Abstract 205: Minimizing Post Procedural Bleeding Complications - A Quality Improvement Initiative

Abstract

Objectives: The primary purpose of this study is to implement the National Cardiovascular Data Registry (NCDR) CathPCI bleeding risk score pre-procedurally, in order to identify the patients who are at high risk for bleeding complications and secondly, to examine accurate documentation to decrease hemorrhagic complications among adult patients undergoing percutaneous coronary intervention (PCI). Background: Bleeding is one of the most common complications of PCI. The NCDR CathPCI bleeding risk score can predict patient risk for bleeding complications pre-procedurally. This tool is recognized as an assessment tool that can modify bleeding risk among adult patients undergoing PCI. This validated, individualized bleeding risk score (BRS) is useful in clinical decision making to promote quality of care, patient safety, and patient satisfaction and PCI outcomes. Specific outcomes evaluated in this project include number of blood transfusion and length of stay (LOS). Currently, this BRS tool is under utilized in the clinical setting. Methods: A cross sectional study design was implemented for this quality improvement project in a major medical center in the Northeast. Retrospective clinical data review was conducted for adult patients who underwent PCI prior to initiation of the NCDR CathPCI assessment tool. A data collection form was implemented to obtain this retrospective data related to bleeding complications. The NCDR CathPCI bleeding score tool was then implemented for adult patients who underwent PCI. Prospective data collection after implementing NCDR cathPCI bleeding risk tool is in progress. Results: The preliminary findings of the retrospective data review prior to implementation of the NCDR CathPCI bleeding score suggests that, 34.4% of the patients who received blood transfusions had documented bleeding complications (hematoma 15.6% (10 of 64); retro-peritoneal bleeding 9.4% (6 of 64); gastrointestinal bleeding 9.4% (6 of 64). Only 14.1% (9 of 64) of these patients had a drop in hemoglobin of 3grams from the baseline prior to transfusion. There was also a lack of documentation of hematoma size. Chronically anemic patients who received blood transfusion without bleeding complications accounted for 65.6% (42 of 64) of the patients reviewed in the retrospective data review. Average LOS of patients who required blood transfusion was an average of 1.34 days when compared with patients who did not develop bleeding complications. Final results of the prospective data analysis post implementation of the NCDR CathPCI assessment tool are pending. Conclusion: Pending.