An All-Star Team Approach to Cardiac Care at Vassar Brothers Medical Center

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1 AirStrip Case Study An All-Star Team Approach to Cardiac Care at Vassar Brothers Medical Center Through sophisticated technology, a team approach to care and a new model centered on uniform adoption of best practices to enhance overall outcomes, cardiac specialists at Vassar Brothers Medical Center provide comprehensive cardiac services to patients throughout the Hudson Valley. At Vassar Brothers Medical Center, a Health Quest hospital, specialists in cardiology and cardiac surgery unite to provide surgical and noninvasive treatment options to patients of all ages. Acknowledging the hospital s superior outcomes, Healthgrades has awarded Vassar Brothers Medical Center its Cardiac Care Excellence Award. The hospital has ranked among the top 5 percent in the nation for overall cardiac services for three consecutive years ( ), is the recipient of Healthgrades Cardiac Surgery Excellence Award for six consecutive years ( ) and has ranked among the top 5 percent in the nation for cardiac surgery for five consecutive years ( ). Daniel O Dea, MD, FACC, Chief of Cardiology at Vassar Brothers Medical Center and President of the Heart Center in Poughkeepsie, NY, says these honors are a source of pride for Health Quest physicians and each provider strives to maintain award-winning standards of care. We work hard to achieve this recognition, Dr. O Dea says. It takes a tremendous amount of institutional pride and a high level of diligence on the part of the physicians and staff involved. Each provider has to want to do the right thing for each patient and sustain that drive. To use

2 a gardening metaphor, it takes a bit of watering to ensure the gains we ve achieved grow rather than wilt. For any program to be successful, you must have a good relationship between cardiologists and the cardiothoracic surgery team, which we ve maintained at Vassar Brothers Medical Center and with cardiology groups in the area. That s what has sustained our program s success. Mohan R. Sarabu, MD, FACS, FACC, Chief of Cardiothoracic Surgery at Vassar Brothers Medical Center WIRELESS, IN-TRANSIT COMMUNICATION One of the seeds sown in the hospital s cardiac program is faster delivery of care brought about by technology investments. Among the more innovative technological additions to Vassar Brothers Medical Center s cardiac treatment battery is a device used before patients even set foot on its premises. Equipped on local ambulances, AirStrip ONE Cardiology is a wireless system that allows emergency medical technicians (EMTs) to send electrocardiogram (EKG) readings to the emergency room from the field. Previously, EKG readings were available only at patients bedsides, so specialists tasked with performing balloon angioplasty had to wait until after patients were delivered to the hospital to obtain the results and accordingly prepare for the procedure. An Eye for Research At any given time, estimates Daniel O Dea, MD, FACC, Chief of Cardiology at Vassar Brothers Medical Center and President of the Heart Center in Poughkeepsie, NY, Vassar Brothers Medical Center has five or six open and enrolling clinical trials examining new technologies, such as defibrillators, pacemakers and stents, as well as novel treatments for arrhythmia, heart attacks and heightened cholesterol. Each year, hundreds of patients enroll in trials conducted in conjunction with leading research institutions, such as the Cleveland Clinic Lerner Research Institute, Duke Clinical Research Institute, Harvard Clinical Research Institute and the Mayo Clinic. CHOLESTEROL CONTROL WITHOUT STATINS Patients using statins may suffer from slightly higher risk for Type 2 diabetes, liver injury, memory loss and muscle damage, according to the U.S. Food and Drug Administration. These patients may benefit from two currently ongoing clinical trials Accelerate and Odyssey that study alternatives for patients with high cholesterol who can t tolerate side effects caused by statin medications. These medications hold promise to provide patients who are intolerant of statin therapy with an alternative that hopefully translates into lower cholesterol levels and reduces the incidence of heart attacks, strokes and death, says Dr. O Dea. From wherever EMTs take care of patients in the field or in the ambulance EKG 2

3 electrodes attached to the patient send this information to the hospital, says Dr. O Dea. Patients may be 15 to 20 minutes away, but we re receiving this information. While the ambulance is transporting the patient to us, the cardiac team responsible for opening the artery and restoring blood to the heart is already assembling at the hospital. When the patient arrives, the team is ready to proceed. This technology reduces the time from when the patient enters the doors of the hospital to when he or she receives balloon angioplasty by an average of 15 minutes, making the average door-to-balloon time 60 minutes. (The national standard per the American Heart Association is 90 minutes or less.) Dr. O Dea notes this shortened time reduces the incidence of heart failure. GUIDED BY MAGNETS Within Vassar Brothers Medical Center s walls, electrophysiologists take advantage of leadingedge technology to perform ablation and other catheterization procedures. Magnetic navigational tools provide electrophysiologists more precise methods for directing catheters to ablation focal points to treat abnormal electrical pathways and manipulating catheters through arteries, according to Dr. O Dea. Compared to traditional methods, which require electrophysiologists to stand bedside for the entirety of the procedure and direct the catheter under X-ray guidance, magnetic navigation provides a less grueling procedure that exposes patients to less radiation. Magnetic technology requires taking one electrocardiographic image that we match up to the magnetic system, eliminating the need for X-ray guidance to move catheters from place to place in the body, Dr. O Dea explains. Electrophysiologists perform the procedure while sitting at a console, and the procedure is quicker and more precise. It is also safer because the imaging provides 3-D visualization as opposed to 2-D X-rays, reducing the risk of untoward events. COLLABORATION ACROSS THE CONTINUUM When patients require more intensive intervention, Dr. O Dea explains, collaboration between cardiologists and cardiothoracic surgeons provides complete care for the entire disease process. Cardiologists work in concert with cardiac surgeons to ensure patients receive the best care before and after surgery, Dr. O Dea says. Often, surgery alleviates the problem, but doesn t cure it, and the underlying disease is still present surgeons don t remove diseased arteries; they work around them. For many cardiac conditions, patients require long-term care to make certain the disease doesn t progress. We work diligently with cardiothoracic surgeons to provide patients the most appropriate operation at the right time as well as excellent aftercare. The cardiothoracic surgery team at Vassar Brothers Medical Center is comprised of cardiothoracic surgeons, physician assistants, nurse practitioners, cardiothoracic and critical care nurses, physical therapists, and nutritionists. This team provides comprehensive surgical treatment options, including aortic aneurysm repair, coronary artery bypass graft surgery, surgical ablation for cardiac arrhythmias, valve surgery and redo heart surgery, among others, according to Mohan R. Sarabu, MD, FACS, FACC, Chief of 3

4 Cardiothoracic Surgery at Vassar Brothers Medical Center. THE REALITY OF REOPERATIONS In partnership with an expert team of cardiologists who provide medical treatment for all points on the care continuum, Vassar Brothers Medical Center s cardiothoracic surgical team is committed to delivering surgical excellence for all cardiac conditions, including inevitable and complex redo cardiac operations. The truth is that the majority of patients who had heart surgery will almost certainly need a second or third operation if they live long enough, Dr. Sarabu says. We have the expertise and capabilities to offer reoperations for patients who may not be candidates for these procedures at other places. Dr. Sarabu explains that when surgeons perform heart surgery, scar tissue eventually forms around the area of each cut made through skin, fat, chest bone and pericardium to access the heart. When a reoperation is needed, surgeons must navigate through altered anatomical planes because of scar tissue formation and be prepared for complications, such as excessive bleeding, which can result in higher risks for morbidity and mortality. According to Dr. Sarabu, reoperation procedures comprise an estimated percent of Vassar Brothers Medical Center s cardiothoracic surgery practice, and many of these are not simple redo cardiac bypass procedures. The hospital has excellent outcomes in these reoperations. Heart disease affects patients of all ages, Dr. Sarabu says. When they need surgical intervention for their conditions, many times, it has to be a combination procedure. We perform bypass and valve, double valve, bypass and valve reoperations, or any other necessary combination, including aortic aneurysm surgery. This is the norm in this day and age, and even though we perform high-risk operations on a high-risk population, we have very good outcomes. According to Dr. Sarabu, the decision between repairing and replacing a valve depends on the type of damage to the valve, the patient s general health, the condition of the damaged valve, the presence of other health conditions and the expected benefits of surgery. In all cases, the team collaborates to determine the most effective therapeutic option for each diagnosis and creates an individualized plan for every patient. Vassar Brothers Medical Center has garnered many accolades for low mortality rates and the quality care maintained by its cardiology and cardiothoracic surgery departments during the years. Dr. Sarabu explains that only an expert team of providers working together can achieve such a high standard of care. It s not a one-man show, Dr. Sarabu emphasizes. Every procedure surgical or otherwise needs to be a collective and cooperative effort. We have expert cardiologists at the forefront to diagnose these complex medical conditions and use the right tools to identify any underlying cardiac problems and help surgeons plan for their operations. 4

5 On top of that, we have a team of dedicated, exceptionally trained physician assistants, perfusionists and nurses in both the operating room and the intensive care unit to take care of our cardiology and cardiothoracic surgery patients. The backbone of our cardiac services is our team, and we have one that stands on the leading edge of care. FOSTERING REPRODUCIBLE SUCCESS Key to the team approach across all Health Quest facilities is a new Cardiovascular Institute model, which aims to systematize operational objectives, policies, priorities, procedures and operational objectives based upon national guidelines introduced by the American College of Cardiology, American Heart Association and the American Diabetes Association, among others. We wanted to ensure what we re doing correctly at one hospital we re duplicating at every hospital, Dr. O Dea explains. Then, those best practices spill over into physicians practices and foster congruity between the care provided within hospitals and physicians offices. Under the auspices of the Cardiovascular Institute s approach, an inclusive system of checks and balances ensures patients receive the appropriate treatment and medications. Clerks, nurses, physical therapists and respiratory therapists all know medical protocols, so patients should always receive the most appropriate treatment. READY FOR ANYTHING In tandem with the protocols initiated through the Cardiovascular Institute, individualized The Area s Only Expert for Heart Failure Although innovative technologies and procedures available to physicians within Vassar Brothers Medical Center have helped establish it as a leading tertiary-care center in the area, the unique capabilities of James Lyons, MD, board-certified congestive heart failure expert, distinguish it from other area hospitals. To best utilize Dr. Lyons specialization, Vassar Brothers Medical Center is developing a comprehensive heart failure program through which patients can receive aggressive treatment including left ventricular assist implantation optimal medical therapy and referrals for complete heart transplant. Such aggressive treatment aims to keep patients out of the hospital and, if they should require transplant or other serious inpatient interventions, prevent future rehospitalization. cardiac care tailored to each patient is of utmost importance, Dr. Sarabu notes. Access to the right tools is a necessity for any cardiothoracic surgery program to be successful, Dr. Sarabu says. In addition, surgeons must obtain all the appropriate information to best execute their skills as each patient s needs dictate. You can t simply treat every patient based only on the protocols. You have to treat the particular needs of the patient and his or her condition. Every patient is unique and has unique attributes. Patients with congestive heart failure demonstrate the necessity for individually tailored care. Whether due to previous heart 5

6 attacks, valve leaks or stenosis, damage to the heart muscle can impair its ability to successfully pump blood through the body. When blood pools in the heart or lungs and the rest of the body receives less blood, many organ systems may suffer. Cardiologists and surgeons must examine the way congestive heart failure impairs any organ in the body and incorporate that information into making an accurate diagnosis and determining the best surgical approach to treat the disorder, Dr. Sarabu says. For example, if congestive heart failure has impaired a patient s kidney function, providers may use medications and/or dialysis to treat it preoperatively and during the postoperative period. Dr. Sarabu notes that situations such as this exemplify the necessity for surgeons to be holistically involved in patient care. As surgeons, we not only perform the operation, but we must get involved with every system and component of the body, Dr. Sarabu says. This is the only way to treat the patient s condition and ensure we act appropriately when an organ is affected by impaired heart function. If surgeons perform operations without incorporating every other part of the body in patient care, then these operations would certainly result in bad outcomes. We have the right ingredients to provide the best care possible, Dr. Sarabu says. We have every tool necessary to provide any cardiac surgery at Vassar Brothers Medical Center. Our expert cardiologists, dedicated anesthesiologists, physician assistants, perfusionists and excellent nursing staff play an equally important role in producing great outcomes and ensuring we are prepared for almost any component directly or indirectly involved in patient care. We take care of our patients as we would our own family members. Source: MD News July 2013, Mid Hudson Edition Article?id=36440 ABOUT AIRSTRIP AirStrip is guided by a bold vision: harness the power of mobile communications to change the way healthcare is practiced. The AirStrip ONE enterprise mobility solution can improve the quality and timeliness of care, increase patient and clinician satisfaction, can enhance financial performance, and reduce risk. Headquartered in San Antonio, Texas, AirStrip is empowering the nation s leading health systems to compete and succeed in today s rapidly changing environment. DEMONSTRATED COMMITMENT As Health Quest s Cardiovascular Institute develops, the system s award-winning standard of care and resultant positive outcomes will surely continue its upward trajectory. Behind all the advanced technology and years of medical training, a very simple concept guides each physician s philosophy of care AirStrip Technologies, Inc. All rights reserved. Trademarks not belonging to AirStrip Technologies are the property of their respective companies. iphone and ipad are registered trademarks of Apple Inc. AirStrip ONE is intended for use by professional medical personnel. This product is to be installed by AirStrip Technologies Professional Services personnel only. For complete information about Intended Use, contact AirStrip Technologies via telephone at +1 (210) or via at info@airstrip.com. Imaging functionality is provided outside AirStrip ONE. Vassar Case Study V