Table 4 Barriers and Facilitators to the implementation of AUC
Theme | High Sites | Medium Sites | Low Sites |
|---|---|---|---|
Facilitators to the Implementation of AUC | |||
Relationships and Competition | Described strong collaborative environments | Described good environments | Described “friendly relationships” |
Responsibility for Pre-Procedural Processes | Interventional cardiologists were often directly involved in the pre-procedural review of each case | Variety of processes | Leaned towards the referring cardiologist having the responsibility for the PCI appropriateness |
Documentation of Referral Reviews | Established ways to ensure documentation, usually with the interventional cardiologists taking the responsibility for such documentation. | 1/2 had formal documentation processes | Obligation of the referring physician to work the patient up appropriately |
Pressures (External/Internal) and Education | Education was used to improve appropriateness of PCIs within multiple organizations. Educating patients -Educating the internal staff of the AUC | ||
Peer Review Process | Developed their own peer review processes to ensure appropriateness, team communication, and proper documentation | None of the medium performing sites described any type of peer-review processes. | None of the low sites mentioned peer review processes |
Barriers to the Implementation of AUC | |||
Appropriate Referrals | Most referrals from inside organization | Variety of referrals | More referrals from providers outside their organization compared to medium and high performing sites |
Documentation of Referral Reviews | See above for facilitator | See above for facilitator | Lack of staff or other staff responsible extracting data from medical record, and separate medical records systems |
Pressures (External/Internal) and Education | Patient pressure -patient satisfaction was very important Difficulty to get outside referring physicians up to speed with AUC | ||