1910. Developing a multi-disciplinary team for infective endocarditis – a quality improvement project
Session: Poster Abstract Session: Clinical Practice Issues: HIV, Sepsis, QI, Diagnosis
Saturday, October 6, 2018
Room: S Poster Hall
Posters
  • ID week poster - Final.pdf (330.8 kB)
  • Background: Early diagnosis and treatment improve outcomes and delays increase mortality in infective endocarditis (IE). Multidisciplinary teams (MDT) have reported improved outcomes but no guideline exists to develop such a team in United States. From mortality reviews we identified gaps in caring for IE. We describe a process of MDT development for IE at our institution.

    Methods: We used Tuckman’s model: (1)Forming: Infectious Diseases fellows and faculty (frontline) brain stormed to create a library of evidence and reviewed electronic records of cases coded as IE using international classification of diseases (ICD) codes in VizientTM [ICD-9(421/AC, 4210, 4211, 4219, 4249, 42490, 42491, 42499) and ICD-10(I33, I330, I339, I38, I39, M3211)] for the period January to December 2016. (2)Storming: Shared evidence with cardiovascular service line and formulated a plan (Fig 1). (3)Norming: Designed an outline of streamlined workflow for providers (Fig 2 and Fig 3). (4)Performing: Standardize approach throughout institution by integrating a care process model and then measure care variation with specific metrics derived from this model.

    Results: Of 82 cases coded as IE in VizientTM, 29 met definite criteria for IE (Modified Duke Criteria). In 8(27.6%) cases, there were no indications for surgery. Of the 21 (72.4%) cases who met one or more criteria for surgical intervention per guidelines, only 9 (42.9%) underwent surgery. In 12 (57.1%, leverage point) cases with indications but who did not have surgery, 9 (75%) were left sided IE and 6 (66.67%) died. All right sided IE (3, 25%) survived. Among those who died, at least 2 cases (22.2%) had potential for early intervention. Our aim statement from leverage point: Reduce the number of patients with left sided IE who did not have surgery despite indications by 50% (57.1% to 28.5%) following implementation of a MDT and care process model for IE. Our process diagram in Fig 3.

    Conclusion: Standardizing care for infective endocarditis using a care process model incorporating primary teams, infectious diseases, cardiology and cardiothoracic surgery services holds promise to improve care for infective endocarditis.

    Figure 1: Ishikawa chart

    Figure 2: Steps in consulting specialty providers

    Figure 3: Steps in the care process model for integration into electronic health records

     

    Archana Vasudevan, MD1, Kapil Vyas, DO2, Li-Chien Chen, DO3, Jane Terhune, RRT4, Stevan Whitt, MD4 and Hariharan Regunath, MD3, (1)Infectious Diseases, University of Missouri, Columbia, MO, (2)Internal Medicine, University of Missouri, Columbia, MO, (3)Division of Infectious Diseases, University of Missouri, Columbia, MO, (4)University of Missouri, Columbia, MO

    Disclosures:

    A. Vasudevan, None

    K. Vyas, None

    L. C. Chen, None

    J. Terhune, None

    S. Whitt, None

    H. Regunath, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.