Abstract 106: A Dedicated Atrial Fibrillation Program Improves Catheter Ablation Outcomes and Electrophysiology Lab Resource Utilization

Abstract

Introduction: Atrial fibrillation (AF) is a common condition that adversely impacts quality of life, reduces survival and requires significant healthcare resource utilization. Catheter-based ablation is an effective tool commonly used in the management of symptomatic AF patients, but it remains technically and logistically complex. Data describing the impact of team-based process improvement initiatives on laboratory resource utilization and outcomes of AF ablation are limited. To address this knowledge gap, we examined the impact of a real-time review of quality indicators and systems-based process improvement (PI) initiative on outcomes and resource utilization over 5 years. Methods: We developed an AF Treatment Program to conduct real-time review of ablation outcomes and lab resource utilization to facilitate PI and promote accountability. Key stakeholders and operational deficiencies were identified, and process changes, when needed, were implemented. Real-time feedback on performance was given and monthly results posted. In this analysis we examine the impact of our AF PI initiative on case start times, case duration, procedural adverse outcomes and ablation success rates. Results: Over the study period, concurrent with PI efforts, the rate of adverse outcomes decreased from 16.7% to 1.9% (p=0.03), average case start time improved by 85% (p=0.04), and the mean case duration decreased by 70 minutes (p=0.11). Maintenance of sinus rhythm at 1 year for the pre-intervention group was 78% versus 83% during the most recent study year (p=0.04). Conclusions: A continuous quality improvement AF program was associated with significant declines in adverse event rates and increased laboratory efficiencies, without adversely affecting long-term ablation outcomes. Although the non-randomized nature of our study precludes assumptions of causality, we hypothesize that real-time review and feedback was a major driver of performance improvement.