Table 2 Results care delivery process analysis
Treatment | Process Phase | Potential improvement intervention | Impact on outcome |
|---|---|---|---|
SAVR | Monitoring and preventing | Identify high-risk patients by measuring a Frailty Score | Mortality, Quality of Life |
Organize a specific pre-operative screening for older patients | None* | ||
Diagnosing | Introduce a frailty protocol | Quality of Life, mortality | |
Discuss older patients in a multidisciplinary team | Quality of Life, Mortality | ||
Introduce a checklist for uniform imaging | Quality of Life, Mortality | ||
Screen abdominal vascular disease | Mortality | ||
Screen for long-vein narrowing | Mortality | ||
Preparing | Adjust the anticoagulation protocol | Mortality | |
Intervening | Standardize with a protocol for the blood or crystalloid cardioplegia | Mortality | |
Use of MECCa and improve experience of the operation team | Mortality | ||
Implant the long-term pacemaker as fast as possible after operation | Mortality | ||
Recovery/Rehab | Conduct an echocardiography only with indication | Quality of Life | |
Improve nightly supervision at the ICUb (cultural change) | Mortality, valve re-intervention | ||
Offer every patient heart rehabilitation program | Quality of Life | ||
Raise more attention to diet of the patient, practice spirometry | Quality of Life | ||
Introduce a checklist for the exit consult | Re-intervention | ||
Monitoring/ Managing | Adjust the medication protocol | Quality of Life | |
TAVR | Monitoring and preventing | Optimize Frailty identification | None* |
Introduce home monitoring system for measuring blood pressure (E-Health) | Quality of Life | ||
Diagnosis | Introduce more frequent TAVR team meetings to discuss patients | Mortality, 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 diagnosis | Complications | ||
More frequent TAVR Team meetings to discuss patients | Mortality | ||
Digitalize the treatment plan | Mortality | ||
Involve an anesthetist in the TAVR Team meetings | Mortality | ||
Introduce a diagnosis checklist for treatment choices | None* | ||
Preparing | Conduct pre-operative check-up and CT-scan on the same day | Waiting-times | |
Introduce a checklist for the check-up | Mortality | ||
Involve an anesthetist much more this phase | Complications | ||
More local anesthesia | Mortality | ||
More procedures in one day or another day for TAVI procedure to shorten the waiting times | None* | ||
Intervening | Introduce the presence of a surgeon, cardiologist and anesthetist during the procedure | Complications | |
Use ACIST Pumpc (control of injection rate) | None* | ||
Only use the new generation of valves (replaceable valves) | Mortality | ||
Use of a debris catch device | Stroke | ||
Recovery/Rehab | Introduce clinical pathway | Quality of Life | |
Ensure removal of the pacemaker the following day and directly implant the long-term pacemaker if needed | Infections | ||
Apply telemetry monitoring for full period until dismissal | None* | ||
Monitoring/Managing | Define targets for medication | Re-intervention |