San Diego, California — Screening patients and educating referring primary care providers about appropriate use criteria resulted in a significant reduction in the incidence of "inappropriate" cardiac catheterizations performed at a rural hospital system, according to research to be presented next week at the SCAI 2015 Scientific Sessions, May 6-9.

After publication of the Appropriate Use Criteria for Diagnostic Catheterization in 2012 created ways to stratify cardiac catheterizations by their appropriateness, Talwinder Kahlon, MD, and a team of researchers at Geisinger Medical Center in Danville, Pa., launched a quality improvement program to identify and reduce the incidence of "inappropriate" cardiac catheterizations performed in the hospital system. Their initial analysis revealed that "inappropriate" cardiac catheterizations were 15 percent in patients referred by primary care physicians compared with 2 percent in patients referred by cardiologists.

Dr. Kahlon and colleagues developed the Appropriate Outpatient Cath Program (AOCP), an educational and screening program directed at primary care physicians. Patients referred for cardiac catheterization were screened at scheduling and again when they presented for their procedure. If screening indicated a potentially inappropriate case, the referring physician was contacted and asked to provide additional information. If the additional information justified the intervention, then the procedure was performed.

The researchers reviewed charts and calculated an appropriateness score for all cardiac catheterization patients referred by primary care physicians and randomly selected patients referred by cardiologists for 12 months before and 12 months after the AOCP. The incidence of inappropriate cardiac catheterizations among primary care physicians dropped to zero after the program.

"The intent of appropriate use criteria has been to assist practitioners in the delivery of care," said SCAI 2014-15 President Charles Chambers, MD, FSCAI. "This study demonstrates how AUC should be applied, namely to support clinicians’ efforts to improve quality.

Dr. Kahlon reports no potential conflicts of interest.

Dr. Kahlon will be available at the SCAI 2015 ePosters Bar to discuss the study "Successful Prevention of Inappropriate Cardiac Catheterizations by an Educational and Screening Program in a Rural Tertiary Cardiac Referral Center" on Friday, May 8, at 1:20 pm (Pacific Time).

SCAI’s Quality Improvement Toolkit (SCAI-QIT) includes a downloadable tool to support optimal coordination of patient care across providers. The tool, which addresses a range of topics concerning patient care before, during and after cardiac interventions, can be accessed here.