1012. Outcomes of a Quality Improvement Initiative: Multi-Disciplinary Team for Infective Endocarditis Improves the Numbers of Patients Who Undergo Surgery

Abstract

Abstract Background In a prior study we identified leverage points for improving infective endocarditis (IE) outcomes at an academic medical center¹. We aimed to improve the rate of surgery for those with guideline-based indications for surgery by 50%. Methods We recorded outcomes and surgical indications for patients with IE from December 2018 to June 2020 and compared to our prior published data from January to December 2016, using similar criteria.¹ Changes implemented in the interim period included development of a multidisciplinary team (MDT) for IE that provided recurring conferences, participated in heart valve team case discussions, and promoted the use of a home-grown algorithmic clinical care pathway within the electronic health record to guide providers on the next steps in management. Primary outcomes were surgery or transfer to a higher center for surgery, and in-hospital death. Odds ratios were calculated using a multivariate logistic regression model including age and sex covariates. Results We identified 31 IE patients with guideline indications for surgery. Of those patients, 15(48.39%) were female, 15(48.4%) were 18 - 44 years of age, 8(25.8%) were 45 - 64 years, 8(25.8%) were >64 years, 28(90.3%) white, 2(6.4%) black, 1(3.2%) East Asian, 17(54.8%) were intravenous drug users. Prior to the intervention, 6 of 21 (28.6%) patients with indications underwent surgery or were transferred outside for surgery and 6 (28.6%) patients died. Post-intervention, 17 of 31 (54.8%) patients with indications underwent or were transferred for surgery, and 5 (16.1%) died. After adjustment for age and sex, compared to the pre-intervention period, the odds of surgery or transfer for surgery for patients in the post-intervention period was 4.88 (95% CI 1.20, 19.79, p=.027). The odds ratio for death among patients in the post-intervention period was 0.40 (95% CI 0.09, 1.69, p=0.21). Pre- and post-intervention outcomes for infective endocarditis patients Conclusion MDT team with continued educational and health IT interventions improved the number of surgeries performed for IE. 1. Regunath H, Vasudevan A, Vyas K, et al. A Quality Improvement Initiative: Developing a Multi-Disciplinary Team for Infective Endocarditis. Mo Med. 2019;116(4):291-296. Disclosures All Authors: No reported disclosures.