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Prospective peer review of regional percutaneous interventional procedures: a tool for quality control and
Lucy H J Blows1, Gaynor F Dixon, Miles W H Behan
1Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, Eastern Road, East Sussex, United Kingdom.
Insights
A prospective peer review audit tool improved percutaneous coronary intervention (PCI) quality. This method enhanced clinical decision-making in PCI strategy appropriateness, demonstrating its value in ensuring procedural quality.
Area of Science:
- Cardiology
- Health Services Research
Background:
- Current quality measures for percutaneous coronary intervention (PCI) rely on major adverse cardiac events (MACE), which lack clinical nuance.
- A need exists for improved quality assessment in PCI procedures.
Purpose of the Study:
- To establish and evaluate a prospective peer review audit tool for assessing PCI quality within a cardiac network.
- To determine the effectiveness of peer review in improving clinical decision-making for PCI.
Main Methods:
- A prospective peer review audit tool was implemented in five PCI hospitals.
- A rotating panel of interventional cardiologists and a cardiac surgeon assessed 326 PCI cases.
- Cases were evaluated for anatomical suitability, lesion severity, strategic appropriateness, and outcome.
Main Results:
- Coronary anatomy and lesion severity were appropriate in over 94% of cases.
- PCI strategy appropriateness was confirmed in 86.2% of initial cases, improving to 92.6% (p=0.004) in subsequent analyses.
- Overall procedural outcomes were considered satisfactory in 90.8% of cases.
Conclusions:
- Prospective peer review by a regional committee is a valuable method for ensuring PCI procedural quality.
- This audit tool demonstrated a statistically significant improvement in clinical decision-making regarding PCI strategy.
Aims:
Current quality measures of percutaneous coronary intervention (PCI) procedures are based on the incidence of major adverse cardiac events (MACE). This crude marker ignores the many clinical nuances that make for sound decision making in PCI. We have established a prospective peer review audit tool to determine the quality of PCI within our cardiac network, which consists of five PCI hospitals serving a population of 1.4 million people in Sussex, UK.
Methods And Results:
Analysis of 10% of all PCI cases selected at random each month by a non-clinical audit manager is made by a rotating panel of two PCI operators and one cardiac surgeon. Each PCI case is assessed for anatomical suitability, lesion severity, strategic appropriateness and final outcome. Panel findings were reported back to the operator and the audit manager. A total of 326 cases were assessed by the review committee. Results were disseminated to individual operators. Coronary anatomy and lesion severity were considered appropriate for PCI in 94.2% and 96.0% of cases, respectively. Appropriateness of strategy was confirmed in 86.2% and the outcome considered satisfactory in 90.8%. A total of 242 subsequent cases were analysed to assess practice trends. This analysis demonstrated a statistically significant improvement in clinical decision making with respect to appropriateness of strategy (from 86.2% to 92.6%; p=0.004).
Conclusions:
Prospective peer review of percutaneous coronary intervention cases by a rotating regional committee is valuable in ensuring procedural quality.
