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Table 4 Barriers and Facilitators to the implementation of AUC

From: Assessment of barriers and facilitators in the implementation of appropriate use criteria for elective percutaneous coronary interventions: a qualitative study

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