SUCCESS STORY
Increasing TAVI procedures
The Impact of the TAVI Pathway Optimization Project
Key facts
partner
Pisa University Hospital Pisa, Italy
20%
increase in TAVI procedures
€1.92 million
potential revenue increase
1 day
reduced LOS per TAVI patient
Overview
Heart centers in Italy have seen demand for transcatheter aortic valve implantation (TAVI) procedures grow by 21% over the last seven years. The Tuscany region sees 30% more TAVI patients than the rest of Italy due partly to an aging population and increased adoption.
At the same time, heart centers are dealing with scarce resources and cost sensitivity. Therefore, they must maximize operational efficiency and productivity to ensure patients have timely access to this procedure.
A heart center must systematically analyze its operations to achieve TAVI operational excellence. This requires visibility into current performance, knowledge of TAVI best practices and sustainable implementation, and a mindset of continuous improvement. By optimizing the TAVI pathway, heart centers can unleash greater productivity while maintaining or improving the quality of care.
The hospital & heart centre
In Italy, the Cardiac Catheterization Laboratory (Cath Lab) of Pisa University Hospital (Azienda Ospedaliero Universitaria Pisana, or AOUP) is a high-volume TAVI procedure center.
It is one of the most important Italian centers for Cath Lab procedures, with considerable demand from local patients and 202 TAVI implanted in 2021. One of the center’s objectives is to set up a network with the leading heart hospitals in the North-West Tuscany area and strengthen its position as a hub center of reference for TAVI procedures.
Medtronic has worked in a strategic partnership with the hospital for several years. For this project, the hospital enlisted IHS to help them increase the number of TAVI procedures per year to help meet demand while ensuring good clinical outcomes and a positive patient experience, all while cost-effectively improving resources and capacity utilization.
1
Planning and scheduling issues
The nurses' schedules were not conducive to performing TAVI procedures, especially in the afternoon when only three nurses were present to cover two different Cath Labs - the same amount needed to cover a single TAVI procedure. In addition, planning was not optimized.
The nurses’ day-to-day activities, delayed start times, and lengthy turnover between procedures meant the hospital could only perform an average of two TAVI procedures per day.
2
Procedural issues
The scheduling activity pattern and the strong impact of emergency procedures - at least 30% of daily procedures - did not optimize the efficiency of the Cath Labs and exacerbated the planning and scheduling issues mentioned above.
3
Post-procedural issues
The high bed occupancy rate during the year, with weekly peaks over 85%, and a slightly higher LoS than the top-performing European centers were mainly due to the following: 1. Patient hospitalization the day before the procedure 2. Several pre-procedure blood tests often lead to longer hospital stays for the patient
In addition, the Cath Lab Unit of Pisa University Hospital required additional ward beds to support current structural heart procedural volumes (6 beds). Varied demand throughout the year, a low ICU bed occupation rate, and a lack of Cardiology ICU and sub-ICU beds reserved for Interventional Cardiology/Structural Heart procedures meant the hospital needed to utilize post-surgical ICU beds to meet increased demand, using more resources and costing more money.
The hospital engaged Medtronic IHS to implement the TAVI Pathway Optimization Project with these objectives in mind:
- Increase the number of daily/weekly TAVI procedures without increasing resources
- Define a referral network model, structuring itself to be able to respond to the growing demand for TAVI Procedures and to set up a network with the leading heart hospitals in Northern West area of Tuscany by looking at the following critical aspects:
- Share patient’s evaluation and clinical processes with spoke centers
- Facilitate a real-time image-sharing process with other centers
- Set up a structured heart team to share clinical information during pre-care and follow-up phases
- Improve the interaction and attendance of spoke centers during the procedure
- Train spoke centers on the latest procedural techniques and device updates
- Improve the speed of patient care and hospitalization (slot availability)
The Medtronic IHS team worked together with multiple stakeholders in the hospital team, including Cath Lab clinicians, assistants, nurses, cardiologists, and management. The goal was to evaluate the Cath Labs’ performance and inefficiency drivers, to scan other related services (i.e., outpatient clinic, ward, radiology service), and list areas of improvement along the entire patient pathway (from referral to follow-up). The IHS team also needed to identify the main challenges for the center to cover spoke centers’ needs in a referral network model.
Working together, we successfully:
The hospital successfully increased the total annual number of TAVI procedures without adding resources or infrastructure, but increasing the efficiency of each phase of the patient journey. The impact was significant:
In addition, patients are experiencing a smoother admission process, less time spent anxiously awaiting the procedure during the pre-procedure day, and shorter hospital stays — with comparable clinical outcomes and complication rates. Furthermore, because of the increase in TAVI procedures, the hospital is on its way to achieving its goal of becoming a reference center in the region.
What the hospital is saying:
Due to Medtronic IHS’ expertise and structured and multidisciplinary approach, we were able to increase production levels and realize our growth ambitions.”— Head of Interventional Cardiologists
The data collection and process analysis are not competencies of physicians: we need to rely on specialized consultants. The consultant’s point of view may highlight criticalities that we cannot see (or do not want to see).”— Interventional Cardiologist & Project Manager
Medtronic IHS team did a highly valuable and outstanding job and surpassed expectations.”— Chief Administrative Officer
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