Safety
Journal Articles: OBJECTIVES This study compared the efficacy and safety of the VASCADE MVP Venous Vascular Closure System (VVCS) device (Cardiva Medical, Santa Clara, California) to manual compression (MC) for closing multiple access sites after catheter-based electrophysiology procedures. BACKGROUND The The VASCADE MVP VVCS is designed to provide earlier ambulatory hemostasis than MC after catheter-based procedures. METHODS The AMBULATE (A Randomized, Multi-center Trial to Compare Cardiva Mid-Bore (VASCADE MVP) VVCS to Manual Compression in Closure of Multiple Femoral Venous Access Sites in 6 – 12 Fr Sheath Sizes) trial was a multicenter, randomized trial of device closure versus MC in patients who underwent ablation. Outcomes included time to ambulation (TTA), total post-procedure time (TPPT), time to discharge eligibility (TTDe), time to hemostasis (TTH), 30-day major and minor complications, pain medication usage, and patient-reported outcomes. RESULTS A total of 204 patients at 13 sites were randomized to the device arm (100 patients; 369 access sites) or the MC arm (104 patients; 382 access sites). Baseline characteristics were similar between groups. Mean TTA, TPPT, TTDe, and TTH were substantially lower in the device arm (respective decreases of 54%, 54%, 52%, and 55%; all p < 0.0001). Opioid use was reduced by 58% (p ¼ 0.001). There were no major access site complications. Incidence of minor complications was 1.0% for the device arm and 2.4% for the MC arm (p ¼ 0.45). Patient satisfaction scores with duration of and comfort during bedrest were 63% and 36% higher in device group (both p < 0.0001). Satisfaction with bedrest pain was 25% higher (p ¼ 0.001) for the device overall, and 40% higher (p ¼ 0.002) for patients with a previous ablation. CONCLUSIONS Use of the closure device for multiple access ablation procedures resulted in significant reductions in TTA, TPPT, TTH, TTDe, and opioid use, with increased patient satisfaction and no increase in complications. (A Randomized, Multi-center Trial to Compare Cardiva Mid-Bore VVCS to Manual Compression in Closure of Multiple Femoral Venous Access Sites in 6 - 12 Fr Sheath Sizes [AMBULATE]; NCT03193021)
Read MoreJournal Articles: Aim of study is to report the feasibility and safety of AF ablation in an ambulatory setting (Alaska Heart and Vascular Institute). Metrics include procedural complications, postoperative utilization of hospital services, and emergency room utilization.
Read MoreChecklists: Helpful checklist for the care team when treating a patient with cardiac tamponade.
Read MoreChecklists: This Preoperative Checklist can be used by teams for all patients coming to the EP lab.
Read MoreOrganizations for QI: Library of completed/ongoing projects related to quality. Topics include Health and Well-Being, Person- and Family-Centered Care, Patient Safety, and Health IT.
Read MoreTools: The Toolkit for Using the Agency for Healthcare Research and Quality’s Quality Indicators (QI Toolkit) is a free and easy-to-use resource for hospitals planning to use the AHRQ Quality Indicators (QIs), including the Patient Safety Indicators (PSIs), to track and improve inpatient quality and patient safety. The QI Toolkit also may serve as a general guide to applying improvement methods in a hospital setting.
Read MoreEducation – Clinical: The Agency for Healthcare Research and Quality’s Team Strategies and Tools to Enhance Performance and Patient Safety. This is an evidence-based set of teamwork tools, aimed at optimizing patient outcomes by improving communication and teamwork skills among healthcare teams, including patients and family caregivers. Program includes welcome guides, curriculum materials, a diagnosis improvement course, patient videos, measurement tools, and training simulation tools.
Read MoreOrganizations for QI: The Agency for Healthcare Research and Quality Patient Safety Network is a national Web-based resource featuring the latest news and essential resources on patient safety. Supported by an extensive system for organizing the site’s patient safety information into categories and subcategories (i.e., a patient safety taxonomy) and robust Web architecture, AHRQ’s PSNet provides powerful searching and browsing capability, as well as the ability for diverse users to customize the site around their interests (My PSNet). AHRQ’s PSNet also includes WebM&M (Morbidity and Mortality Rounds on the Web) content, including Cases and Commentaries as well as Perspectives on Safety.
Read MoreOrganizations for QI: The Agency for Healthcare Research and Quality offers free tools to help prioritize concerns and maximize interactions between providers, patients, and families. Whether you see patients at a hospital, primary care office, or other setting, time is often limited and patients and family members who have prioritized their questions or concerns will experience the most meaningful, efficient visits. To help you and your patients get the most out of your time together, AHRQ offers these free resources that you can use with your team and share with your patients.
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