LAUSR

Plan-Do-Study-Act is a model for improvement that provides a framework for developing, testing and implementing changes leading to improvement. It is also known as the Plan-Do-Check-Act cycle or Deming circle, named after its inventorWilliam Edwards Deming, a management consultant in the 1950s. The article by Van Steenbergen et al. in this issue of the Netherlands Heart Journal is a perfect example of how to set up (Plan) and implement an improvement process in the Cardiology Department (Do), how to evaluate this process (Study) and how to decide whether this improvement process will to be implemented (Act) [1]. The authors designed an outcomebased quality improvement strategy for patients who had been referred for transcatheter aortic valve replacement (TAVR) to the Catharina Hospital in Eindhoven, the Netherlands, by making changes to the selection process, pre-procedural workup, TAVR procedure and aftercare process. From November 2015 onwards, all referred patients were seen pre-procedurally at a dedicated outpatient clinic, after which all of them underwent a dedicated computed tomography (CT) scan analysis and geriatric evaluation. Furthermore, from that moment on, all complex TAVR procedures were carried out by two dedicated operators, preferably under local anaesthesia, and the results were evaluated monthly. This study cohort of 532 patients was compared with a historical pre-quality strategy cohort (inclusion from January 2013 till October 2015) from the same hospital and with cohorts of TAVR patients registered in the Netherlands Heart Registration (NHR) from all other Dutch TAVR centres during the same study pe-