ACTION PROJECTS

Decreasing Complications After Ventricular Assist Device (VAD) Implant

Some heart failure patients may need a VAD to pump their blood. These devices can be associated with adverse events such as strokes, bleeding, or infection. Using quality improvement and research methodology we've decreased stroke rates by 50% and continue to focus on decreasing all VAD therapy complications.

ABCD’s of Reducing Stroke

What is the project focus?

ACTION has been working to reduce the frequency of stroke associated with pediatric VAD care ever since it was established in 2017. Previous studies showed stroke rates in children on VADs ranged from 10% to 29% depending on device. We introduced the ABC’s of Stroke Prevention to standardize care and ultimately improve outcomes. These ABCs have dramatically decreased the rate of stroke to <12% in Berlin Heart and <5% in implantable VADs. In 2020, we organized discussion & data or commonly known as morbidity and Mortality review of all stroke events that occur in the network. We are now identifying the root causes of every stroke that occurs at every single ACTION site as a team.

To learn more, see the Project Charter. 

Who is impacted?

Heart failure patients implanted with a ventricular assist devices.

What are we doing to help?

  • standardized anticoagulation protocol
  • standardized blood pressure management protocol
  • communication checklist for the bedside
  • standard presentation format for every stroke that occurs in network

What data do we have?

Aggregate network stroke data, updated July 2022. We sustained our initial efforts, see graphs below. New interventions coming soon.

Percent of patients who had a stroke with all devices (by first implant date)
Percent of patients who had a stroke with paracorporeal continuous flow device (by first implant date)
Percent of patients who had a stroke with intracorporeal continuous flow device (by first implant date)
Percent of patients who had a stroke with paracorporeal pulsatile flow devices (by first implant date)

VAD Discharge & De-Escalation of Care

What is the project focus?

For over a year, we have focused on improving discharge rates for VAD patients. We found that only about 50% of pediatric patients with dischargeable VADs actually are discharged from the hospital on their VAD. We also found that 1/3 of VAD patients undergo transplant prior to discharge from the hospital, in some cases these patients may not be as strong as possible before transplant. The scope of our project has now expanded to better understand factors influencing transplant listing, specifically de-escalation of care. We are also focused on improving communication regarding the milestones of post-operative care.

Who is impacted?

Heart failure patients implanted with ventricular assist devices. 

What are we doing to help?

HeartMate 3TMLVAD Patient Journey (English)
HeartMate 3TMLVAD Viaje del Paciente (Español)
HVADTM System Patient Journey (English)
Berlin Heart EXCOR® Patient Journey (English)
Berlin Heart EXCOR® Viaje del Paciente (Español)
ACTION VAD Flight Plan

What data do we have?

22 HeartMate 3TM and Berlin Heart patients have been entered in the De-Escalation Project. 8 of the 22 patients achieved de-escalation before either 1. activation for transplant, 2. completing hospital course to discharge, or 3. receiving their transplant. Achieving de-escalation means the patient was extubated, off inotropes, ambulating or age equivalent, and stated feeds. This project is designed to encourage patient stability prior to transplant. It is also an effort to encourage discharge of patients on HeartMate 3TM.

The data above was taken from our interactive Power BI report, which represents real time data collection and not finalized cases. 
Percent of Elgible Patients Discharged (HVAD & HM3)

De-Escalation & Discharge Committee cohort data, updated April 2022.