# Implementation trial of a coaching intervention to increase the use of transradial PCI

> **NIH VA I01** · VA PUGET SOUND HEALTHCARE SYSTEM · 2020 · —

## Abstract

Background: Of the two approaches to performing cardiac catheterization, cardiologists in the VA and US
overwhelmingly choose the approach that is known to be less comfortable and more dangerous to patients and
more costly to the health care system. The trans-radial approach (TRA), which is accessed via the wrist, is more
comfortable for patients; is much safer with half the rate of bleeding complications; and has lower overall costs
per episode of care than the trans-femoral approach (TFA), which is accessed via the groin. Yet, today in the
US TRA is used in only 25%-30% of cardiac catheterizations, and in the VA is used for just over 40% of
catheterizations. The reasons are that TFA predominates in the fellowships where cardiologists train to perform
catherizations; certain aspects of TRA, such as the anatomy of the radial artery, make it initially more
challenging than TFA; and there is a lack of training resources that address the needs for hands-on training,
feedback from an expert, and training of the team. This challenge is common to many medical and surgical
specialties where new, superior procedures emerge regularly. We previously developed and piloted a coaching
intervention to help cath labs become “TRA-dominant.” The coaching intervention was team-based, included
hands-on instruction with multiple opportunities for corrective feedback, and included a period of support and
accountability beyond a training session. The pilot test garnered positive reports from participating teams;
however, we do not know if it successfully increases use of TRA. Nor do we know if the coaching intervention
works the way we believe it does, through creating a non-punitive atmosphere where participants develop self-
efficacy with TRA, overcome the steep learning curve and become proficient. Finally, we do not know the
budget impact of the coaching intervention, and whether the costs may be offset by the savings from reduced
complications and associated costs.
Objectives: Our objective is to improve the VA’s ability to systematically implement new technically
challenging, evidence-based clinical procedures. We have 3 aims. Aim 1: Test the effectiveness of a
successfully-piloted, team-based coaching intervention in increasing implementation of radial-artery access
cardiac catheterization. Aim 2: Adapt, test and refine a conceptual model of team-based coaching for
implementation of new procedures based on the Promoting Action on Research Implementation in Health
Services framework. Aim 3: Perform a cost analysis of the coaching intervention and effects on costs per
episode of care.
Methods: We will use a stepped wedge design (i.e., graduated participation) to maximize validity and permit
formative evaluation of the coaching intervention to improve it in real time. The primary outcome will be change
in number of TRAs as a function of all catheterizations. Secondary outcomes will include improvements in
complications, and cost per catheterization. We will conduc...

## Key facts

- **NIH application ID:** 9655230
- **Project number:** 5I01HX002043-02
- **Recipient organization:** VA PUGET SOUND HEALTHCARE SYSTEM
- **Principal Investigator:** Christian D Helfrich
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2018-02-01 → 2021-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9655230

## Citation

> US National Institutes of Health, RePORTER application 9655230, Implementation trial of a coaching intervention to increase the use of transradial PCI (5I01HX002043-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9655230. Licensed CC0.

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