PCI Bleeding Reduction Initiative (2021 – 2025):
In October 2021, FHCQ launched COAP’s PCI Bleeding Reduction Initiative, a regional quality improvement initiative aimed at reducing intra- and post-procedural bleeding events in PCI.
Why do we need a regional initiative? While bleeding rates have somewhat decreased over the last few years, both across our region and across the country, risk adjusted bleeding rates are still higher amongst COAP hospitals than the national average. In 2020, the average COAP risk adjusted bleeding rate was 3.8%, compared with 2.2% nationally. Transfusions within 72 hours of PCI were 1.2% for COAP, compared to 0.7% nationally.
Why do we care? Evidence has shown that patients who experience a major bleeding event are three times more likely to die following PCI. Bleeding is also associated with higher costs of care.
Can we do better? Yes. Significant variation in bleeding rates between hospitals and amongst physicians indicate that we have room to improve. Hospital bleeding rates range from 0% – 6.5%; PCI Operator rates range from 0% – over 10% with no correlation to expected bleeding rates. There are evidence-based strategies to reduce bleeding risk, with variation in the use of these prevention strategies at both the hospital and physician levels.
What are the goals of COAP PCI Bleeding Reduction Initiative?
- Promote bleeding reduction best practices
- Increase rates of radial access for STEMI by 10% within 1 year
- Decrease routine use of GP llb/llla inhibitors by 5% within 1 year
- Reduce overall bleeding and transfusion rates
- Decrease rates of risk adjusted post-PCI bleeding by 10% within 1 year and 25% within 3 years
- Decrease post-PCI transfusion (within 72 hours) by 5% within 1 year
- Develop collaborative relationships between COAP hospitals and health systems
How did we do?
The PCI Bleeding Reduction Initiative wrapped up with 2024 year-end data. A final initiative review was presented on June 4th at COAP’s Annual Meeting and final PCI Operator reports were emailed in August 2025. While the need to further reduce variation between hospitals across our region remains, significant regional gains were made in reducing bleeding events post PCI. Please see a final initiative report below with progress on goals and links to best practice recommendations.