Quality or Patient Safety Concerns Regarding Catheterization Lab Patients

Quality or Patient Safety Concerns Regarding Cath Lab Patients
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Quality or Patient Safety Concerns Regarding Cath Lab Patients
The catheterization laboratory is a sophisticated operating environment where several highly skilled subspecialists led by a cardiologist interact with one another using complex medical equipment to care for patients with critical cardiac disorders and comorbidities. Even though thousands of patient lives are saved or significantly improved every year in the catheterization laboratory, unfortunate and potentially preventable adverse patient events continue to occur. Most of these complications are brought about by organizational factors such as complex patients, knowledge deficit, repetitive tasks, lack of systematic communication channels, and interruptions. They are also the result of human factors like policy violations, misjudgment, lapses, and miscommunications. In most cases, adverse patient outcomes in the catheterization laboratory result from multiple organizational and human factors co-occurring and heightening the possibility of medical errors.
Adverse patient events are not solely tied to organizational and human factors but also relate to the potentially hazardous nature of the complex interventions performed in the catheterization laboratory. The interventions, ranging from complex percutaneous valve implantations to routine coronary angiography, come with attendant risks and complications well documented in the existing literature. While time pressures and poor synchronization between multidisciplinary teams continue to be the leading causes of adverse patient events, the procedures themselves are responsible for a significant proportion of patient morbidity and mortality in the catheterization laboratory environment (Wahr et al., 2013). Moreover, there has been a lack of systematic attention to the reasons for suboptimal patient safety standards in the interventional cardiology setting. Consequently, efforts at identifying patient safety hazards and developing risk mitigation strategies in the catheterization laboratory have been slow. This essay will explain how EBP, research, and PI can be utilized to address the issue and how the proposed PI process will capture and disseminate data to improve quality improvement processes in the catheterization laboratory.
Evidence-based practice (EBP) is a valuable tool in introducing and naturalizing current best evidence, clinical expertise, and patient values to guide patient safety initiatives. For instance, the Agency for Healthcare Research and Quality (AHRQ) periodically releases Surveys on Patient Safety Culture (SOPS) Hospital Survey for clinicians and other hospital staff to evaluate and improve patient safety culture in their institutions. Another valuable EBP resource is the CathPCI Registry, which provides a wide array of reporting options to support progressive quality improvement in facilities. For instance, the CathPCI User Dashboard allows clinicians and hospital administrators to review their Institutional Outcomes Reports and Data Quality Reports by providing weekly data on quality metrics specific to the catheterization laboratory, including volume of cases treated, procedure adverse events and outcomes, percutaneous coronary intervention (PCI) process metrics, as well as PCI appropriateness (NCDR, 2021).
The dashboard also highlights areas for improvement that clinicians and hospital administrators should focus on to reduce adverse patient outcomes. Patient safety research and performance improvement are also critical to identifying and mitigating patient safety hazards. Both initiatives involve analysis of the catheterization laboratory setting at multiple points, including structural measures (clinician certification and procedural volume), process measures (discharge medications, door to balloon times), as well as outcomes measures (complications, risk-adjusted mortality, readmission, quality of life) (Henien et al., 2020). Studying these multiple points of the catheterization laboratory to determine existing or potential patient safety risks and then implementing performance improvement processes to address the same can help address the issue of patient complications in the interventional cardiology setting.
The quality improvement process I would apply is the door-to-balloon time, which is a measurement of the time between the arrival of a patient with an ST-elevation myocardial infarction (STEMI) in the emergency department and the time that an inflated balloon is placed in the occluded, culprit coronary artery. Door-to-balloon time is a crucial performance quality metric in the catheterization laboratory as it denotes the proficiency of the healthcare team in the emergent delivery of PCI. I chose this quality improvement process because it is a measure of quality that directly impacts patient survival: patient survival rates depend on reduced door-to-balloon times. Early reperfusion therapy is critical to salvaging cardiac muscle. Therefore, patient safety is directly tied to how efficiently the healthcare team identifies a patient with STEMI and performs reperfusion of the compromised vessel through coronary intervention within the shortest time possible (Menees et al., 2013). Therefore, decreasing door-to-balloon time is a necessary quality i...