Policy, Payment & Practice -> Clinical Quality Measures and Outcomes D-PO04 - Poster Session IV (ID 15) Poster

D-PO04-076 - Impact Of A Procedural Outcomes Registry On Reduction Of Vascular Access Complications With Pacemaker And Defibrillator Implantation (ID 1200)

Abstract

Background: Vascular access complications (VACs) with cardiac implantable electrical device (CIED) implant increase patient morbidity and prolong hospitalization
Objective: Evaluate the impact of a registry on VACs associated with CIED implant
Methods: A procedural outcomes registry was implemented at a single site over 3 years. The registry was then expanded to 5 additional sites within a large integrated health system. VACs were reviewed and adjudicated by an RN/MD team and each operator was notified of their VACs quarterly and given an opportunity to participate in adjudication.
Results: After institution of the registry, overall rates of pneumothorax (PTX)(2016: 1.4%; 2017: 1.7%; 2018: 0.3%, p < 0.01) and PTX requiring chest tube (PTX-CT) (2016: 0.4%; 2017: 0.9%; 2018: 0%; p < 0.01) decreased significantly. After adoption of the registry, operators were encouraged to use a micropuncture (MP) needle, and to use some method of visualization of the venous system (VV: cut-down, ultrasound or venography) during new lead implant. MP use significantly increased (2017: 41%; 2017: 71%, p < 0.001). VV increased significantly over the study period (2016: 74%; 2017: 78%; 2018: 88% (p < 0.01). The registry was expanded to all sites within the medical system and initial evaluation demonstrated a wide range in the use of MP and VV that did not correlate with PTX rates (Table).
Conclusion: Operator notification of complication rates reduced PTX rates. Standardization of operative technique had an equivocal effect on outcomes. The results suggest that operator feedback on their own complications relative to those of the practice is the best strategy to improve outcomes.

Site 1Site 2Site 3Site 4Site 5Site 6
PTX (%)4.3000.71.80.3
PTX-CT (%)0.900000
MP (%)31251489155
VV523099524387
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