Introduction
The left heart catheterization (LHC) is a diagnostic and therapeutic intervention for CAD. In elective cases, patients with iodinated contrast allergy must complete a 13-hour steroid preparation (SP) to ensure safe administration of contrast during the procedure. This study explores inconsistencies in the timely administration of the SP for patients with documented contrast allergy undergoing elective LHC at a large academic medical center.
Methods
The LHC scheduling team and a cardiology resident were interviewed to better understand the burden of procedure delays. Quantitative data was obtained by reviewing charts of randomly selected patients with documented contrast allergy who underwent LHC between April 2022 and April 2024. Collected data include: date of LHC case request, date of LHC, time of SP initiation, time intervals between steroid doses, total number of steroid doses received, how SP was ordered (via the SP orderset or not), and LHC complications.
Results
The interview process yielded anecdotal data that LHC cancellations related to inadequate SP occur approximately once weekly on each of the four general cardiology services within our institution. Quantitative data revealed: 2/40 patients had LHC delayed by ≥1 day due to delayed SP; 12/40 patients received extra doses of steroid due to premature SP initiation; 8/40 SP orders were placed outside the SP orderset, resulting in variable dosing intervals. 3/40 patients with documented contrast allergy were not given SP and did not suffer any allergy-related complications.
Conclusions
Based on qualitative data, LHC delays related to inadequate SP occur approximately 1-4 times per month across all general cardiology services. Chart review, however, revealed a rate of 8.3%, but was limited by lack of documentation regarding procedure cancellations/delays, and possibly by our sampling process. Chart review revealed additional issues related to SP, including patients receiving extra steroid doses, mistimed steroid administration due to inconsistent SP orderset use, and occasional lack of SP administration for patients with contrast allergies, all of which represent areas for further investigation. Overall, inadequate or incorrect SP represents a patient safety and quality of care risk due to delayed patient care, allergy-related complications, and potential increased cost of care from cancellations/delayed procedures.
References
Mayo Foundation for Medical Education and Research. (2022, December 9). Prednisone and other corticosteroids: Balance the risks and Benefits. Mayo Clinic. https://www.mayoclinic.org/steroids/art-20045692
Change in steroid prep policy for patients receiving intravenous contrast material - effective 6/1/15: Radiology: Michigan medicine. Radiology. (2018, October 30). https://medicine.umich.edu/dept/radiology/news/archive/201506/change-steroid-prep-policy-patients-receiving-intravenous-contrast-material-effective-6115