Development and implementation of a cardiac resynchronisation therapy care pathway: improved process and reduced
Antonius Martinus Wilhelmus van Stipdonk1, Stijn Schretlen2, Wim Dohmen3
1Cardiology, Maastricht Universitair Medisch Centrum+, Maastricht, Netherlands twan.van.stipdonk@mumc.nl.
BMJ Open Quality
|February 25, 2021
Summary
A new standardized Cardiac Resynchronisation Therapy (CRT) care pathway successfully transitioned care to nurses, reducing hospital resource use and referral times without compromising clinical outcomes.
Area of Science:
- Cardiology
- Healthcare Management
- Nursing
Background:
- Cardiac resynchronisation therapy (CRT) demands complex, multidisciplinary care typically led by specialized physicians.
- Current CRT care pathways can be heterogeneous and may not maximize patient benefit.
- A novel, standardized CRT care pathway (CRT-CPW) was developed to improve care delivery.
Purpose of the Study:
- To implement and evaluate a standardized, multidisciplinary CRT care pathway (CRT-CPW).
- To transition CRT care from a physician-led model to a nurse-led model.
- To assess the impact of the CRT-CPW on process-related outcomes and clinical efficacy.
Main Methods:
- A comparative analysis of two CRT patient cohorts: usual care (2012-2014) and CRT-CPW (2015-2017).
- Primary outcomes included physician/nurse consultations, length of stay, hospitalization days, and referral-to-treatment time.
- Clinical outcomes, including mortality and heart failure hospitalizations, were assessed for non-inferiority.
Main Results:
- The CRT-CPW cohort showed significantly fewer physician consultations but more nurse and technician consultations.
- Referral-to-treatment time, length of stay at implantation, and total hospitalization days were significantly reduced with CRT-CPW.
- No significant differences were observed in 12-month all-cause mortality or heart failure hospitalizations between cohorts.
Conclusions:
- The novel CRT-CPW facilitated a successful shift to nurse-led care, optimizing resource utilization.
- The standardized pathway achieved reduced resource use while maintaining equivalent clinical outcomes compared to usual care.
- Future research will investigate the cost-effectiveness of the CRT-CPW.
Keywords:
efficiencyhealthcare quality improvementlength of staynursesorganizationaltime-to-treatmentMore Related Videos
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