Page 149 - Simplicity is Key in CRT

ABSTRACT
Aims Cardiac resynchronization therapy (CRT) reduces mortality and morbidity in selected heart failure (HF) patients. Selection, implantation procedure and follow-up care of patients treated with CRT is complex and puts a significant burden on health care resources. As a result, a significant proportion of patients does not derive maximum benefit from CRT. The objectives of this study are to implement a structured clinical care pathway, reassuring structured referral and management of CRT patients, with the goal to derive maximal benefit for HF patients, as well as reducing health care resource burden.
Methods and results Leveraging the European Pathway Associations’ (EPA) care pathway methodology and the Lean Six Sigma methodology, the creation of the care pathway consisted of 3 phases. The first phase aimed at designing a “model best practice care pathway” by evaluating current practices, reviewing the literature and reaching consensus amongst multiple European CRT centres. In a second phase, the model pathway was translated into an “operational pathway” fitting with the specific needs and environment of the Maastricht University Medical Centre, after a thorough assessment of the current state of the care process and the local contributors’ input. In a final phase, the gaps between current state and the defined “operational pathway” were prioritised and improvements to the current care process were implemented in a continuous improvement process.
Conclusion This paper introduces a structured care pathway for HF patients treated with CRT and shows its implementation in a referral centre in the Netherlands.
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