INTRODUCING PHASE OF CARE MORTALITY ANALYSIS (POCMA) IN AN ITALIAN CARDIAC SURGERY CENTRE

Background and Aim: Phase of Care Mortality Analysis (POCMA) is a method for analysing deaths following cardiac surgery. The first aim is to identify the “seminal event” (SE), defined as the most proximal component in the sequence of care, starting a cascade of deterioration culminating in death. Secondly, the phase (time period in relation to the operation) where SE took place is ascertained. Last, the SE is classified as avoidable, when protocols/pathways are available to prevent or rescue and the system lacks the resources; unavoidable when there is a >50% likelihood that the SE could not have been prevented. Methods: Between January 2023 and September 2024, each case of in-hospital death following cardiac surgery was discussed at a dedicated monthly multi-disciplinary team (MDT) meeting, and classified according to POCMA. All healthcare providers involved in patient’s care were invited to participate. Results: Average number of MDT participants was 15 ±4,5, the majority of whom were cardiac surgeons. Patients: n=72; age 73 ±9 years; female n=33 (46%); EuroScore2 mean 21 ±19, median 11 (IQR 6). Only 26 (36%) of cases consisted of an isolated procedure, while the rest were combined. POCMA: Preoperatory 23,6% (judgement 70%); Intraoperative 15,3% (surgeon 33%, stroke 25%); Postop ICU 33% (respiratory care 40%, catastrophe 24%, ICU care 20%); Postop Ward 18% (catastrophe 66%). Avoidable SE n=38 (53%). Conclusions: This is the first reported experience with POCMA for internal audit in cardiac surgery in Italy. Issues emerged from MDT discussion, particularly avoidable SE, prompted initiatives aimed at quality improvement.