Seven cardiology leaders shared small changes that have made a big difference in their programs' clinical, financial or operational outcomes.
Respondents shared their insights with Becker's via email June 17-23. Responses were lightly edited for clarity and length and are presented alphabetically.
William Blincoe, MD, chief of the Piedmont Heart Institute at Piedmont Healthcare in Atlanta.
Over the past three years, we have focused on improving percutaneous coronary intervention complications, including PCI bleeding, acute kidney injury and PCI mortality across six of our hospitals. As we have refined and applied multiple small changes each year that implement best practices and reduce care variation, we’ve seen improvement in clinical outcomes as well as positive financial impact. This has been a multidisciplinary effort led by cardiologists, clinical nurse improvement specialists and process improvement professionals.
Gopi Dandamudi, MD, medical director of the cardiovascular service line at CHI Franciscan in Tacoma, Wash.
In the past year, our cardiology program implemented same-day discharges for the vast majority of outpatients who underwent cardiac electrophysiology procedures, such as device implants and cardiac ablations, including atrial fibrillation ablations. On average, we perform eight such cases a day. The ability to safely discharge patients home rather than admit them for overnight observation led to positive patient outcomes, including reduced utilization of several hospital beds a day, improved patient satisfaction, as they prefer to recover at home, and reduced nosocomial infection risk.
Alex Jehle, MD, cardiology division chief of the International Heart Institute at Providence St. Patrick Hospital in Missoula, Mont.
In an effort to reduce our 30-day readmission rate for acute myocardial infarction, Providence St. Patrick Hospital implemented a new step in the post-discharge care continuum for all high-risk patients. All high-risk AMI patients now get a follow-up phone call two days after their discharge (in addition to an appointment with the patient’s cardiologist and primary care provider). The follow-up phone call is made by a cardiology clinic nurse on the interventional cardiology care team. These calls ensure issues with medications, home care or the procedure site are caught early to prevent further complications. The nurse is able to advise the patient, connect them with appropriate support services, or get them seen sooner by their cardiologist, as needed. Providence St. Patrick Hospital has seen a decrease in its AMI 30-day readmission rate since implementation of the follow-up phone calls.
Gerald Mancuso, MD, interventional cardiologist at St. Joseph Medical Center in Kansas City, Mo.
We have made a few small changes that have made a difference in our outcomes. The first was creating competitive cash pricing to allow patients with high-deductible or no insurance to receive the care they need at an affordable rate. At first we weren’t sure how the program would do, but it has been a huge success. We also moved our clinic to the hospital campus, allowing us to improve throughput from office appointment to radiology to cath lab, if needed. This allows us to provide the highest level of cardiology care.
Gregory Mishkel, MD, chief of cardiology, vice president of the cardiac service line and co-director of the Cardiovascular Institute at NorthShore University HealthSystem in Evanston, Ill.
The cardiology value analysis team is a collaborative effort between physicians, administration, clinicians and supply chain working toward the goal of providing the best patient outcomes while achieving optimum cost savings. At NorthShore, our cardiologists are highly engaged from the top down. On our committee, we have the division chief, three medical directors, and staff physicians routinely participate in the discussion. Due to our strong clinical integration embracing the dyad leadership model, we are nimble yet thoughtful when attempting to manage supply and implant expenses and outcomes. To help set up this structure for success, NorthShore’s administrative leadership encouraged physician contribution through collaborative goals, gain-sharing and asking people to do the right thing. Since making these changes, the results of our cardiology value analysis team have improved the amount saved per year by more than 20 percent, while NorthShore continues to be ranked among Becker’s top 100 hospitals nationwide
Lawrence Phillips, MD, cardiologist and medical director of outpatient cardiology at NYU Langone Health in New York City.
The cardiology division at NYU Langone Health was able to rapidly expand the use of video visits among faculty group practices at all sites during the COVID-19 pandemic. The integration between the telemedicine platform and our EMR system allowed for a seamless transition for our patients who did not have to leave their homes. We are now parlaying this success into uploading home device monitoring input such as blood pressure, daily weights, telemetry strips directly into the patient’s EMR. As the city continues to ramp up, my colleagues and I are prepared to continue to provide the best care for our patients.
Kim Allan Williams, Sr., MD, chief of cardiology and James B. Herrick professor at Rush University Medical Center in Chicago.
The largest change was redeploying all of cardiology into three areas during the upsurge of the COVID-19 pandemic in Illinois: medical intensive care, hospital medicine and telehealth cardiology. Rush University was built with the capacity to increase intensive care unit beds. We can transform wards, recovery rooms and endoscopy suites to create a maximum of 175 ICU beds at Rush, representing one-fourth of all ICU beds in Illinois. At maximum, we had 20 percent of the COVID-19 cases in Chicago at Rush. Our cardiology fellows and faculty switched on our medical ICU genes for nearly three months. Helping the hospitalists on the floor was less challenging, but working through the mechanisms for telehealth video and phone calls was a cultural shift and a new skill, affording folks with travel issues to have medical care. This practice will not leave with the end of the COVID-19 pandemic.