Centered Approach Research Articles

Returning to Growth: One Academic Medical Center's Successful Five-Step Approach to Change Management.

The University of Alabama at Birmingham academic medical center (UAB AMC) had achieved great success and growth during the 50 years since its founding. However, the challenging and more competitive environment of the 2000s left the UAB AMC on a downward trajectory. The UAB AMC had to overcome difficult internal cultural and structural barriers that stood in the way of the transformational change needed to remain competitive. Competition rather than collaborative and strategic financial investment were the primary cultural barriers for the UAB AMC, while people were the primary structural barrier. Leadership identified 5 steps that were critical for the transformation that occurred between 2013 and 2018: alignment of leadership; creating a compelling and credible shared vision; identifying cultural and structural barriers; creating a thoughtful, data-driven intervention; and improved communication and accountability. Following these steps enabled the UAB AMC to transform its institutional structure and culture. As a result, the UAB AMC thrived, returning to substantial growth in research and clinical care. UAB AMC School of Medicine grew by $100 million in National Institutes of Health funding and moved up 10 spots in ranking. In 2018, UAB Hospital had 10 specialties ranked by U.S. News & World Report, 7 more than in 2013. This article outlines the approach taken and provides a conceptual framework for other AMCs eager to transform their structure and culture and position themselves for growth.

Management of Positive Prospective Cross Matches in Lung Transplant Recipients: Outcomes from a Single-Center Experience

Purpose Highly sensitized recipients remain a challenge in lung transplantation. There are no standardized protocols among lung transplant centers to guide management of these patients. Some centers choose not to transplant highly sensitized patients due to the risk of graft dysfunction and death. We describe our center's experience and outcomes managing lung transplant recipients with positive flow-cytometric prospective cross matches (FXM). Methods We retrospectively analyzed patients who underwent lung transplantation with positive FXM from August 2015 to November 2019. Outcomes included overall length of stay, 1-year survival, graft function at one year, and incidence of antibody mediated rejection (AMR) and CLAD (BOS). Results There were 11 patients with FXM (6 females, 5 males; 6 with restrictive lung disease, 3 with obstructive lung disease, 1 with cystic fibrosis, and 1 with pulmonary vascular disease). 7 (63%) had concomitant positive virtual cross matches. 10 (91%) were managed with high-dose IVIg alone immediately post-op. 3 patients additionally received intra and/or post-op plasma exchange, rituximab and/or bortezimab. Median length of hospital stay was 50 days. Median length of follow up is 30 months (range 11-63 months). KM estimate of one-year survival was 90%. Clinical episodes of AMR requiring treatment occurred in 1 (9%) patient at 3 years post-transplant. DSA cleared in 8 patients (73%). Infections occurred in 5 patients (45%). None were life threatening. CLAD grade ≥ 1 occurred in only 2 patients (18%), one at 1.5 years and the other 3 years post-transplant. FEV1 at one year was >89% of personal best in all patients. Conclusion Successful lung transplantation of highly sensitized recipients is feasible. Using our center's approach results in longer hospital stay but excellent one-year outcomes. Further study is needed to identify patients at risk for graft dysfunction and death due to AMR who benefit from early aggressive treatment, and to avoid unnecessary treatment in lower risk patients.

Pulsatile ventricular assist device as a bridge to transplant for the early high-risk single-ventricle physiology

BackgroundThe use of ventricular assist devices (VADs) as a bridge-to-transplant in patients with single-ventricle physiology post–stage one palliation has been associated with poor outcomes. We describe our center's successful experience in the use of paracorporeal pulsatile VADs in the palliation of high-risk single ventricle physiology before or after the first stage of palliation with an impetus on pre-palliation implant. MethodsThis is a single-center retrospective review of univentricular patients implanted with the Berlin Heart EXCOR VAD. Our center's approach includes early implantation of the Berlin Heart EXCOR with common atrial cannulation, a cardiac index between 3.5 and 5 L/min/m2, and a bivalirudin-based anticoagulation regimen. Patient-related data were collected postimplant at week 1 and months 1, 2, and 3. Post-transplant data, including neurological outcomes, were collected. ResultsNine patients were supported. Survival to discharge post-transplant was 83% (5/6) in patients bridged-to-transplant and 33% (1/3) in patients bridged-to-decision. Six patients had no previous palliation. Median hospital stay before implantation was 111 days for nonsurvivors versus 20 days for survivors. The need for extracorporeal membrane oxygenation and cardiopulmonary resuscitation in nonsurvivors versus survivors was 1 in 3 versus 1 in 6 and 2 in 3 versus 1 in 6, respectively. There were no major central nervous system complications except for 1 significant hemorrhagic event. The pediatric overall performance category score on follow-up was normal to mild disability in 83% of survivors. Limitations include hemolysis and intermittent periods of infection and/or inflammation. ConclusionsThe use of pulsatile paracorporeal VADs is a feasible option as a bridge-to-transplant in the peri–stage one high-risk single ventricle.

Supporting Public Health Employee Engagement and Retention: One U.S. National Center's Analysis and Approach.

Background: Employee engagement, exemplified by positive perceptions of supervisors, workplace, and job, improves productivity and employee retention. We identified the extent of and barriers to employee engagement at Centers for Disease Control and Prevention's (CDC) National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP). Methods: In 2015, NCHHSTP's leadership collected baseline data through a centerwide Employee Engagement Pulse Survey (EEPS) from NCHHSTP's full-time Civil Service employees, U.S. Public Health Service Commissioned Corps officers, and Title 42 service fellows. EEPS included six demographic questions; nine Likert-type scale questions measuring 26 perceptions related to immediate supervisors, the work environment, and job satisfaction; and four open-ended questions soliciting recommendations for improvement. Findings: Among 727 of 1,171 staff (response rate = 62%), positive perceptions of supervisors ranged from a high of 94% (supervisor conducts performance reviews) to a low of 63% (supervisor assists employees with career development). Perceptions of work experience ranged from 98% (respondents were willing to put in extra effort to get a job done) to 68% (respondents' talents were used well in the workplace). Perceptions of job satisfaction ranged from 87% (support from their coworkers) to 69% (satisfaction with opportunities to learn or grow professionally). Conclusion/Application to Practice: Overall, NCHHSTP staff have positive perceptions of their work, their leaders, and the agency. Other public- and private-sector employers might be able to improve their employees' engagement and retention by listening to their opinions and needs and frequently recognizing their individual achievements. NCHHSTP's workforce development initiatives can be used as a model for assessing a baseline of their employees' engagement.

Opioid Misuse: An Organizational Response While Managing Cancer-Related Pain.

Opioids are commonly prescribed to manage cancer pain. Similar to the general population, patients with cancer are not excluded from the risk for opioid misuse and dependence. This situation can contribute to clinician reluctance to prescribe and manage pain using opioids. The purpose of this article is to provide an overview of how opioid misuse may affect pain management in patients with cancer and to describe a comprehensive cancer center's approach to safely managing cancer pain. Based on a literature review, the project team developed a stewardship program. Project components included selecting a validated screening tool for risk of opioid misuse, determining if a history of addiction affects pain management in patients with cancer, and establishing a task force to focus on the opioid crisis and to follow the Joint Commission's revised pain assessment and management standards. The project established a hospitalwide opioid stewardship program. Through the use of a multidisciplinary, universal precautions approach to assessing misuse in all patients with cancer who are prescribed opioids, healthcare teams can potentially reduce risks associated with misuse while safely managing cancer pain.

Upgrading Pediatric Transition: Combining Best Practices for Success

The period of transition from pediatric to adult care is a risk to the health of a heart transplant recipient. Best practice resources are available for transplant centers yet pose an additional time-consuming task. This study overviews one center's approach to improving their transition program utilizing current literature, continuous quality improvement and individualization for optimal outcomes. A gap assessment was completed reviewing the current transition program against the literature's best practice standard. Surveys of stakeholders were performed to identify areas of strength and weakness. Four focus areas for improvement were selected: 1) Development of high-quality transition care harnessing limited clinician time and budget resources utilizing American Society of Transplantation Pediatric Transition action plans and readiness assessments. To simplify clinician workload, all patients in the transition program were divided into groups by transition phase and age. Content from each phase was divided into focus sections that repeat with increasing complexity. 2) Normalize the transition process using patient-peer support groups along with goal mastery. A group learning session for each transition group was implemented every 6 months where new transition topics were introduced, and individual goals were set. These goals were discussed at each clinic visit to individualize care. 3) Improving transition of primary medical responsibility from caregiver to the young adult patient. Caregivers were made an essential part of each child's goals with annual "caregiver only" transition learning and support sessions. 4) Incorporating surveys of patient, caregiver and adult transplant center teams to guide a continuous quality improvement process. Using PDSA (Plan-Do-Study-Act) cycles has led to high satisfaction and preparation of the transition patients. Our transition program was initiated in 2011 and educated a total of 38 patients. Since modifying our transition program in 2017: 51 patients have been part of the revised format, 5 patients have successfully transitioned and 100% of patients and caregivers reporting feeling well prepared for transition. Utilizing industry standards, existing resources and addressing identified center specific needs can result in an effective, streamlined and successful transplant transition program.

Overcoming Challenges to Support Clinician-Scientist Roles in Canadian Academic Health Sciences Centres.

Clinician-scientists (CSs) make significant contributions to the healthcare system, yet their roles are not fully understood, supported or recognized by healthcare leaders or policy makers. CSs are healthcare professionals with advanced research training who continue to pursue clinical work and are considered an essential component of the research infrastructure in academic health sciences centres. The current literature supports the role of CSs but is also clear that there are multiple challenges in attracting and retaining clinicians to the role. To gain a comprehensive understanding of the current status of the CS role, two literature reviews were conducted. The findings reported here include an overview of: the education and training preparation for CS roles; the importance of the CS role; barriers and challenges to developing and implementing the CS role; and strategies for supporting and sustaining CS roles in practice. The paper further describes one Canadian academic health sciences centre's approach to supporting and increasing the number of CSs from nursing and allied health professions to support academic practice. Non-physician CSs may conduct research using multiple research designs across the research continuum from randomized controlled trials to grounded theory or qualitative descriptive approaches. Their research generally focuses on practice-based issues such as best practices for managing pain or frailty or evaluating the effectiveness of new approaches to care. Researchers and healthcare leaders in other organizations may find this work helpful for establishing their own structures to enhance research capacity and practice-based research, especially for non-physician CSs.

Improving Medication Timeliness in Pediatric Sickle Cell Disease Population Presenting to the Emergency Department with Vaso-Occlusive Episode

Abstract Background: Vaso-occlusive episode (VOE) is the most common acute complication for individuals with sickle cell disease (SCD) and most common reason to seek medical care. Rapid initiation of analgesia therapy, with timely subsequent doses as needed upon presenting to the emergency department (ED) for VOE are current established guidelines. Our center's initial analgesic approach aligns with NHLBI Guidelines of initial analgesic therapy within 60 minutes of registration and reassessment along with subsequent doses every 15 to 30 minutes if severe pain persists. Our center also recommends initiation of continuous infusion (CI) of pain medication within 60 minutes following third bolus dose of pain medication for those not achieving sufficient analgesia. Objective: This project's aim is to reduce time to initial dose of analgesic therapy in patients with SCD presenting to the ED with VOE to less than 60 minutes from registration in 90% of study population, decrease time interval between first and third dose of opioids to less than 60 minutes in 90% of study population, and initiate CI of pain medication within 60 minutes of third dose of opioids in 75% of individuals requiring further analgesic support. The goal is to achieve these measures within the completion of 6 monthly Plan-Do-Study-Act (PDSA) cycles. Methods: Three initial countermeasures were implemented within our institution to achieve the targeted objectives. (1) An adjustment to current ED order sets was made to include intranasal fentanyl as an initial one time option for a quicker analgesic option upon registration. (2) Another adjustment was made to the initial ED order set used upon presentation of the patient to include CI orders instead of the current system of having separate order sets for initial bolus dosing of analgesic therapy and CI order. (3) Final initial adjustment was made to change nursing prompt within the electronic medical record (EMR) for reassessment following bolus doses of pain medication; prompts were changed to every 20 minutes from every 30 minutes for the nurses with idea to better target goal of <30 minutes between doses for those who are in persistent severe pain. Results: Baseline data was obtained by retrospective chart review over a three month period. A median of 58.8% of patients were receiving an initial dose of analgesic therapy within 60 minutes of registration. Sixty minutes between first and third dose occurred in 53.8% of patients. Initiation of CI was occurring in 8.3% of patients within 60 minutes of the third dose of opioids. Over the first PDSA cycle, improvement has been noted across all 3 aims. For the initial dosing, 68% of patients were receiving within 60 minutes. Time between first and third dosing of less than 60 minutes occurred in 60% of patients. Initiation of CI within 60 minutes of the third dose is occurring in 36.3% of patients. Initial qualitative response from ED staff and nursing has been positive regarding countermeasures and care for the patients. Conclusions: This project identified the need for improvement efforts in patient care. The goal is to provide more efficient analgesic support; with these adjustments, quicker pain control can be achieved, with this leading to improvement in patient care. It is anticipated that with the eventual achievement of the aims, a decreased admission rate will be noted; for those individuals still requiring further analgesic support, it is felt faster initiation of CI will lead to quicker control of VOE and, subsequently, shorter hospitalizations. Additional countermeasures have been discussed in anticipation to adding to the current interventions to further improve the project's efforts; these ideas are currently being vetted to determine feasibility within our center and their ability to maintain the success of this project over time. Plan will be to continue to run monthly PDSA cycles for 6 months to evaluate response of timing to initial adjustments before integrating further interventions. Qualitative data will be obtained formally during quarterly meetings between hematology and ED representatives. Disclosures Woods: Global Blood Therapeutics: Research Funding; Pfizer: Research Funding; Guidepoint: Honoraria; Putman: Honoraria; Children's Mercy Hospital: Employment, Membership on an entity's Board of Directors or advisory committees.

Lung transplantation in scleroderma: recent advances and lessons.

The purpose of this review is to highlight recent data regarding feasibility and outcomes following lung transplantation for patients with systemic sclerosis related pulmonary disease as well as to emphasize areas of uncertainly in need of further study. We include a description of our centre's approach to lung transplant evaluation and posttransplant management in this complex patient population. Historical data have demonstrated that patients with scleroderma have an increased risk of complications following lung transplantation owing to the multisystem nature of disease, particularly concurrent gastrointestinal, cardiac and renal involvement. Emerging data support the safety of lung transplant in appropriately selected patients with scleroderma-related interstitial lung disease and pulmonary arterial hypertension. Accumulating evidence validates that a diagnosis of scleroderma is not a priori a contraindication to lung transplant. In the carefully selected patient, both short-term and long-term outcomes following lung transplantation are comparable to counterparts with fibrotic lung disease or pulmonary arterial hypertension. However, further prospective study to detail how these patients should be evaluated and managed posttransplant is definitely needed. Cardiac disease is an emerging cause of morbidity and mortality in the scleroderma population and deserves particular attention during the pre and posttransplant period.

Development and Feasibility of a Community-Based, Culturally Flexible Colorectal Cancer Prevention Program.

Comprehensive cancer centers are an important community resource for cancer prevention education in their catchment areas. Colorectal cancer remains one of the most commonly diagnosed cancers in the United States, making prevention a priority. Colorectal cancer prevention targets include lifestyle modifications that are influenced by cultural norms, such as diet change, physical activity and screening behavior. Cancer centers must tailor prevention efforts to multiethnic catchment areas. This paper describes the development and feasibility of a comprehensive cancer center's approach to community-based colorectal cancer prevention in Houston, Texas, specifically targeting Hispanic and Asian populations. Sites were recruited through a city-wide network of partnerships between the community relations department in the hospital and community organizations. The program consisted of three workshop-style classes per community site. Each class had a similar overall structure, but cultural and site-specific adaptations were made for each group. A total of 33 classes were taught at nine distinct community sites to 1054 participants over 9months. This program structure may be adapted for the future dissemination of other cancer prevention tools to communities in the area.

Transitioning From Volume to Value: One Academic Medical Center's Approach to Improving Population Health.

The U.S. health care system is undergoing a major transformation. Clinical delivery systems are now being paid according to the value of the care they provide, in accordance with the Triple Aim, which incorporates improving the quality and cost of care and the patient experience. Increasingly, financial risk is being transferred from insurers to clinical delivery systems that become responsible for both episode-based clinical care and the longitudinal care of patients. Thus, these delivery systems need to develop strategies to manage the health of populations. Academic medical centers (AMCs) serve a unique role in many markets yet may be ill prepared for this transformation. In 2013, Oregon Health & Science University (OHSU) partnered with a large health insurer and six other hospitals across the state to form Propel Health, a collaborative partnership designed to deliver the tools, methods, and support necessary for population health management. OHSU also developed new internal structures and transformed its business model to embrace this value-based care model. Each Propel Health partner included the employees and dependents enrolled in its employee medical plan, for approximately 55,000 covered individuals initially. By 2017, Propel Health is expected to cover 110,000 individuals. Other outcomes to measure in the future include the quality and cost of care provided under this partnership. Anticipated challenges to overcome include insufficient primary care networks, conflicting incentives, local competition, and the magnitude of the transformation. Still, the time is right for AMCs to commit to improving the health of populations.

Transradial Access for Interventional Radiology: Single-Centre Procedural and Clinical Outcome Analysis

PurposeThe study sought to describe a single centre's technical approach to transradial intervention and report on clinical outcomes and safety. MethodsA total of 749 transradial access (TRA) procedures were performed at a single hospital in 562 patients (174 women and 388 men). Procedures included 445 bland embolizations or chemoembolizations of the liver, 88 uterine artery embolizations, and 148 procedures for Selective Internal Radiation Therapy (Y90), which included mapping and administration. The mean age of the patients was 62 years (range 27–96 years). ResultsFour cases (0.5%) required crossover to transfemoral (tortuous anatomy, inability to secure a stable position for embolization, vessel spasm and base catheter not being of a sufficient length). A single asymptomatic, short-segment radial artery occlusion occurred (0.3%), 3 patients (0.4%) developed small hematomas postprocedurally, and 2 patients (0.7%) had transient neurological pain, which was resolved within a week without treatment. It was found that 98% of patients who had a previous femoral access procedure would choose radial access for subsequent procedures. ConclusionsTransradial access is a safe, effective technique, with a learning curve; however, this procedure has the potential to significantly improve departmental workflow and cost savings for the department and patient experience.

The use of immunosuppression in autoimmune hepatitis: A current literature review.

Autoimmune hepatitis (AIH) is an organ specific autoimmune condition which can manifest at any age of life. The heterogeneous nature of this condition means that great variation can be seen in severity, progression of disease and response to treatment within this patient group. Since the 1980s prednisolone and azathioprine have been used for induction and remission of the disease and remain the mainstay of treatment. Other immunosuppressive agents have been employed in difficult to treat cases. While there is less published data regarding these agents compared with the conventional treatments of steroid and azathioprine, there is mounting evidence to support the use of mycophenolate mofetil as a second-line agent. The calcineurin inhibitors, though less studied, additionally show promise. More data is needed on the use of biological agents in refractory disease. This review focuses on our centre’s approach to treatment of AIH in the context of a contemporary review of the literature.

Treatment of infants identified as having severe combined immunodeficiency by means of newborn screening

Severe combined immunodeficiency (SCID) is characterized by severely impaired T-cell development and is fatal without treatment. Newborn screening (NBS) for SCID permits identification of affected infants before development of opportunistic infections and other complications. Substantial variation exists between treatment centers with regard to pretransplantation care, and transplantation protocols for NBS identified infants with SCID, as well as infants with other T-lymphopenic disorders detected by using NBS. We developed approaches to management based on the study of infants identified by means of NBS for SCID who received care at the University of California, San Francisco (UCSF). From August 2010 through October 2016, 32 patients with NBS-identified SCID and leaky SCID from California and other states were treated, and 42 patients with NBS-identified non-SCID T-cell lymphopenia were followed. Our center's approach supports successful outcomes; systematic review of our practice provides a framework for diagnosis and management, recognizing that more data will continue to shape best practices.

Understanding Science Centre Engagement in Nurturing Visitor Interest and Curiosity

Reaching and engaging visitors within exhibitions and throughout the museum environment, recurred as an area of design concern. Using the recent experience of Science Centre Singapore, The Mind Museum Philippines and The Experimentarium Denmark, the responses of the centre managements provided initial findings towards quality visitor experience and informal learning intentions. The biggest challenge is to provide an opportunity for cognitive and affective learning while collectively facilitating enjoyment and fun. Learning and educational theory are explored with implications for the exhibition development process. Nurturing visitor interest and curiosity theme reveal the centre's approach to offer a rich and cohesive experience.

Establishing a Research Center: The Minority Male Community College Collaborative (M2C3)

This chapter describes the establishment of the Minority Male Community College Collaborative (M2C3), a research and practice center at San Diego State University. M2C3 partners with community colleges across the United States to enhance access, achievement, and success among men of color. This chapter begins with a description of the national trends and concerns that led to the center's focus on supporting the capacity of community colleges to address challenges facing historically underrepresented and underserved men, particularly men of color. Next, the chapter describes the concepts of “equity‐mindedness” and “institutional responsibility” that informed the conceptualization of the center's intervention approach. Guided by these concepts, partnerships advanced by institutional assessment tools such as the Community College Survey of Men (CCSM), the Community College Insights Protocol (CCIP), and the Community College Student Success Inventory (CCSSI) are described.

A single center's approach to discriminating donor versus host origin of renal neoplasia in the allograft kidney.

Renal cell carcinoma (RCC) in the allograft of kidney transplant recipient (KTR) patients is rare and may represent a de novo process arising from the transplanted organ or metastasis from a clinically undetectable host primary. Determination of host versus donor origin is important for staging and management. We report our experience utilizing Penta-C (PC) and Penta-D (PD) short-tandem repeat (STR) microsatellite analysis to discriminate between host and donor origin of RCC identified in renal allografts. We identified 5 KTR patients with RCC in the allograft kidney. The PC and PD microsatellite analysis was applied to tumor, host, and donor formalin-fixed, paraffin-embedded tissue sections and/or fresh blood leukocytes to identify the origin of the neoplastic cells. The PC and PD microsatellite alleles were robustly amplified in all samples. Each case showed one or more informative alleles indicating that the neoplastic cells originate from donor tissue. Allele frequency data indicate that by using both PC and PD markers, we will be able to discriminate between host and donor cell of origin in over 99% of cases. The PC and PD microsatellite analysis is a convenient, robust, and efficient strategy to determine donor versus host origin or RCC in transplant kidney specimens.

The family planning service and the pill in Geneva (1965–1980): a step towards women's emancipation?

In 1965, a family planning service was created in Geneva which aimed at spreading information on contraception. This article focuses on the attitude of the centre vis-à-vis the new contraceptive methods, especially the pill, and puts it in perspective with other voices, such as those of feminists. In order to address the question of women's emancipation, it relies on the archives of the family planning centre and of the Women's Liberation Movement of Geneva. The centre's pedagogical discourse about contraception focuses on stable couples and a rational attitude towards reproduction and family planning. It reflects the dominance of medical theories in the field of sexuality in Geneva during this period. The author suggests that the centre's approach to contraception contributed to the diffusion of a new contraceptive norm by combining contraceptive information with messages concerning the proper type of relationship, the state of mind and even the feelings with which contraception should be associated. The sources, however, also suggest a gap between the messages delivered and actual uses made of the centre. While maintaining a conservative and normative discourse, the family planning service nevertheless gave women the possibility to increase their autonomy.

From Individual Empowerment to Social Movement: Drought Management for Ecological Restoration

If we believe human life is a gift then we ought to safeguard it. Today this life is at stake from the womb to the tomb. As a result there is imbalance in many aspects of life even in the climatic conditions. At Kankewadi, in Ahmednagar, Maharashtra, where we began community mobilisation work, many people were facing a losing battle. They could hardly see any light at the end of the tunnel. Jesuit Priests responded to this situation through an innovative method known as the Watershed Development Programme which holds an ultimate vision of holistic, people centred development. The 'Social Centre', a philanthropic NGO came into being as a ray of hope to the rural folk in the drought prone Ahmednagar district of Maharashtra. The paper describes the methods adopted to empower people and usher in improvements in the quality of life of the people. The results of the process disturbed social, economic, political and cultural benefits across all sections of the society in Kankewadi and its neighbouring villages. The so-called voiceless people became leaders of the local governing bodies. The social centre's approach of problem solving with participatory ideology has motivated Government institutions to adopt the watershed development. This involves the building of water as a critical resource for community empowerment, livelihood development and also to reduce internal displacement of the poor in India. The results of over 125 villages from this programme have the potential to turn into a movement of development which restores the ecological sanity, tackling both short term goals of poverty alleviation and long term goals of positively retaining people in their native habitat.

Multidisciplinary approach to transvenous lead extraction: a single center's experience.

To evaluate the success and complication rates of a single center's multidisciplinary approach to transvenous lead extraction. One university hospital. One hundred ninety-five patients scheduled for transvenous lead extraction. A multidisciplinary approach to transvenous lead extraction involving cardiac surgery, electrophysiology, perfusion, and cardiac anesthesiology. A case series of 351 lead extractions performed in 195 patients over a 42-month period. Indications, success rates, and complication rates were tracked and retrospectively evaluated and reported. Indications for lead extraction included 53.3% because of lead malfunction, 36.9% because of infection, with the remaining 9.7% from other categories such as venous stenosis. The lead extraction rate was 99.7%, with complete removal in 97.7%. The overall major complication rate was 3.08%. After an initial 1-year period of performing lead extractions, the overall major complication rate reduced to 1.23%. Transvenous lead extraction generally is a safe procedure, but not without complications. A multidisciplinary approach involving cardiac surgery, electrophysiology, and cardiac anesthesiology allows for successful management and the ability to rapidly manage major complications.