Fanelli Simone, Lanza Gianluca, Pratici Lorenzo, Benatti Giorgio, Vignali Luigi
Department of Economics and Management, University of Parma, Parma, 43125, Italy.
Division of Cardiology, Parma University Hospital, Parma, 43126, Italy.
BMC Health Serv Res. 2025 Jul 1;25(1):835. doi: 10.1186/s12913-025-13021-z.
Transcatheter Aortic Valve Implantation (TAVI) has emerged as a standard of care for patients suffering from symptomatic severe aortic stenosis. However, organisational analyses and investigations of this intervention's economic impact are lacking. This study aims to assess the potential impact of implementing a process designed to optimise the TAVI pathway regarding organisational, human, material, and economic resources.
The research is conducted through a case study. The methodology consisted of three stages: (1) mapping of the current TAVI pathway; (2) identification of the organisational changes necessary to optimise it and implementation of the identified action with a multidisciplinary teamwork; (3) simulations of the organisational and economic impact of the optimisation process. Data related to costs, revenues, and activities were provided by the hospital's Management Control office. The data analysed refer to a 12-month period. The TAVI pathway optimisation presented in this analysis is aligned with the best practices described in the BENCHMARK study.
The analysis of the current TAVI pathway in the studied hospital highlighted several critical points during the three phases of the course (pre-procedure, peri-procedure, and post-procedure). The working groups identified five areas for TAVI pathway improvement: patient and family education, coronary risk stratification, conduction disorders management, fast-track discharge eligibility, nurse-led rapid mobilisation and early discharge. The organisational solutions highlighted by the working groups outline a new TAVI pathway capable of generating a significant impact not only from an organisational point of view, but also from an economic point of view. We estimated that in our cohort TAVI optimisation would have saved approximately 112 ICCU bed-days and have led to an average cost reduction of about €3,900 per patient.
This study showed a process of optimisation of the TAVI pathway highlighting the positive impacts for patients, caregivers, healthcare workers, and the hospital. A Clinical Valve Coordinator may help to manage the procedural programme for individual patients while maintaining seamless communication with the Heart Team throughout the patient care journey, making the process even more streamlined. The case study analysed can be useful to all hospitals wishing to undertake processes aimed at improving the TAVI pathway.
经导管主动脉瓣植入术（TAVI）已成为有症状的严重主动脉瓣狭窄患者的标准治疗方法。然而，缺乏对该干预措施经济影响的组织分析和调查。本研究旨在评估实施旨在优化TAVI路径的组织、人力、物力和经济资源的流程的潜在影响。
本研究通过案例研究进行。方法包括三个阶段：（1）绘制当前TAVI路径；（2）确定优化该路径所需的组织变革，并通过多学科团队合作实施已确定的行动；（3）模拟优化过程的组织和经济影响。与成本、收入和活动相关的数据由医院管理控制办公室提供。分析的数据涉及12个月的时间段。本分析中提出的TAVI路径优化与BENCHMARK研究中描述的最佳实践一致。
对所研究医院当前TAVI路径的分析突出了该过程三个阶段（术前、术中和术后）的几个关键点。工作组确定了TAVI路径改进的五个领域：患者及家属教育、冠状动脉风险分层、传导障碍管理、快速出院资格、护士主导的快速活动和早期出院。工作组强调的组织解决方案勾勒出了一条新的TAVI路径，不仅能在组织层面产生重大影响，而且能在经济层面产生重大影响。我们估计，在我们的队列中，TAVI优化将节省约112个重症监护病房床位日，并使每位患者的平均成本降低约3900欧元。
本研究展示了TAVI路径的优化过程，突出了对患者、护理人员、医护人员和医院的积极影响。临床瓣膜协调员可以帮助管理个体患者的程序计划，同时在整个患者护理过程中与心脏团队保持无缝沟通，使过程更加简化。所分析的案例研究对所有希望开展旨在改善TAVI路径的过程的医院都可能有用。
