Excellence in Cardiology
The pursuit of Excellence in Cardiology began with a multi-disciplinary team approach, consisting of representatives from Cardiology, Administration, Case Management, Medical Records, and Performance Improvement, along with a Physician Advisor. One of the first decisions made was to define “excellent performance”. Benchmarks researched included top performance according to HealthGrades, Centers for Medicare and Medicaid Services (CMS), Louisiana Hospital Association (LHA), and Thomson Reuters Top 100 Hospitals for Cardiology. This encouraged Thibodaux Regional Medical Center to set the bar high for this initiative.
HealthGrades, a nationally recognized health care consulting firm, was engaged to assist in clinical improvements focusing on cardiology outcomes. A detailed analysis of our cardiology outcomes was performed by a HealthGrades physician and engineer, and our performance was compared to best practices. This information was presented to the Cardiologists. Consensus was gained to focus on Heart Failure, Acute Myocardial Infarction, Percutaneous Angioplasties and Morbidity and Mortality Reviews. Teams were formed and developed guidelines and protocols based on best practices.
Examples of best practices implemented include the use of research based scoring tools such as the Mayo Score and Euro Score to assist the cardiologists in predicting a patients risk of mortality for coronary artery bypass graft (CABG) surgery versus an angioplasty. The results of the scoring tools lead to proactive treatment for moderate risk patients. The Heart Failure team has implemented a comprehensive educational program for patients with this chronic condition. The education covers diet instructions, weight management, pathophysiology and medication compliance. The team has also implemented post discharge phone calls to reinforce the teaching the patient received in the hospital, discuss follow up appointments and track the patient’s daily weight gain. These two interventions have made a tremendous impact on congestive heart failure (CHF) readmissions. The acute myocardial infarction (AMI) team developed a comprehensive physician order set under the direction of the cardiologist. Implementation and use of the order set has demonstrated a reduction of length of stay by one day. The successes we have seen thus far would not have been possible without the physician support and leadership to improve cardiology outcomes.