Proposed Topic (Most preferred): :
Clinical Safety and Quality Service II (Projects aiming to enhance clinical safety and outcomes, clinical governance / risk management)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Authors (including presenting author) :
Lau KY(1), Ma TSK(1), Lau FM(1), Leung AMS(1), Tai PWH(1), Lai PCK(1), Chan WK(1), Ngo OL(1), Yu KY(1), Ngai CW(1)
Affiliation :
(1) Adult Intensive Care Unit, Queen Mary Hospital
Introduction :
Percutaneous Catheter-based Ventricular Assist Device (cVAD) is a technology utilized to support patients in cardiogenic shock. Since 2021, the adult intensive care unit (ICU) of a university-affiliated hospital has provided cVAD service through a collaborative model with cardiology division. This paper presents the essential processes in service development with an emphasis on efficiency, sustainability, and patient safety.
Objectives :
1. To establish a model that supports patients requiring cVAD service in a tertiary hospital.
2. To strengthen cross-departmental collaboration in cardiology care provision along the patient journey.
3. To empower healthcare professionals with advance circulatory support strategies.
Methodology :
The service was developed using the double diamond process model. In phase one, the cardiology team identified the service gap. In phase two, the cardiology team and ICU team jointly defined possible clinical scenarios and explored the limitations in service provision through the existing evidence base. In phase three, multiple care pathways were formulated to ensure seamless care delivery once a patient was put on cVAD. In phase four, care provision models were co-piloted in a controlled environment with the aim to lift any onerous and redundant process for subsequent evaluation in real-world practice. Staff was empowered through a structured educational program incorporating a quality assurance framework.
Result & Outcome :
25 doctors and 84 nurses from three departments received the interdisciplinary cVAD training in the 2021– 2023 period. Between July 2021 and October 2023, 29 patients received cVAD under the joint care programme. 23 were referred by the cardiology team due to either cardiogenic shock or failure to wean from cVAD following percutaneous coronary interventions. 6 required cVAD after ICU admission due to delayed cardiac events or requiring left ventricular unloading for venoarterial extracorporeal membrane oxygenation). The mean duration on cVAD was 4.72 ± 3.74 days, and the ICU length of stay was 9 ± 12 days. 30-day all-cause mortality was 34.5%, and the survival to explant was 75.9% for this cohort. No patient developed severe or life-threatening bleeding. One patient developed a peripheral vascular complication requiring early removal of the device. These results were better than those reported in the international community.
Implementing the service model has improved collaboration between the cardiology and intensive care teams, resulting in a more coordinated management of patients requiring cVAD. Regular training can ensure staff competency as the service evolves and adapts to advancements in cardiac care.
