title: Prospective peer review of regional percutaneous interventional procedures: a tool for quality control and revalidation.
abstract: OBJECTIVE
  Current quality measures of percutaneous coronary intervention (PCI) procedures are based on the incidence of major adverse cardiac events (MACE). This crude marker ignores the many clinical nuances that make for sound decision making in PCI. We have established a prospective peer review audit tool to determine the quality of PCI within our cardiac network, which consists of five PCI hospitals serving a population of 1.4 million people in Sussex, UK.
  
  
  RESULTS
  Analysis of 10% of all PCI cases selected at random each month by a non-clinical audit manager is made by a rotating panel of two PCI operators and one cardiac surgeon. Each PCI case is assessed for anatomical suitability, lesion severity, strategic appropriateness and final outcome. Panel findings were reported back to the operator and the audit manager. A total of 326 cases were assessed by the review committee. Results were disseminated to individual operators. Coronary anatomy and lesion severity were considered appropriate for PCI in 94.2% and 96.0% of cases, respectively. Appropriateness of strategy was confirmed in 86.2% and the outcome considered satisfactory in 90.8%. A total of 242 subsequent cases were analysed to assess practice trends. This analysis demonstrated a statistically significant improvement in clinical decision making with respect to appropriateness of strategy (from 86.2% to 92.6%; p=0.004).
  
  
  CONCLUSIONS
  Prospective peer review of percutaneous coronary intervention cases by a rotating regional committee is valuable in ensuring procedural quality.
authors.affiliation: Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, Eastern Road, East Sussex, United Kingdom.
authors.forename: Lucy H J
authors.initials: LH
authors.lastname: Blows
authors.forename: Gaynor F
authors.initials: GF
authors.lastname: Dixon
authors.forename: Miles W H
authors.initials: MW
authors.lastname: Behan
authors.forename: Richard
authors.initials: R
authors.lastname: Allen
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Cohen
authors.forename: Katherine
authors.initials: K
authors.lastname: Dickinson
authors.forename: Stephen
authors.initials: S
authors.lastname: Furniss
authors.forename: Robert
authors.initials: R
authors.lastname: Hatrick
authors.forename: David
authors.initials: D
authors.lastname: Hildick-Smith
authors.forename: Stephen
authors.initials: S
authors.lastname: Holmberg
authors.forename: Jonathan A J
authors.initials: JA
authors.lastname: Hyde
authors.forename: Barry
authors.initials: B
authors.lastname: Kneale
authors.forename: Michael E
authors.initials: ME
authors.lastname: Lewis
authors.forename: Guy
authors.initials: G
authors.lastname: Lloyd
authors.forename: Nik R
authors.initials: NR
authors.lastname: Patel
authors.forename: Nicholas
authors.initials: N
authors.lastname: Pegge
authors.forename: Mark
authors.initials: M
authors.lastname: Signy
authors.forename: A Neil
authors.initials: AN
authors.lastname: Sulke
authors.forename: Uday
authors.initials: U
authors.lastname: Trivedi
authors.forename: David M
authors.initials: DM
authors.lastname: Walker
authors.forename: Adam J
authors.initials: AJ
authors.lastname: de Belder
mesh_terms: D002983:Clinical Competence; D003324:Coronary Artery Disease / Q000628:therapy*; D006801:Humans; D008485:Medical Audit / Q000379:methods*; D018579:Patient Selection; D018024:Peer Review, Health Care / Q000379:methods*; D062645:Percutaneous Coronary Intervention / Q000592:standards*; D011446:Prospective Studies; D011786:Quality Control; D011897:Random Allocation; D006113:United Kingdom