Table 3.
Monitoring overview
| MONITORING IMPROVEMENT | ||||||||
|---|---|---|---|---|---|---|---|---|
| Treatment | Indicator | Initiative | Based on outcome measures yes/no | How did it take place? | Implementation date | Intended impact on which outcome | Implementation completion (%) | How is it measured? |
| TAVR | 30-day mortality | 1) Pre-TAVR/frailty outpatient clinic started in 2014, 2) TAVR complication discussion started in 4th quarter 2014 with the following issues discussed: A) Choice of valve selection, B) Creation of a specialization team, C) Add additional CT images in report to the TAVI Team. | yes | 1st quarter 2015 | 30-day mortality | 100% | Valve choice: registry measured | |
| 1-year mortality | Pre-TAVR/frailty outpatient clinic started in 2014 | yes | 4th quarter 2014 | 1-year mortality | 100% | Not | ||
| long-term survival | Proposal change training plan - development of online course small private online course for residents with focus on frailty, functional decline and shared decision making | no | specific project team for elderly care | 4th quarter 2015 | none | 0% | Not | |
| Vascular complications | 1) Routine CT scan required pre-TAVR, 2) Start study new closing device in 2015, 3) Start complication discussions in 4th quarter 2014, where it was discussed to lower the threshold for a surgical cut down | yes | 4th quarter 2014 | Vascular complications | 100% | Not | ||
| SAVR | Re-sternotomy | Coagulation policy: Optimization of the transfusion policy based on for example the TEGa at the operation room, or no coagulation correction. In addition, the aim is to reduce the number of blood transfusions. The number of re-sternotomies could decrease at a targeted corrected clotting status of the patient. | no | Initiative from Anesthesiologists who conducted research | 1st quarter 2015 | Bleeding complications | 50% | As part of a study |
aTEG thromboelastography for testing the efficiency of blood coagulation