1910. Developing a Multi-Disciplinary Team for Infective Endocarditis: A Quality Improvement Project

Abstract

BackgroundEarly diagnosis and treatment improve outcomes and delays increase mortality in infective endocarditis (IE). Multidisciplinary teams (MDT) have reported improved outcomes but no guideline exists to develop such a team in United States. From mortality reviews we identified gaps in caring for IE. We describe a process of MDT development for IE at our institution.MethodsWe used Tuckman’s model: (1) Forming: Infectious Diseases fellows and faculty (frontline) brain stormed to create a library of evidence and reviewed electronic records of cases coded as IE using international classification of diseases (ICD) codes in Vizient™ [ICD-9(421/AC, 4210, 4211, 4219, 4249, 42490, 42491, 42499) and ICD-10(I33, I330, I339, I38, I39, M3211)] for the period January to December 2016. (2) Storming: Shared evidence with cardiovascular service line and formulated a plan (Figure 1). (3) Norming: Designed an outline of streamlined workflow for providers (Figures 2 and 3). (4) Performing: Standardize approach throughout institution by integrating a care process model and then measure care variation with specific metrics derived from this model.ResultsOf 82 cases coded as IE in Vizient™, 29 met definite criteria for IE (Modified Duke Criteria). In 8 (27.6%) cases, there were no indications for surgery. Of the 21 (72.4%) cases who met one or more criteria for surgical intervention per guidelines, only 9 (42.9%) underwent surgery. In 12 (57.1%, leverage point) cases with indications but who did not have surgery, 9 (75%) were left sided IE and 6 (66.67%) died. All right sided IE (3, 25%) survived. Among those who died, at least two cases (22.2%) had potential for early intervention. Our aim statement from leverage point: Reduce the number of patients with left sided IE who did not have surgery despite indications by 50% (57.1% to 28.5%) following implementation of a MDT and care process model for IE. Our process diagram in Figure 3.Figure 1.Ishikawa chartFigure 2.Steps in consulting specialty providersFigure 3.Steps in the care process model for integration into electronic health recordsConclusionStandardizing care for infective endocarditis using a care process model incorporating primary teams, infectious diseases, cardiology, and cardiothoracic surgery services holds promise to improve care for infective endocarditis.Disclosures All authors: No reported disclosures.