Quality Measurement and Improvement in the Cardiac Catheterization Laboratory

Abstract

Case Presentation: A 46-year-old man with a past medical history significant for morbid obesity (body mass index of 66), hypertension, tobacco use, and dyslipidemia presented to an outside hospital with a non–ST-segment elevation myocardial infarction and was transferred for coronary angiography. Femoral arterial access was obtained for an uncomplicated percutaneous intervention (PCI) with the use of unfractionated heparin and a glycoprotein IIB/IIIA inhibitor. After successful PCI of the right coronary artery with drug-eluting stent implantation, the femoral arteriotomy was closed without complication. Two hours after the completion of the procedure, the patient experienced ventricular fibrillation and respiratory arrest requiring prolonged resuscitation with a subsequent hematocrit level noted to be 12.5%. The patient was resuscitated with fluid and blood products. Emergent angiography showed no active iliofemoral contrast extravasation and a widely patent coronary stent. An abdominal CT scan without contrast confirmed the diagnosis of a retroperitoneal hemorrhage. Unfortunately, the patient experienced recurrent ventricular fibrillation, and he died despite additional resuscitative efforts. Cardiac catheterization is one of the most common invasive procedures performed in the United States.1 Although the benefits of cardiac catheterization remain great, the large number of procedures performed coupled with infrequent but potentially significant complications make the cardiac catheterization laboratory an important environment in which to constantly strive to improve quality. Although optimal patient outcomes remain paramount, state and national regulatory requirements, public reporting, and payers' interests in both outcomes and cost raise the importance of quality measurement and improvement in the cardiac catheterization laboratory.2 Minimal requirements for quality monitoring in the cardiac catheterization laboratory vary with individual state regulatory practices. As an example, in Massachusetts, data elements are collected and reported as mandated by the Massachusetts Department of Public Health, The Joint Commission, Centers for Medicare & Medicaid Services, and mandated participation in the American College …