• 3,000 diagnostic caths; 1000 PCI
• 8 Interventionalists (5 Geisinger, 3 non-Geisinger)
• 35 Cardiologists
• 2 Hospitals

ProvenCare PCI Process Steps

1. Consent obtained
2. Pre-PCI GFR calculated
3. Bicarb. drip 1 hr pre, during & 6 hrs. after PCI (For GFR<60, CI for RF or CHF}
4. Patient on ASA or received ASA prior to PCI
5. Pt.rec'd clopidogrel 600mg 24hrs prior to or on table
6. Contrast allergy patient received pre-treatment prior to PCI
7. PCI performed for Class III indications
8. Discussion with additional cardiologist regarding reasons to proceed with Class 3 PCI
9. PCI contrast load exceeded 260 ml
10. Physician notified that contrast load exceeded 260 ml
11. Fermoral angiography performed during PCI
12. Multiple angulations utilized during PCI & f/u 2 wk. Exam documented (for cases of > 6 Gy)
13. A distal embolic protection device was used for SVG intervention
14. Contraindication of distal embolic protection device was documented
15. Immediate pre-PCI CK-MB level obtained
16. Final residual stenosis of stented lesion  < 10% (WITT or Cath. Report)
17. LV function assessed (unless done within last 1 year & no documented MI within last 1 year)
18. PCI report sent to PCP & referring physician
19. Creatinine level done day after PCI
20. If post-PCI creatinine exceeded pre-PCI creatinine by > 0.3 ml/dL, order. 48 post-PCI creat
21. Two post-PCI CK-MB levels were obtained
22. If 2nd post-PCI CK-MB level above nl, obtain CK-MB levels until CK & MB decline
23. Groin access site issue (Over 5 cm hematoma or painful hematoma or continuous bruit)
24. Vascular duplex ordered & results documented
25. Post-PCI day of procedure ECG obtained
26. Post-PCI day after ECG obtained
27. If post-PCI CK or MB > 5 x over pre-PCI level, patient placed on Beta Blocker
28. Post-PCI statin therapy
29. Post PCI ASA therapy (81 mg nonenteric coated)
30. Post-PCI clopidogrel therapy
31. Pt received secondary risk modification education {smoking,HTN,lipids,weight,exercise,DM}
32. Post-PCI ACE-I or ARB (if LVEF<40%)  
33. Post-PCI BMP ordered (for patients "new" to ACE-I)
34. HgbA1C obtained & if > 7%, result relayed to PCP
35. Post-procedural groin exam (within 12hrs of completed PCI) by clinician (mid-level/physician)
36. Prior to d/c f/u post-procedural groin exam by clinician (mid-level/physician)
37. Patient given instructions re: rec.duration of clopidogrel & risks of NSAID's
38. PCP & ref.physician given instructions re: rec.duration of clopidogrel & risks of NSAID's
39. Prior to d/c or w/in 72hrs post-d/c, appoint. made for 30 day f/u appoint. w/ a provider
40. NCDR data form will be initiated and completed