Focus on cardiology care in Iowa's Corridor

To improve heart care in the Corridor, area hospitals have worked to improve their own efficiency.

“One-seventh of our national budget is attributed to health care costs, and the United States has some of the highest costs in the world,” said Cam Campbell, Cedar Rapids Heart Center, and medical director of Mercy Medical Center's Cardiovascular Services in Cedar Rapids.

“As a physician, I rely on the hospital to manage the processes. As a physician, the hospital relies on me to provide clinical input,” Campbell said.

He said this philosophy has helped Mercy achieve efficiencies and improve patient satisfaction scores.

A partnership between Mercy Medical Center and Cedar Rapids Heart Center also has allowed heart center cardiologists privileges at Mercy and St Luke's Hospital, 24 hours a day.

With 20 employees in the invasive department and 15 in the non-invasive department, the past three years have been spent on cross-training, said Eric Voss, Mercy's senior director of cardiovascular and pulmonary services.

“In an outpatient department, for example, there might be holes in certain schedules,” Voss said. “So how can we use those staff members in another area to gain efficiency and keep everyone busy all the time? Then you don't need more staff.”

Certain roles don't participate in cross-training, such as electrophysiology nurses and radiation technicians, due to the specificity of their tasks. But other positions allow the hospital to combine staffs to find gains in efficiency.

SHARING

St. Luke's Hospital also shares resources when possible. It purposely placed the heart failure clinic on the fifth floor, for example,where respiratory and pulmonary clinics, pediatric cardiology and other facilities also are located.

Recent upgrades to Mercy's cath lab have included new imaging machines.

“With this new technology, we can see things better and better identify problems,” Campbell explained.

Through changes like these, Mercy has been able to cut costs by approximately 15.7 percent in the cath lab, he said.

The department also has installed new echo equipment in the past year to more quickly examine heart chamber size, pumping function and valve function, among other processes.

Voss said the department's cost per case is down about $2,000 because of some of these changes.

“The national average is a little over $7,000, and Dr. Campbell's group came in at a little over $5,000 per case this last quarter,” Voss said.

Electronic documentation also has made a difference.

“It can be debatable as to whether it increases your efficiency, but it decreases errors,” Voss noted.

EASIER, FASTER

In the St. Luke's cardiology department, inserting catheters through radial arteries in the arm versus in the groin has made the process faster for medical staff, and improved recovery time for patients.

“With our cardiac caths, which are patients coming in for diagnostic angiography so we can look at their coronary arteries, this method has been a lot easier and faster,” said Peg Bradke, director of heart care services at St. Luke's.

When a catheter was inserted in the groin, the patient had to lay flat for a long period of time and had to be careful about movement for a few days after the procedure. They also were at risk of bleeding or having a hematoma.

“Using the radial artery is quicker for the doctor, and recovery time is much better. Patients can go back to work probably sooner than they can when it was originally done in the groin,” Bradke said.

“Back in 2005, when we looked at our data, we realized we had a re-admission rate of close to 25 percent,” she continued. “That means that one-fourth of our patients were going home with a heart failure diagnosis and then coming back within 30 days.”

To give these patients the attention they needed without slowing down the cardiovascular department, St. Luke's created a heart failure program eight years ago. A team of three professionals deal specifically with heart failure patients to improve care and decrease readmission rates.

“These patients are very complex,” Bradke said.

She noted they often have other health problems that triggered heart failure, such as diabetes and lung or renal problems, which makes their care more involved.

The first step in creating this program was offering an outpatient heart-failure class. A lot of the information shared with patients during hospitalization was forgotten or not put into practice once the patient returned home, Bradke said.

REMINDERS

“When they're in the hospital, and you're trying to teach them all these life style changes, it can be overwhelming,” Clinical Director Sue Halter said.

In the four-hour weekend classes, patients can come back after they feel better and spend time with the cardiac rehab nurse and dietitians.

Although the classes were helpful, St. Luke's wasn't seeing any major reductions in readmission rates. So in 2007 the cardiovascular department implemented the teach-back method, in conjunction with the Institute for Healthcare Improvement in Cambridge, Mass.

The method involves asking open-ended questions and requesting that the patient show or explain what he or she has just learned.

To further improve the program St. Luke's in 2011 implemented a three- to five-day follow-up visit after discharge for all heart-failure patients. The department now sees a readmission rate of closer to 17 percent.

There are approximately 250 patients participating at any one time, and Halter estimated that the heart failure nurse talks to between 30 and 40 patients a day.

“With technology for heart-failure care, there haven't been any major advances in the last 10 years,” Halter said. “The most important things continue to be close contact with the patient, education, and monitoring.”