpose We report on the findings of the Benchmark programme, a peer-to-peer, evidence-based, team-driven and patient-centred quality improvement program designed to optimize care in diverse regions and health systems and tailored to the priorities of the Canadian publicly funded health system. We describe the changes in pre-, peri-, and post-procedure care associated with participation in the program and discuss the sustained adoption of best practices and impact on program resources. Methods Canadian TAVI teams that participated in the quality improvement project were invited to participate in a retrospective, self-reported study to describe key elements of care delivery mapped to patients’ journey of care, 6 months before and after the implementation of the programme, and in contemporary practice. Using a survey co-constructed with nursing and medicine, we conducted a comprehensive evaluation of changes in clinical practices measured along key metrics. Findings: Between 2019 and 2023, 18 of the 31 (58.1%) Canadian programmes that provide access to aortic valve replacement participated in the Benchmark program; of these, 14 (77.7%) reported on their experience. Illustrations of key findings related to pre-procedure care include a mean decrease in days from referral to procedure from 127.5 to 114.4 days, a 50% increase in restricting the assessment pathway consultations to 2 (vs. 3 or 4), and 14% increase in same-day admission. Peri-procedurally, programmes reported a mean decrease in procedure time of 16.6 minutes (60.2 vs. 43.6), with an increase in the mean number of procedures completed from 3.1 to 4.5/procedure day. In the post-procedure period, teams reported 27.5% increase in direct transfer to cardiology (vs. critical care), 38.5% increase in 4-hour mobilisation, and 19.3% increase in next-day discharge. Conclusion The Benchmark program presents an effective framework of quality improvement opportunities to address issues related to clinical care, human and organizational resources, patient experiences and cost savings to accelerate the uptake of current evidence in TAVI programmes.
Lauck et al. (Wed,) conducted a observational in Transcatheter aortic valve implantation (TAVI) (n=14). Benchmark quality improvement program vs. Pre-implementation (6 months before) was evaluated on Changes in clinical practices measured along key metrics (pre-, peri-, and post-procedure care). Implementation of the Benchmark quality improvement program in 14 Canadian TAVI centers reduced mean referral-to-procedure time from 127.5 to 114.4 days and procedure time from 60.2 to 43.6 minutes.