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Published on: January 20, 2019
A Quality Improvement Initiative: Developing a Multi-Disciplinary Team for Infective Endocarditis
Hariharan Regunath1, Archana Vasudevan1, Kapil Vyas1
1Hariharan Regunath, MD, Kapil Vyas, DO, and Stevan P. Whitt, MD, are in the Department of Medicine, Division of Pulmonary, Critical Care and Environmental Medicine, and the Division of Infectious Diseases. Archana Vasudevan, MD, Chen Li-Chien, MD, and Sachin Patil, MD, are in the Department of Medicine - Division of Infectious Diseases. Jane Terhune, MD, is in the Office of Clinical Effectiveness, University of Missouri Hospital and Clinics. All at the University of Missouri-Columbia, Columbia, Mo.
Background:
As guidelines do not describe how to develop a multi-disciplinary team(MDT), we provide a model using quality improvement tools to design a MDT for infective endocarditis (IE).
Methods:
Primary service, specialty teams and whether they had surgery or not (indications, reasons, outcomes and complications) were recorded for IE patients for January-December 2016. Criteria: age >18years and definite IE per modified Duke criteria.
Results:
Of all cases, 29/82 met criteria. Primary service: internal medicine 18(62.1%), medical intensive care and cardiology 4(13.8%) each, family medicine 2(7.9%) and pediatrics 1(3.4%). Surgery was indicated in 21(72.4%), 9 (42.9%) underwent surgery, 12 (57.1%) did not [6/9(66.67%) left side IE died, all right side IE (3,25%) survived] and 2 (22.2%) had missed opportunities and this was chosen as the leverage point. MDT was developed to reduce the number of left sided IE patients not undergoing surgery despite indications.
Conclusions:
Quality improvement and team development tools help in developing MDT for IE.
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