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 Tuckmans 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
L. C. Chen, None
J. Terhune, None
S. Whitt, None
H. Regunath, None
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