Improved Procedural Efficiency of Atrial Fibrillation Ablation Using a Dedicated Ablation Protocol and Lean Management
| Autor: | Vanessa Hoop, Benjamin Berte, Guido Schüpfer, Helmut Pürerfellner, Stefan Toggweiler, Dirk Lehnick, Mattias Duytschaever, Pasquale Santangeli, Richard Kobza |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Standardization Radiofrequency ablation medicine.medical_treatment 030204 cardiovascular system & hematology Lean manufacturing law.invention 03 medical and health sciences 0302 clinical medicine law Atrial Fibrillation medicine Humans 030212 general & internal medicine Prospective Studies Protocol (science) business.industry Atrial fibrillation medicine.disease Ablation Surgery Treatment Outcome Pulmonary Veins Catheter Ablation Procedure Duration business |
| Zdroj: | JACC. Clinical electrophysiology. 7(3) |
| ISSN: | 2405-5018 |
| Popis: | In this study the authors hypothesized that "Lean management" within a dedicated ablation protocol could standardize the pulmonary vein isolation (PVI) procedure and improve quality.There is a large variability in safety, effectiveness, and efficiency of PVI.This was a single-center prospective study with inclusion of all consecutive PVI procedures from 2017 to 2019. A 3-step intervention was introduced based on Lean management: step 1) simplification (CLOSE protocol); step 2) waste elimination (higher power shorter duration); and step 3) improved standardization (Lab Optimization Tool [LOT]). PVI was divided into steps that were tracked (in minutes) using LOT. Parameters were compared in 6-month intervals.Overall, 295 patients (146 patients with LOT) were analyzed. Step 1 reduced skin-to-skin procedure duration (2017: 119 ± 21 min vs. 2018: 77 ± 15 min; p 0.001) and variance (from 2018 to 2019 p = 0.024). Step 2 reduced the radiofrequency time (2017: 38 ± 6 min vs. 2018: 20 ± 3 min; p 0.001) and variance (from 2018 to 2019 p 0.001). Analysis of step 3 demonstrated that only 53% of the entire procedure length (143 ± 22 min) was used for treatment (skin-to-skin time 77 ± 16 min), the remaining time being devoted for setup (42 ± 12 min, 29%); left atrial access (16 ± 7 min, 12%); respiratory gating, left atrial map, and pseudo-circle annotation (10 ± 6 min, 7%); ablation (39 ± 10 min, 27%); and bilateral block validation (10 ± 8 min, 7%).Standardization of PVI using a dedicated ablation protocol and Lean management can help to reduce procedure and radiofrequency ablation duration and variance, and increase procedural efficiency without compromising safety. To improve health care utilization, increased efficiency should become an accepted goal in addition to procedural safety and effectiveness. |
| Databáze: | OpenAIRE |
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