番茄社区

ORLANDO -- A bleeding risk calculator has helped a health system to reduce bleeding events after percutaneous coronary intervention (PCI), a study suggested.

As part of an ongoing quality improvement project of the CHI National Cardiovascular Service Line -- comprising 12 regional health systems and three medical schools -- the National Cardiovascular Data Registry (NCDR) bleeding risk calculator was used by operators to divide their patients into high-, intermediate-, and low-risk groups. They then implemented appropriate PCI strategies for each cohort, whether it differed through different drug or PCI access strategies.

Over a 2-year period (2013-2015), adjusted rates of bleeding events fell progressively from 6.30% to 3.78%, reported , of Catholic Health Initiatives in Lexington, Ky., at the Society for Cardiovascular Angiography and Interventions (SCAI) meeting.

"Our results showed that, in a very large patient population and an expansive health system, we were able to change behaviors that resulted in better patient care and significant financial savings," he said in a SCAI press release. "We believe this process could easily be adopted by other health systems."

With the hospital system saving $1 million over the study period, a 40% reduction in bleeding can be relevant to both the patient care and finances of large healthcare institutions, Granato suggested.

"The surprise is really around the fact that this type of change can be achieved across a health system," commented , of Duke University School of Medicine in Durham, N.C. "Integration of formal risk assessment at the bedside is extremely important to improve outcomes. But it has to be done systematically and integrated into the normal workflow."

Rao, who was not involved in the study, told 番茄社区 that he agreed with Granato's conclusions for several reasons. "This was a very well done quality improvement study; they used proved bleeding avoidance strategies; the approach was implemented across a health system (thus representing multiple sites and operators), and they used a single data source with one bleeding definition (NCDR CathPCI registry)."

Similarly, Granato suggested that "significant quality improvements, involving numerous physicans at multiple sites" can be achieved with standardized processes, continuous surveillance and timely feedback.

The study included 8,713 PCI procedures from 21 hospitals.

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