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Scooped by Seth Bilazarian, MD
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Radial Access: Get Onboard or Get Left Behind

Radial Access: Get Onboard or Get Left Behind | Heart and Vascular Health | Scoop.it
Converting Holdouts to Transradial Access: This is Seth Bilazarian from theheart.org on Medscape, at the Transcatheter Cardiovascular Therapeutics (TCT) 2014 meeting in Washington, DC. I am here with Dr Sunil Rao, from Duke University and section chief at the Durham Veterans Affairs Medical Center.
Seth Bilazarian, MD's insight:

My interview with Dr. Sunil Rao on transradial (from the wrist) catheterization.  His expertise on uptake and "how - to" tips on a catheterization technique that is increasing in the US but still lags behind other parts of the world.  Requires free registration at Medscape.

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Quality Care in Community Hospitals - Lawrence General Hospital advances quality processes with Accreditation for Cardiovascular Excellence (ACE)

Quality Care in Community Hospitals - Lawrence General Hospital advances quality processes with Accreditation for Cardiovascular Excellence (ACE) | Heart and Vascular Health | Scoop.it

What would you do if you found yourself to be David in the Goliathian world of Healthcare? If you were Lawrence General Hospital, Lawrence, Massachusetts, you would look to innovative and quality initiatives to hold your ground on the slippery slope of accountable care. As the first hospital in New England to achieve ACE accreditation, not only does Lawrence General Hospital hold distinction amongst its peers, but this hospital is also the first nationally to voluntarily validate and offer transparency of quality processes within a community hospital setting. Lawrence General Hospital performs diagnostic cardiac cath, ST-elevation myocardial infarction (STEMI) cases, and percutaneous coronary intervention (PCI) procedures without on-site surgery. 

Seth Bilazarian, MD's insight:

Great accomplishment for Lawrence General Hospital.  First community Hospital in US with ACE accreditation.

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#OnThisDay 25 years ago Trial of Outpatient vs. Inpatient Cardiac Catheterization

#OnThisDay 25 years ago Trial of Outpatient vs. Inpatient Cardiac Catheterization | Heart and Vascular Health | Scoop.it

To evaluate the safety and cost of outpatient cardiac catheterization, we conducted a randomized trial at three hospitals of outpatient (n = 192) as compared with inpatient (n = 189) cardiac catheterization in low-risk patients.

There were no significant differences between the two groups in whether they resumed normal activities or in the rates of rehospitalization within one week of the procedure. Total catheterization-related charges per patient were $679 lower for outpatients, with total savings in hospital charges of $885 per patient.

We conclude that elective cardiac catheterization as an outpatient procedure for selected patients is feasible and safe. Given the small size of our sample, however, we urge caution in interpreting these findings, since they do not exclude a small increase in complication rates with outpatient cardiac catheterization.

Seth Bilazarian, MD's insight:

25 years ago this paper helped pave the way for outpatient catheterization.  Coronary angiography (pictures of the heart arteries) was done at the time only as an inpatient with an overnight stay.  In the last few years, hospitals have just begun taking the next step, allowing outpatient same day discharge after coronary angioplasty (PCI) and stenting.  These changes are welcomed by patients (more comfort at home), hospitals and insurance payers (lower cost), but have been adopted slowly by physicians.

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Systems of Care for Heart Attack => ST-Segment–Elevation MI from AHA

Systems of Care for Heart Attack => ST-Segment–Elevation MI from AHA | Heart and Vascular Health | Scoop.it

Key take away for patients:

This paper was a survey of over 300 hospitals that take care of the sickest type of heart attack called the STEMI.  Best practices to improve care by reducing the time to open up the artery (called door to balloon time (D2B)) were identified. 

 

These practices are:

1.  accepting patients at a PCI hospital regardless of bed availability

2.  single phone call activation of cath lab

3.  emergency department physician activation
of lab without cardiology consultation

4.  national data registry participation

5.  Prehospital activation of the catheterization laboratory by paramedics & transferring physicians.

 

The most commonly reported barriers to system
implementation were hospital and cardiology group
competition and EMS transport and finances.

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