The Benchmark program: Peer-to-peer quality improvement program to optimize transcatheter aortic valve implantation processes and resources

Background Patient demand for transcatheter aortic valve implantation is growing while competing demands on program capacity are barriers to timely access to care for patients with aortic stenosis. Methods We report on the retrospective evaluation of Benchmark in Canada, a peer-to-peer multidisciplinary quality improvement initiative to accelerate the adoption of evidence-based best practices. Centres self-reported indicators of pre, peri, and post-procedure practices 6 months before and after their participation, and in 2024. Results Between 2019 and 2023, 18 of the 31 (58.1%) Canadian cardiac programs participated in Benchmark; 14/18 (77.7%) reported on their experience. Pre-procedure, mean time from referral to procedure decreased by 13 days. The assessment pathway was streamlined from 3 to 2 pre-procedure visits in 6 centres, and 8 centres transitioned to a process of individualized decision to perform diagnostic coronary angiography, with 11/14 (78.6%) reporting this practice in 2024. Peri-procedure changes included the deescalation of anaesthesia strategy in 7 programs; 3 of the 4 centres that routinely held an operating room on standby, and 5 of the 9 programs that had open heart surgery equipment open or available ceased these practices. Overall, there was 27.6% and 20.9% decrease in the mean procedure and total room time respectively. Post-procedure, 6 centres established new processes to avoid critical care with 11 (78.6%) now reporting this established process; 10 centres implemented new early mobilization protocols. Clinical outcomes remained excellent. Conclusion Structured, peer-enabled benchmarking across the TAVI care continuum drives practice change and program performance improvement.