Abstract 18105: Lean Six Sigma Approach to Improve Post Percutaneous Coronary Intervention Cardiac Rehab Referral Rates

Abstract

Background: Cardiac rehabilitation referral rates remain low despite known benefits including decreased mortality and improved quality of life. Studies have identified factors tied to both positive and negative predictors of referral rates, however, overall, it appears to be due to site-specific variation demonstrating the need for hospital-level intervention. Aims: This quality improvement study aimed to improve cardiac rehabilitation referral rates after PCI at our institution utilizing the Lean Sigma Six (LSS) approach, which has been described as a means to improving the quality of healthcare delivery. Methods: An interdisciplinary team used the Define-Measure-Analyze-Improve-Control (DMAIC) framework to implement this study. A GEMBA walk i.e., personal observation of workflow was performed. We Define d and Measure d process of cardiac rehabilitation and the referral rates. We Analyzed to identify that the orders were being placed by multiple team members including residents, general and interventional cardiology fellows, attendings, and nurse practitioners. Process maps were created, and our Intervention was to involve interventional cardiology fellows as stakeholders best suited to place orders since they are involved in all PCIs at our institution. Education was provided specifically to them beginning in July 2022. Statistical Process Control charts were used to analyze data trends from 2019 - 2022 where a total of 3046 PCIs were performed. Control process involved reinforcing the effect of intervention in quarterly meetings. Results: Baseline referral rates ranged from 10-60%. A significant increase in cardiac rehabilitation referral rate achieving a target referral greater than 90% was observed and maintained through the subsequent quarters. Conclusion: LSS is a powerful methodology to examine causes of delay in care. Intervention using LSS principles and tools, may help improve system processes to achieve desired quality outcomes.