Abstract 12852: Process Mapping the Aortic Stenosis Patient Journey

Abstract

Introduction: In November 2019 the American Heart Association (AHA) launched Target: Aortic Stenosis, an initiative to improve outcomes of aortic stenosis (AS) patients. Utilizing a learning collaborative model with 15 hospitals, the AHA sought to impact the patient journey from diagnosis by echo through definitive treatment. At three years, process mapping was undertaken to outline learnings from the sites. Goals: The goals were to determine the steps that an AS patient follows from diagnosis to definitive treatment, identify gaps in process that prevent diagnosed patients from progressing to appropriate treatment, analyze areas that impact timeliness of this process, and identify changes that can improve identification and movement to definitive treatment. Methods: Site interviews were conducted utilizing the “Five Whys” approach of determining root cause. Sites analyzed three segments of the patient journey: identification, echo report findings, and multidisciplinary valve team (MDT) meeting occurrence. An ideal process map was created identifying areas that impact the patient journey. A prioritization matrix was created outlining the impact and effort of needed changes. Results: Reporting capability in both echo registries and medical records are key to identifying patients but are not commonly available. Previously unreferred patients were identified. Lack of surveillance tools impacts the ability of hospitals to monitor AS patient care. Lack of defined next steps detailed within echo reports prevents patients from receiving appropriate, timely treatment. The MDT meeting is not often recorded in patient records. Surgical patients often do not go through the MDT process. It is difficult for hospitals to impact patients that are initially identified but that do not continue in the system for unknown reasons. Conclusions: There are elements of the patient journey that impact the identification and treatment of moderate and severe AS patients. The prioritization matrix demonstrated solutions to improve processes that range from low effort - low impact to high effort - high impact. Hospitals participating in Target: Aortic Stenosis have identified changes to improve identification of AS patients and impact the timeliness of treatment.