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Table 2 Results care delivery process analysis

From: Selecting interventions to improve patient-relevant outcomes in health care for aortic valve disease – the Intervention Selection Toolbox

TreatmentProcess PhasePotential improvement interventionImpact on outcome
SAVRMonitoring and preventingIdentify high-risk patients by measuring a Frailty ScoreMortality, Quality of Life
Organize a specific pre-operative screening for older patientsNone*
DiagnosingIntroduce a frailty protocolQuality of Life, mortality
Discuss older patients in a multidisciplinary teamQuality of Life, Mortality
Introduce a checklist for uniform imagingQuality of Life, Mortality
Screen abdominal vascular diseaseMortality
Screen for long-vein narrowingMortality
PreparingAdjust the anticoagulation protocolMortality
InterveningStandardize with a protocol for the blood or crystalloid cardioplegiaMortality
Use of MECCa and improve experience of the operation teamMortality
Implant the long-term pacemaker as fast as possible after operationMortality
Recovery/RehabConduct an echocardiography only with indicationQuality of Life
Improve nightly supervision at the ICUb (cultural change)Mortality, valve re-intervention
Offer every patient heart rehabilitation programQuality of Life
Raise more attention to diet of the patient, practice spirometryQuality of Life
Introduce a checklist for the exit consultRe-intervention
Monitoring/ ManagingAdjust the medication protocolQuality of Life
TAVRMonitoring and preventingOptimize Frailty identificationNone*
Introduce home monitoring system for measuring blood pressure (E-Health)Quality of Life
DiagnosisIntroduce more frequent TAVR team meetings to discuss patientsMortality, Quality of Life
Improve hospital logistics (with the support of the Lean method)Mortality, Quality of Life
Assure that an echo is always available before diagnosisComplications
More frequent TAVR Team meetings to discuss patientsMortality
Digitalize the treatment planMortality
Involve an anesthetist in the TAVR Team meetingsMortality
Introduce a diagnosis checklist for treatment choicesNone*
PreparingConduct pre-operative check-up and CT-scan on the same dayWaiting-times
Introduce a checklist for the check-upMortality
Involve an anesthetist much more this phaseComplications
More local anesthesiaMortality
More procedures in one day or another day for TAVI procedure to shorten the waiting timesNone*
InterveningIntroduce the presence of a surgeon, cardiologist and anesthetist during the procedureComplications
Use ACIST Pumpc (control of injection rate)None*
Only use the new generation of valves (replaceable valves)Mortality
Use of a debris catch deviceStroke
Recovery/RehabIntroduce clinical pathwayQuality of Life
Ensure removal of the pacemaker the following day and directly implant the long-term pacemaker if neededInfections
Apply telemetry monitoring for full period until dismissalNone*
Monitoring/ManagingDefine targets for medicationRe-intervention
  1. *The proposed potential improvement intervention is not expected to have considerable impact on one of the patient-relevant outcome measures, but process or structure measures
  2. aMECC is minimal extracorporeal circulation
  3. bICU is intensive care unit
  4. cACIST Pump simplifies contract injection for procedures