Hospital Referral Guidelines

Michigan Health and Safety Coalition Hospital Referral Guideline for Percutaneous Coronary Interventions*

• This volume-based guideline applies to all percutaneous coronary interventions (PCIs) performed by a hospital. (See appendix A for a list of codes.)

• All Michigan hospitals and operators performing PCIs should collect hospital and physician-specific risk-adjusted morbidity and mortality indicators, and contribute to a comprehensive database to be used for risk assessment, quality improvement, and benchmarking.

• All Michigan hospitals and operators performing PCIs should actively participate in designing and implementing a process improvement strategy.

• Hospitals should perform ideally a minimum 400 percutaneous coronary interventions per year and individual physicians should perform at least 75 percutaneous coronary interventions per year.

1. Physicians performing less than 75 PCIs per year should be encouraged to work with a high volume operator OR document clinical outcomes.
2. Performance of PCIs by low volume physicians (<75 PCIs per year) in hospitals performing less than 200 PCIs per year is not recommended and it should be discouraged.
3. Hospitals performing between 400 and 200 PCIs per year should be able to document satisfactory risk-adjusted mortality and morbidity outcomes and have in place particular structural characteristics and processes of care.

• Hospitals should require that their medical staff implement appropriateness criteria and use the criteria to conduct clinical case review of percutaneous coronary interventions.

* This is meant to be a guideline and not a standard of care; this guideline represents the best of an evidence-based review at this time; the guideline is based on the principles of CQI and is not intended to be used in a punitive manner; this guideline needs to be taken as a whole, and not have selected parts be used without considering the entire content of the guideline.