Transcatheter Heart Valve Postprocedural Care: Improving the Cardiac Rehabilitation Referral Process Before Discharge.

BACKGROUND

Cardiac rehabilitation (CR) referral following transcatheter heart valve procedures was suboptimal at a tertiary hospital in Northern California due to the absence of standardized internal processes.

PROJECT RATIONALE: The Society of Thoracic Surgeons and American College of Cardiology Transcatheter Valve Therapy Registry identify documentation of CR referral as a key quality metric. In Q4 2022, a quality-improvement initiative was launched to standardize referrals before discharge for patients undergoing transcatheter heart valve procedures.

PROJECT SUMMARY: A multidisciplinary team implemented a Plan-Do-Study-Act framework to modify workflow changes, including electronic health record optimization and bedside consult protocols. Over 7 quarters, documentation for CR referrals reached and sustained 100% across 530 patients. This initiative aligned institutional practices with evidence-based recommendations and American Association of Cardiovascular and Pulmonary Rehabilitation certification standards.

TAKE-HOME MESSAGE: Key barriers included staffing limitations and documentation inconsistencies, while facilitators included electronic health record optimization, multidisciplinary collaboration, and alignment with certification goals.