A multidisciplinary team approach, a program for coronary artery bypass surgery patients and professional development of critical care nursing staff are among the initiatives hospitals and health systems have implemented to improve clinical outcomes in heart care.
For a closer look at these efforts, Becker’s Hospital Review asked organizations on Healthgrades’ list of top hospitals for cardiac care to share how they are working to improve clinical outcomes in heart bypass surgery, coronary interventional procedures, heart attack treatment, heart failure treatment and/or heart valve surgery. Their responses are presented below, alphabetically.
Editor’s note: Responses were lightly edited for length and clarity.
Sabet Hashim, MD. Chair of Cardiac Surgery and Co-Physician in Chief of the Hartford (Conn.) HealthCare Heart & Vascular Institute: About two years ago, the heart and vascular institute developed a new program called Enhanced Recovery After Cardiac Surgery for coronary artery bypass surgery patients. The goals were clear: reduce narcotic use, reduce the rate of postoperative atrial fibrillation, reduce a patient’s length of stay and improve patient satisfaction. The initiative was organized by cardiac surgeons, cardiac anesthesiologists, pharmacists, advanced practitioners and nurses — a multidisciplinary team that always kept the patient in mind. Together, we implemented an algorithm that defined, on a day-to-day basis, the milestones to be achieved with documentation of any deviation from the expected care. We focused on preventing atrial fibrillation, elimination of fluid retention and reduction of postoperative pain.
For pain management, we used a new combination that includes low-dose narcotics with oral Tylenol and anti-inflammatory agents. The program has been incredibly successful in reducing narcotic use while also improving patient satisfaction. Our data was presented at the Society of Thoracic Surgeons’ annual national meeting and has shown other success, including a significant reduction in the rate of postoperative atrial fibrillation, intensive care unit length of stay, as well as the total postoperative length of stay.
Dean Kereiakes, MD. Medical Director of the Christ Hospital Heart and Vascular Center (Cincinnati): The care here in heart and vascular has been driven by clinical research. Clinical research drives quality, and excellence in patient care at the Christ Hospital through innovation and technology. We create programs for patient care around specific disease entities like heart failure, women’s heart health, complex coronary intervention, and we design those programs with a credible physician champion, enable them with infrastructure support, meaning a clinical coordinator/navigator and dedicated advanced practice providers who are disease-focused. Each of those miniature Centers for Excellence are then matrixed with the Lindner Research Center at the Christ Hospital for access to leading-edge technologies.
So when we decided to focus on women’s heart health, we hired Odayme Quesada, MD, an established clinical researcher from the Barbra Streisand Women’s Heart Center at the Smidt Heart Institute at Cedars-Sinai in Los Angeles, and we enabled her with a superstar nurse practitioner, specialized scheduler, and we’ve already got multiple clinical research trials on microvascular disfunction, microvascular angina, and Dr. Quesada has a $1 million National Institutes of Health grant.
Also, to stabilize critical care nursing units, like cardiovascular intensive care unit, cardiovascular operating room and catheterization labs, we raised philanthropic gifts to underwrite educational and professional development of our critical care nursing staff to underwrite their credentialing, certification, professional society membership, and created a clinical ladder based on those objectives. If they satisfy certain objectives, they get a salary bonus. So we invest in and incentivize our nursing staff. Our turnover rate in the cardiovascular ICU was between 30 percent and 35 percent. Now, for three years in a row, we have a documented turnover rate well below the national average at 10 percent or less. That philanthropic investment resulted in a huge increase in quality. When you retain these people, and they get smarter and better, everybody wins.
Farhan Khawaja, MD. Interventional Cardiologist and President of Orlando (Fla.) Health Heart and Vascular Institute: One quality initiative that we performed over the last year was a total care redesign of our heart failure services. To strengthen our existing initiatives and add new strategies to reduce readmission rates, we set out to design a more comprehensive program that addresses these patients throughout the care continuum. We now have a system of seamless transition from the hospital to home that includes rapid follow-up in our advanced practice provider heart failure clinics, remote patient monitoring, social work, pharmacy and multiple other resources available to our patients.
Srinivas Murali, MD. Chair of the Allegheny Health Network Department of Cardiovascular Medicine and Stephen Bailey, MD. Director of Cardiac Surgery at Allegheny General Hospital (Pittsburgh): At Allegheny General Hospital, we’ve implemented a multidisciplinary team approach to ensure the best patient-centered, evidence-based clinical practice throughout all programs under the AHN Cardiovascular Institute. We mobilize highly specialized clinicians from across all cardiovascular health disciplines to design effective care pathways for patients living with complex heart and vascular diseases.
To further sustain this success, we also measure our performance against a rigorous quality assessment program that allows for outcomes tracking in real time. The integrated program offers full visibility into quality metrics, which in turn, allows our teams to identify areas of success and opportunities for improvement and innovation. By leveraging our multidisciplinary heart specialist teams and informed decision-making, we’re able to drive high-quality clinical outcomes and an exceptional overall experience for our cardiac patients.
Oana Madalina Petrescu, MD. Cardiologist with the Swedish Heart and Vascular Institute (Seattle): One key initiative of the Swedish Heart and Vascular Institute this year is our quality care initiative. It is part of the greater effort to create meaningful impact at the patient level in order to improve outcomes in patients with valvular heart disease and reduce cost of care. Our efforts in this space include artificial intelligence and smart data capture; standardization of echo capture and reporting; education of patients, primary physicians and cardiologists; dedicated coordinator to discuss options with patients and physicians; and heart team evaluation of patients, discussing which patients are for medical therapy, catheter therapy, surgery or palliative care. CardioCare enables the right care of the right patient at the right time.
This large comprehensive evaluation provided visibility of our own echo lab metrics and clinical data across the entire Swedish system. This included quantified analysis of protocol measurement adherence for aortic stenosis and sonographer compliance. These metrics are predictors for accurate and early diagnosis of aortic stenosis.
Stuart Seides, MD. Physician Executive Director of MedStar Heart & Vascular Institute (Washington, D.C.): MedStar Heart & Vascular Institute at MedStar Washington Hospital Center cared for the largest and sickest group of COVID-19 patients in the region this past spring. Many other heart transplant centers on the East Coast were severely curtailing or ending operations to accommodate COVID patients, but we knew many patients in need of cardiac transplantation would deteriorate or die if our teams didn’t maintain care of these patients. Our advanced heart failure and transplant teams doubled our usual number of transplants, even as many of our MHVI physicians were being redeployed to help care for COVID patients.
Maulik Shah, MD. Executive Director of the Cardiovascular Center of Excellence at HonorHealth (Scottsdale, Ariz.): At HonorHealth, our goal is to ensure that every single patient receives the highest quality of care. Within the last year, we’ve been able to advance our approach to post-heart surgery care to successfully reduce hospital readmissions. First, we aligned all physicians within the HonorHealth Cardiovascular Center of Excellence to make this measure a main area of focus that we, as providers, could all commit to improve. Second, our heart surgeons and cardiologists made a pledge to follow up with all patients within three to seven days after surgery to address post-surgery questions or concerns more promptly. Finally, to provide a continued focus on follow-up care, we incorporated telehealth technologies as part of our post-surgery follow-up process. By doing this early on, it helped our care team get ahead of the curve with regards to telemedicine prior to the COVID-19 pandemic.
Hal Skopicki, MD. Chief of Cardiology and Co-director of the Stony Brook (N.Y.) University Heart Institute: We are initiating a transitional care program with telemonitoring that does not require a physical follow-up appointment to uptitrate guideline-directed medical therapy in patients discharged after an acute myocardial infarction.
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