Societies release updated skills for successful coronary interventions

March 18th, 2015

With more than 600,000 coronary interventions performed annually in the United States, the American College of Cardiology (ACC), the American Heart Association (AHA), and the Society for Cardiovascular Angiography and Interventions have released a document outlining the skills required to successfully perform coronary-based interventions. The newly released criteria are an update of the initial 2007 statement that was released, and is in response to the changing landscape of interventional cardiology.

The new report states that the criteria for evaluating clinical competency should reach beyond procedural volume and include an evaluation of risk-adjusted outcomes, periodic case reviews of patient selection, and other factors. Some of the clinical competency tenets listed are:

• Practicing good clinical decision-making;
• Providing optimal health care;
• Communicating clearly with patients about the risks and benefits of different procedures/interventions;
• Participating in continuous quality improvement efforts;
• Achieving and maintaining board certification; and
• Taking advantage of new tools

“We can’t be in every cath lab across the country, so one way to track competency is to define and measure key outcomes,” said Theodore A. Bass, MD, cardiovascular division chief and medical director of the University of Florida Shands Cardiovascular Center in Jacksonville, Fla., vice chair of the writing committee and president of the Society for Cardiovascular Angiography and Interventions. “In the past, we focused mostly on cognitive competency – what does someone know. But when we talk about procedurally based skills, competency also involves the actual performance of the procedure. Practicing physicians and hospitals need to assure that these skill sets and support systems are in place to facilitate delivering optimal care to our patients. It’s not simply a matter of how many are being done or whether we are putting the stent in the right place. It’s also about our ability to appropriately select patients and, once selected, deliver safe care with optimal outcomes.”

“It is the first cardiovascular competency statement to fully utilize the six domains structure promulgated by the Accreditation Council of Graduate Medical Education and adopted and endorsed by the American Board of Internal Medicine,” said John Gordon Harold, MD, MACC, president of the ACC and chair of the writing committee. “It goes beyond medical knowledge and procedure performance, to include the important issues of leading an interdisciplinary team, working in a complex system, communicating effectively, engaging in continuous quality improvement at the individual and system levels, adhering to evidence-based medicine, and demonstrating the highest levels of professionalism.”

“We hope this report will be used as a tool to help health care systems and physicians provide the best possible care to patients receiving coronary-based interventions,” Dr. Bass said. “It reflects a greater appreciation of the multiple dimensions shaping physician competency and provides much broader guidance in these areas.”

In addition to addressing clinical competency, the document also provides hospitals/facilities with PCI programs with recommendations, including:

• Meeting certain requirements;
• Closely monitoring clinical outcomes; and
• Providing quality assurance

With substantial advances in PCI, the report concludes that clinicians and hospitals must stay current through practice-based learning, training, and continuing education.