2022 Quality Summit ePosters (Non-CE) - CathPCI Registry-14. Reduction of Percutaneous Coronary Intervention (PCI) Mortality Through the Implementation of an Acute Cardiogenic Shock Team (ACST)

14. Reduction of Percutaneous Coronary Intervention (PCI) Mortality Through the Implementation of an Acute Cardiogenic Shock Team (ACST)

Back to course

Pdf Summary

The implementation of an Acute Cardiogenic Shock Team (ACST) at AdventHealth Orlando has resulted in improved outcomes for patients undergoing percutaneous coronary intervention (PCI). The goal of the ACST was to improve clinical outcomes and drive multidisciplinary collaboration. The main focus was on reducing observed mortality related to ACST utilization and patient optimization.<br /><br />The improvement in pathway efficiency has also contributed to a better patient experience, reduced resource utilization, and improved physician satisfaction through enhanced collaboration and communication among different specialties.<br /><br />The study found that PCI-related clinical outcomes improved significantly due to the establishment of an evidence-based shock protocol and accountable physician-to-physician real-time communication. The adoption of this approach can be applied to other care pathways and institutions.<br /><br />The PCI Quality Committee examined each phase of care along patient throughput and identified documentation improvement areas. Poor documentation related to cardiogenic shock and heart failure within two weeks was uncovered. Required fields were added to Cath Lab documentation to capture missing elements.<br /><br />The ACST was formed, consisting of cardiologists, heart surgeons, ECMO specialists, emergency medicine physicians, and critical care physicians. An evidence-based cardiovascular shock protocol was created, which included ACTS process activation and phone call conferences to determine the treatment plan.<br /><br />During the study period from January 2017 to December 2021, a total of 9,020 PCIs were performed, including 1,159 STEMIs. Among the STEMI group, 178 patients met the criteria for cardiogenic shock. The mortality rate among patients with cardiogenic shock decreased from 40.9% in 2016 to 34.8% during the study period.<br /><br />Overall, the implementation of the ACST and improvements in documentation resulted in improved PCI Risk-Adjusted Mortality, from less than the 50th percentile in 2017 to approximately the 85th percentile in 2021. Similarly, STEMI Risk-Adjusted Mortality improved from around the 40th percentile in 2017 to the 90th percentile in 2021.<br /><br />This study demonstrates the effectiveness of implementing an ACST and improving documentation in improving clinical outcomes for patients undergoing PCI.

Keywords

Acute Cardiogenic Shock Team

AdventHealth Orlando

percutaneous coronary intervention

clinical outcomes

multidisciplinary collaboration

mortality rate

patient optimization

pathway efficiency

physician satisfaction

care pathways