Objective

Following the international guidelines like the National Institute of Clinical Excellence (NICE) the eligible patients should be those that are not operable with the gold standard technique or very high risk patients. To assess a proper selection of patients in our hospital an “Heart Team” was implemented and a clinical-administrative pathway was created ad hoc. The aim of this study is to evaluate the appropriate use of the TAVI procedure within our hospital setting.

Methods

We defined, following the NICE guidelines the members of the “Heart Team” that was supposed to assess the patients with a possible indication for TAVI. One cardiologist, one cardiac surgeon and one interventional cardiologist where the minimum team to review the patient and discuss the indications and sign for approval. Other specialists could be invited to join and discuss the cases but every discussion had to end with a written document subscribed by all 3 specialist above.

A clinical pathway was created to define the eligible selection criteria and the bureaucratic pathway to request the permission to use TAVI. This pathway defined as well the appropriate ICD 9 coding for the correct reimbursement from the government.

Methods

We defined, following the NICE guidelines the members of the “Heart Team” that was supposed to assess the patients with a possible indication for TAVI. One cardiologist, one cardiac surgeon and one interventional cardiologist where the minimum team to review the patient and discuss the indications and sign for approval. Other specialists could be invited to join and discuss the cases but every discussion had to end with a written document subscribed by all 3 specialist above.

A clinical pathway was created to define the eligible selection criteria and the bureaucratic pathway to request the permission to use TAVI. This pathway defined as well the appropriate ICD 9 coding for the correct reimbursement from the government.

Results

At follow up, during the Audit,

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  the number of the evaluation forms vs TAVI implants was evaluated,

  
  
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  the quality and the completeness of the approval documents done by the “heart team”

  
  
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  the appropriate use of ICD 9 coding were reviewed and evaluated. The findings showed:

  
  
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  Zero evaluation forms of patient that after the discussion were excluded from TAVI procedure

  
  
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  6 to 33% did not have a form at all

  
  
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  63% to 40% had a completed evaluation form (3 signatures)

  
  
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  31 to 27 % had an incomplete form

  
  
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  Several ICD 9 codes were wrong and this created a money loss for the hospital