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

pci

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