Pre-counselling and Quality Assurance for Cardiac Catheterization – Experience of Maccabi Healthcare Services

Background: Cardiac catheterization are a very common procedure. In 2012, 10,175 procedures were performed in Maccabi Healthcare Services. Recently, doubt has been raised about the necessity of a significant percentage of interventions. Consequently, appropriateness Criteria have been published by leading professional groups.

Objectives: To explores the professional, legal and ethical basis for establishung a comprehensive system to pre-evaluate the need for elective cardiac catheterization procedures in Maccabi Healthcare Services, and to review the findings and results of the implementation of such a system.

Methods: As a part of the designing procedure, 400 cardiac catheterization were reviewed by leading interventional cardiologists, in order to estimate the magnitude of possible appropriateness. A thorough, partially automated system within the electronic medical record was sat, to support clinicians referring patients to elective cardiac catheterization. As a part of the quality assurance program, a post-factum control system was designed to evaluate the decisions of both the referring and consulting cardiologists. Attention was also paid to the technical aspect of the procedures. A survey was performed amongst the referring physicians at the beginning of the program, and after 1 year.

Results: Review of the 400 cardiac catheterization has demonstrated in 25% of the catheterizations, there was disagreement between the performers and the reviewers. After 2 years – the number of procedures dropped from 10,175 (2012), to 9,292 (2014), with a 20 million NIS drop of costs, accordingly. Post hoc review and dialogue with the heart institutes was established and added value to the process. Satisfaction among cardiologists has risen from 55% to 75% after one year.

Conclusion: A professional system to manage cardiac catheterization system is both feasible and worthy with a significant impact on the appropriate use of invasive procedures, quality of care, and cost.