Continuous improvement process for a high-risk population: catheter-directed thrombolytic infusions.

Catheter directed infusion of thrombolytics, though beneficial in restoring blood flow to an ischemic limb, remains a high-risk procedure requiring vigilant, coordinated care to prevent complications. A multidisciplinary team that included staff from all care settings and disciplines was formed. This team used a continuous improvement process to identify system problems, analyze work processes and develop tools to standardize and guide care. Because catheter-directed peripheral thrombolytic infusion is a low volume, high-risk procedure, data were collected concurrently over 4 years on all patients. Concurrent data collection identified problems as they occurred, allowing problem analysis and resolution to begin immediately. The outcomes measured included time to initiation of thrombolytic (goal was 30 minutes or less) and the incidence of bleeding complications. Data from 61 cases from November 2003 through November 2007 were analyzed. Although the 30-minute goal for the initiation of the thrombolytic infusion was met for some time periods, it was difficult to sustain and required continued communication and collaboration. The incidence of bleeding complications were within an expected range. Concurrent data collection with real-time problem solving in a team setting enhanced the delivery of safe, effective care to a high-risk, low-volume population.