Contemporary national and international guidelines recommend that patients with stable angina and acute coronary syndromes (ACS) with multi-vessel disease are discussed by a multidisciplinary “Heart Team” (HT) to facilitate optimal evidence-based management. However, there is a paucity of data describing the workings of a HT, actioning of it9s recommendations and reproducibility of decisions.

Methods

We have utilised a HT approach since 2005, meeting twice weekly with our HT database managed by a dedicated co-ordinator. We analysed the data for 2010 and describe the HT process. A random sample of cases were scrutinised to identify whether the HT decision had been implemented. Additionally, cases were re-presented to the HT after 1 year to determine consistency and reproducibility of decision making. The HT panel for the review process did not include members involved in the original discussion.

Results

During 2010, 108 meetings were held, attended by a median of 3 interventional cardiologists, 1 non-interventional cardiologist and 2 cardiac surgeons. A total of 1454 cases were discussed (mean 13.5 cases per meeting). 854 cases (58.7%) were from our own unit and 600 (41.3%) from referring hospitals. 356 (24.5%) were current inpatients and 1098 (75.5%) were outpatients. 1340 (92.2%) were patients with stable coronary artery disease (CAD) or ACS. The HT recommendation was for coronary artery bypass grafting (CABG) ± valve surgery in 429 (32%) cases, percutaneous coronary intervention (PCI) in 303 (22.6%), and optimised medical therapy (OMT) in 264 (19.7%). In the remaining 344 cases (25.7%) further investigation was advised before a HT decision was made; the most frequent recommendation was for a pressure wire study, in 151 cases (43.9%). 117 randomly selected cases were analysed to determine whether the HT recommendation had been actioned. This occurred in 101 (86.3%) cases. In the remaining 16 cases, deviation from the initial plan was due to the patient declining revascularisation (CABG 3, PCI 1), development of new co-morbidity (2) or revascularisation of different vessels (6). The reason for deviation was unclear in four cases. 50 cases were re-presented after 1 year with the original HT recommendation being the same in 38 cases (76%). Different decisions in the remaining 12 (24%) included seven cases (14%) in which further investigation had initially been suggested, and re-vascularisation was recommended on re-presentation.

Conclusions

A well-structured HT allows a large number of cases to be evaluated while interdisciplinary discussion facilitates consensus with evidence-based and individualised advice. There is a prominent role for pressure wire assessment in the further evaluation of equivocal CAD. The HT approach appears robust and reproducible in the majority of cases. Variation in decision making reflects the equipoise between suitability of CABG, PCI and OMT in many cases.

Interventional cardiology

Canadian Cardiovascular Society

10.1136/heartjnl-2012-301877b.150

Cite

Citations (0)

Patient Falls, Nurse Communication, and Nurse Hourly Rounding in Acute Care: Linking Patient Experience and Outcomes

Journal of Public Health Management and Practice (2021)

Melissa Gliner Joe Dorris Kimberley Marshall Aiyelawo Ellen Morris Danielle Hurdle-Rabb

Research has consistently found a link between hourly nurse rounding and patient outcomes, including reduced falls, reduced pressure ulcers, reduced call light usage, and improved patient experience; however, little research exists specific to patient falls and nurse rounding in acute care settings. This study adds to the body of knowledge by statistically quantifying and providing linkages between nurse rounding frequency and patient fall rates using data from 31 military treatment facilities comprehensively over a period from fiscal year (FY) 2017 through FY2019. Poisson regression results indicated that hourly nurse rounding was associated with a reduction of more than 21% in fall rates (incidence rate ratio = 0.79, P < .01) relative to infrequent rounding, and poorly rated nurse communication was associated with an 8.6-fold increase in patient fall rates relative to highly rated nurse communication (incidence rate ratio = 8.6, P < .01).

Rounding

Rate ratio

Acute care

Patient Care

10.1097/phh.0000000000001387

Cite

Citations (3)