Abstract 30: Real-Time Review of AF Ablation Quality Metrics Improves Patient Outcomes and Resource Utilization

Abstract

Background: Atrial fibrillation is an extremely prevalent condition with a high level of associated morbidity, mortality and healthcare resource utilization. Catheter-based ablation is an effective tool for the management of symptomatic AF patients, however the procedure is technically and logistically complex. Data describing process improvement within the context of an AF ablation program are limited. Methods: We developed an AF Treatment Registry to track patients undergoing AF ablation. Our primary purpose was to conduct real-time review of pre-specified quality and resource utilization outcomes, thereby facilitating process improvement. Patient characteristics and procedural details were collected at the time of ablation and at regular intervals thereafter. Members of a multidisciplinary AF treatment team reviewed registry data on a weekly basis. Operational deficiencies were identified and changes implemented. In this study, we evaluated the impact of our intervention on AF ablation case start time, case duration and procedural adverse outcomes. Results: In the six months prior to our intervention, mean AF ablation case start time was 8:31 AM (n=12), mean case duration was 203 minutes (n=24), mean procedural transseptal time was 228 minutes (n=24) and the rate of adverse outcomes was 16.7% (n=24). Over a 20-month period post-intervention, concurrent with process improvement efforts, 104 patients presented for AF ablation. During the last six months of the study period, the rate of adverse outcomes decreased to 0% (n=35, p=0.13), average case start time improved by 52 minutes (n=21, p<0.01), mean case duration decreased by 34 minutes (n=35, p<0.01) and mean procedural transseptal time decreased by 46 minutes (n=35, p=0.05). Conclusion: Use of a registry to facilitate real-time review of AF ablation outcomes and quality metrics was associated with a decrease in adverse events and an increase in the efficiency of hospital resource utilization. Although the non-randomized nature of this study precludes an assumption of causality, we hypothesize that real-time review and feedback was the primary driver of performance improvement.