The power of quality improvement: How a cath lab transformed care for PCI patients
A quality improvement initiative on limiting complications and improving efficiency in the cath lab can make a considerable impact on patient care, according to new data published in JSCAI.[1] Researchers explored years of percutaneous coronary intervention (PCI) data before and after a series of proposals were put in place to study their impact on a variety of outcomes.
“Continuous quality improvement (CQI) in healthcare seeks to identify opportunities for improvement through systematic performance evaluation, case review, staff education and use of nationally standardized benchmarks,” wrote first author Arnav Kumar Singla, MD, with Rush University Medical Center in Chicago, and colleagues. “In PCI, CQI initiatives have been associated with improved adherence to evidence-based practices, increased use of bleeding avoidance strategies and reductions in selected procedural complications”
In October 2022, the cath lab at a single facility launched a new multidisciplinary CQI committee focused on reviewing internal data and proposing protocol updates. The group’s goals included avoiding bleeding events, reducing the risk of acute kidney injury (AKI) and improving the efficiency with which patients were discharged.
Over time, cath lab personnel implemented several changes originally proposed by the committee. A “radial-first” access strategy was put in place, for example, and ultrasound guidance was standardized for patients being treated with both radial and femoral access. In addition, AKI was targeted with new hydration protocols an added emphasize on minimizing contrast volume whenever possible. Finally, the group finalized a same-day discharge (SDD) pathway that saved planned overnight admissions for high-risk cases, procedures performed late in the day and patients with transportation issues.
To track the value of the committee and its suggestions, researchers tracked data from more than 2,700 PCI procedure performed in the same cath lab from 2018 to 2024. Pre-CQI data—patients treated from 2018 to October 2022—were compared to post-CQI data. All PCI data came from the American College of Cardiology National Cardiovascular Data Registry (NCDR) CathPCI Registry.
Bleeding event outcomes
The study’s authors tracked periprocedural changes in hemoglobin (Hgb drop) as a bleeding safety signal. This number is often used to track procedural blood loss or hidden bleeding. Overall, the mean Hgb drop decreased from 0.65 g/dL to 0.54 g/dL after the committee’s proposals were implemented.
NCDR-defined bleeding rates did not significantly change. In addition, pericardial tamponade and the need for new dialysis were rare before the committee’s proposals were put in place and that was still the case afterwards.
AKI outcomes
Mean IV contrast use decreased from 188 mL per patient before the committee to 154 mL per patient after. This reflects the fact that clinicians were actively following the new directive and working to spare contrast when possible. The AKI rate, meanwhile, decreased from 14.3% to 9.7%.
Discharge outcomes
Perhaps the most dramatic difference following the committee’s proposals involved SDD, which increased from 13% before implementation to 24.7% after.
“The increase in SDD was especially pronounced for elective outpatient cases and those finishing by early afternoon,” the authors wrote.
Other key differences
The researchers explored other patient outcomes as well:
- Patients treated after implementation tended to be older and present with more comorbidities.
- In-hospital mortality was 2% before implementation and 1.5% after. This was not seen as a significant change.
- Radial access increased from 33.4% to 58.9%.
- The mean length of stay after PCI was slightly longer after implementation, a shift largely due to more complex patients being treated during that time.
- Monthly PCI volume jumped from 30.7 cases per month to 48.2 cases per month
- Multivessel staged PCI—something operators were encouraged to do when necessary to minimize risk—increased from 3.1% to 16.5%.
Overall thoughts
“PCI volume rose substantially following CQI introduction, demonstrating improved institutional capacity and throughput,” the authors wrote. “Although PCI volume is not included among current guideline-endorsed quality metrics, it is presented as a contextual indicator of procedural demand and institutional capacity, rather than as a direct measure of quality. The observed increase likely reflects evolving referral patterns and willingness to treat older and higher-risk patients, coinciding with the maturation of quality oversight processes. Consistent with this shift, patients undergoing PCI in the post-CQI period were older and more likely to have heart failure, anemia, or severe frailty. Despite this higher-risk profile, several key outcome measures—including bleeding, AKI, in-hospital mortality, and same-day discharge—either improved or remained stable in the post-CQI period.”
Click here to read the full study in JSCAI, the flagship journal of the Society for Cardiovascular Angiography and Interventions.
Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.