1
|
Nelson AJ, Pagidipati NJ, Kelsey MD, Ardissino M, Aroda VR, Cavender MA, Lopes RD, Al-Khalidi HR, Braceras R, Gaynor T, Kaltenbach LA, Kirk JK, Lingvay I, Magwire ML, O'Brien EC, Pak J, Pop-Busui R, Richardson CR, Levya M, Senyucel C, Webb L, McGuire DK, Green JB, Granger CB. Coordinating Cardiology clinics randomized trial of interventions to improve outcomes (COORDINATE) - Diabetes: rationale and design. Am Heart J 2023; 256:2-12. [PMID: 36279931 DOI: 10.1016/j.ahj.2022.10.079] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 10/13/2022] [Accepted: 10/18/2022] [Indexed: 06/16/2023]
Abstract
Several medications that are proven to reduce cardiovascular events exist for individuals with type 2 diabetes mellitus (T2DM) and atherosclerotic cardiovascular disease, however they are substantially underused in clinical practice. Clinician, patient, and system-level barriers all contribute to these gaps in care; yet, there is a paucity of high quality, rigorous studies evaluating the role of interventions to increase utilization. The COORDINATE-Diabetes trial randomized 42 cardiology clinics across the United States to either a multifaceted, site-specific intervention focused on evidence-based care for patients with T2DM or standard of care. The multifaceted intervention comprised the development of an interdisciplinary care pathway for each clinic, audit-and-feedback tools and educational outreach, in addition to patient-facing tools. The primary outcome is the proportion of individuals with T2DM prescribed three key classes of evidence-based medications (high-intensity statin, angiotensin converting enzyme inhibitor or angiotensin receptor blocker, and either a sodium/glucose cotransporter-2 inhibitor (SGLT-2i) inhibitor or glucagon-like peptide 1 receptor agonist (GLP-1RA) and will be assessed at least 6 months after participant enrollment. COORDINATE-Diabetes aims to identify strategies that improve the implementation and adoption of evidence-based therapies.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Tanya Gaynor
- Boehringer Ingelheim Pharmaceuticals, Inc. Ridgefield, CT
| | | | - Julienne K Kirk
- Wake Forest University School of Medicine, Winston Salem, NC
| | - Ildiko Lingvay
- University of Texas Southwestern Medical Center, Dallas, TX
| | | | | | - Jonathan Pak
- Boehringer Ingelheim Pharmaceuticals, Inc. Ridgefield, CT
| | | | | | | | | | - Laura Webb
- Duke Clinical Research Institute, Durham, NC
| | - Darren K McGuire
- University of Texas Southwestern Medical Center, Dallas, TX; Parkland Health and Hospital System, Dallas, TX
| | | | | |
Collapse
|
2
|
Alvarez Villela M, Boucher T, Terre J, Levine B, O'Shea M, Luma J, Jorde UP, Garcia M, Wiley J, Menegus M, Latib A, Bortnick AE. Surge-in-Place: Conversion of a Cardiac Catheterization Laboratory Into a COVID-19 Intensive Care Unit and Back Again. J Invasive Cardiol 2021; 33:E71-E76. [PMID: 33348314 PMCID: PMC7858221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
In Spring 2020, the United States epicenter of COVID-19 was New York City, in which the borough of the Bronx was particularly affected. This Fall, there has been a resurgence of COVID-19 in Europe and the Midwestern United States. We describe our experience transforming our cardiac catheterization laboratories to accommodate an influx of COVID-19 patients so as to provide other hospitals with a potential blueprint. We transformed our pre/postprocedural patient care areas into COVID-19 intensive care and step-down units and maintained emergent invasive care for ST-segment elevation myocardial infarction using existing space and personnel.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Anna E Bortnick
- Jack D. Weiler Hospital, 1825 Eastchester Road Suite 2S-46 Bronx, NY 10461 USA.
| |
Collapse
|
3
|
Mahmud E, Dauerman HL, Welt FGP, Messenger JC, Rao SV, Grines C, Mattu A, Kirtane AJ, Jauhar R, Meraj P, Rokos IC, Rumsfeld JS, Henry TD. Management of Acute Myocardial Infarction During the COVID-19 Pandemic: A Position Statement From the Society for Cardiovascular Angiography and Interventions (SCAI), the American College of Cardiology (ACC), and the American College of Emergency Physicians (ACEP). J Am Coll Cardiol 2020; 76:1375-1384. [PMID: 32330544 PMCID: PMC7173829 DOI: 10.1016/j.jacc.2020.04.039] [Citation(s) in RCA: 219] [Impact Index Per Article: 54.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The worldwide pandemic caused by the novel acute respiratory syndrome coronavirus 2 has resulted in a new and lethal disease termed coronavirus disease-2019 (COVID-19). Although there is an association between cardiovascular disease and COVID-19, the majority of patients who need cardiovascular care for the management of ischemic heart disease may not be infected with this novel coronavirus. The objective of this document is to provide recommendations for a systematic approach for the care of patients with an acute myocardial infarction (AMI) during the COVID-19 pandemic. There is a recognition of two major challenges in providing recommendations for AMI care in the COVID-19 era. Cardiovascular manifestations of COVID-19 are complex with patients presenting with AMI, myocarditis simulating an ST-elevation myocardial infarction (STEMI) presentation, stress cardiomyopathy, non-ischemic cardiomyopathy, coronary spasm, or nonspecific myocardial injury, and the prevalence of COVID-19 disease in the U.S. population remains unknown with risk of asymptomatic spread. This document addresses the care of these patients focusing on 1) the varied clinical presentations; 2) appropriate personal protection equipment (PPE) for health care workers; 3) role of the Emergency Department, Emergency Medical System and the Cardiac Catheterization Laboratory; and 4) Regional STEMI systems of care. During the COVID-19 pandemic, primary PCI remains the standard of care for STEMI patients at PCI capable hospitals when it can be provided in a timely fashion, with an expert team outfitted with PPE in a dedicated CCL room. A fibrinolysis-based strategy may be entertained at non-PCI capable referral hospitals or in specific situations where primary PCI cannot be executed or is not deemed the best option.
Collapse
Affiliation(s)
- Ehtisham Mahmud
- Sulpizio Cardiovascular Center, University of California-San Diego, La Jolla, California.
| | | | | | | | - Sunil V Rao
- Duke University Hospital, Durham, North Carolina
| | - Cindy Grines
- Northside Cardiovascular Institute, Atlanta, Georgia
| | - Amal Mattu
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Ajay J Kirtane
- Columbia University Medical Center, Center for Interventional Vascular Therapy, New York, New York
| | | | - Perwaiz Meraj
- Hofstra North Shore-LIJ School of Medicine, Manhasset, New York
| | | | | | - Timothy D Henry
- The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, Ohio
| |
Collapse
|
4
|
Katz JN, Sinha SS, Alviar CL, Dudzinski DM, Gage A, Brusca SB, Flanagan MC, Welch T, Geller BJ, Miller PE, Leonardi S, Bohula EA, Price S, Chaudhry SP, Metkus TS, O'Brien CG, Sionis A, Barnett CF, Jentzer JC, Solomon MA, Morrow DA, van Diepen S. COVID-19 and Disruptive Modifications to Cardiac Critical Care Delivery: JACC Review Topic of the Week. J Am Coll Cardiol 2020; 76:72-84. [PMID: 32305402 PMCID: PMC7161519 DOI: 10.1016/j.jacc.2020.04.029] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 04/13/2020] [Accepted: 04/13/2020] [Indexed: 12/12/2022]
Abstract
The COVID-19 pandemic has presented a major unanticipated stress on the workforce, organizational structure, systems of care, and critical resource supplies. To ensure provider safety, to maximize efficiency, and to optimize patient outcomes, health systems need to be agile. Critical care cardiologists may be uniquely positioned to treat the numerous respiratory and cardiovascular complications of the SARS-CoV-2 and support clinicians without critical care training who may be suddenly asked to care for critically ill patients. This review draws upon the experiences of colleagues from heavily impacted regions of the United States and Europe, as well as lessons learned from military mass casualty medicine. This review offers pragmatic suggestions on how to implement scalable models for critical care delivery, cultivate educational tools for team training, and embrace technologies (e.g., telemedicine) to enable effective collaboration despite social distancing imperatives.
Collapse
Affiliation(s)
- Jason N Katz
- Division of Cardiology, Duke University, Durham, North Carolina.
| | - Shashank S Sinha
- Inova Heart and Vascular Institute, Inova Fairfax Medical Center, Falls Church, Virginia. https://twitter.com/ShashankSinhaMD
| | - Carlos L Alviar
- Leon H. Charney Division of Cardiology, New York University Langone Medical Center NYU Langone Medical Center, New York, New York
| | - David M Dudzinski
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Ann Gage
- Division of Cardiology, Cleveland Clinic, Cleveland, Ohio
| | - Samuel B Brusca
- Critical Care Medicine, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - M Casey Flanagan
- Inova Heart and Vascular Institute, Inova Fairfax Medical Center, Falls Church, Virginia
| | - Timothy Welch
- Inova Heart and Vascular Institute, Inova Fairfax Medical Center, Falls Church, Virginia; Virginia Heart, Falls Church, Virginia
| | - Bram J Geller
- Division of Cardiology, Maine Medical Center, Portland, Maine
| | - P Elliott Miller
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Sergio Leonardi
- Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology-Fondazione IRCCS Policlinico San Matteo, and Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Erin A Bohula
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Susanna Price
- Royal Brompton and Harefield NHS Foundation Trust, Royal Brompton Hospital, London, United Kingdom
| | | | - Thomas S Metkus
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Connor G O'Brien
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Alessandro Sionis
- Intensive Cardiac Care Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute IIB-SantPaul, Universidad Autonoma de Barcelona, Barcelona, Spain
| | | | - Jacob C Jentzer
- Department of Cardiovascular Medicine and Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
| | - Michael A Solomon
- Critical Care Medicine, National Institutes of Health Clinical Center, Bethesda, Maryland; Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - David A Morrow
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sean van Diepen
- Department of Critical Care and Division of Cardiology, Department of Medicine, University of Alberta Hospital, Alberta, Canada. https://twitter.com/seanvandiepen
| |
Collapse
|
5
|
|
6
|
Wood DA, Mahmud E, Thourani VH, Sathananthan J, Virani A, Poppas A, Harrington RA, Dearani JA, Swaminathan M, Russo AM, Blankstein R, Dorbala S, Carr J, Virani S, Gin K, Packard A, Dilsizian V, Légaré JF, Leipsic J, Webb JG, Krahn AD. Safe Reintroduction of Cardiovascular Services During the COVID-19 Pandemic: From the North American Society Leadership. J Am Coll Cardiol 2020; 75:3177-3183. [PMID: 32380033 PMCID: PMC7198172 DOI: 10.1016/j.jacc.2020.04.063] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 04/29/2020] [Indexed: 11/14/2022]
Affiliation(s)
- David A Wood
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada; Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Ehtisham Mahmud
- University of California, San Diego Sulpizio Cardiovascular Center, La Jolla, California
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia
| | - Janarthanan Sathananthan
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada; Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alice Virani
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Athena Poppas
- Brown University School of Medicine, Providence, Rhode Island
| | | | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Madhav Swaminathan
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina
| | - Andrea M Russo
- Cooper Medical School of Rowan University, Camden, New Jersey
| | - Ron Blankstein
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sharmila Dorbala
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - James Carr
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sean Virani
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada; Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kenneth Gin
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada; Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alan Packard
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Children's Hospital Boston/Harvard Medical School, Boston, Massachusetts
| | - Vasken Dilsizian
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jean-François Légaré
- New Brunswick Heart Centre, Dalhousie University, Saint John, New Brunswick, Canada
| | - Jonathon Leipsic
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada; Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - John G Webb
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada; Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew D Krahn
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada; Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
7
|
Rao P, Diamond J, Korjian S, Martin L, Varghese M, Serfas JD, Lee R, Fraiche A, Kannam J, Reza N. The Impact of the COVID-19 Pandemic on Cardiovascular Fellows-in-Training: A National Survey. J Am Coll Cardiol 2020; 76:871-875. [PMID: 32561407 PMCID: PMC7832440 DOI: 10.1016/j.jacc.2020.06.027] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/10/2020] [Accepted: 06/12/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Prashant Rao
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts. https://twitter.com/DrPRao
| | - Jamie Diamond
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Serge Korjian
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Lila Martin
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Merilyn Varghese
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - John D Serfas
- Division of Cardiovascular Medicine, Duke University Medical Center, Durham, North Carolina
| | - Ran Lee
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ariane Fraiche
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Joseph Kannam
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Nosheen Reza
- Division of Cardiology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
| |
Collapse
|
8
|
Bonalumi G, di Mauro M, Garatti A, Barili F, Gerosa G, Parolari A. The COVID-19 outbreak and its impact on hospitals in Italy: the model of cardiac surgery. Eur J Cardiothorac Surg 2020; 57:1025-1028. [PMID: 32301984 PMCID: PMC7184374 DOI: 10.1093/ejcts/ezaa151] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Giorgia Bonalumi
- Department of Cardiac Surgery, Centro Cardiologico Monzino, Milan, Italy
| | - Michele di Mauro
- Cardiology and Cardiac Surgery, API “Madonna del Ponte”, Lanciano, Italy
| | - Andrea Garatti
- Department of Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Fabio Barili
- Department of Cardiac Surgery, S. Croce Hospital, Cuneo, Italy
| | - Gino Gerosa
- Department of Cardiac Surgery, University of Padua, Padua, Italy
| | - Alessandro Parolari
- Department of Universitary Cardiac Surgery and Translational Research, IRCCS Policlinico S. Donato, University of Milan, Milan, Italy
| | | |
Collapse
|
9
|
Tam DY, Naimark D, Natarajan MK, Woodward G, Oakes G, Rahal M, Barrett K, Khan YA, Ximenes R, Mac S, Sander B, Wijeysundera HC. The Use of Decision Modelling to Inform Timely Policy Decisions on Cardiac Resource Capacity During the COVID-19 Pandemic. Can J Cardiol 2020; 36:1308-1312. [PMID: 32447059 PMCID: PMC7241392 DOI: 10.1016/j.cjca.2020.05.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/17/2020] [Accepted: 05/17/2020] [Indexed: 11/18/2022] Open
Abstract
In Ontario on March 16, 2020, a directive was issued to all acute care hospitals to halt nonessential procedures in anticipation of a potential surge in COVID-19 patients. This included scheduled outpatient cardiac surgical and interventional procedures that required the use of intensive care units, ventilators, and skilled critical care personnel, given that these procedures would draw from the same pool of resources required for critically ill COVID-19 patients. We adapted the COVID-19 Resource Estimator (CORE) decision analytic model by adding a cardiac component to determine the impact of various policy decisions on the incremental waitlist growth and estimated waitlist mortality for 3 key groups of cardiovascular disease patients: coronary artery disease, valvular heart disease, and arrhythmias. We provided predictions based on COVID-19 epidemiology available in real-time, in 3 phases. First, in the initial crisis phase, in a worst case scenario, we showed that the potential number of waitlist related cardiac deaths would be orders of magnitude less than those who would die of COVID-19 if critical cardiac care resources were diverted to the care of COVID-19 patients. Second, with better local epidemiology data, we predicted that across 5 regions of Ontario, there may be insufficient resources to resume all elective outpatient cardiac procedures. Finally in the recovery phase, we showed that the estimated incremental growth in waitlist for all cardiac procedures is likely substantial. These outputs informed timely data-driven decisions during the COVID-19 pandemic regarding the provision of cardiovascular care.
Collapse
Affiliation(s)
- Derrick Y Tam
- Division of Cardiac Surgery, Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - David Naimark
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Nephrology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; COVID-19 Modelling Collaborative, University of Toronto, Toronto, Ontario, Canada
| | - Madhu K Natarajan
- Division of Cardiology, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | | | | | | | - Kali Barrett
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; COVID-19 Modelling Collaborative, University of Toronto, Toronto, Ontario, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, University of Toronto, Toronto, Ontario, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada; University Health Network, Toronto, Ontario, Canada
| | - Yasin A Khan
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; COVID-19 Modelling Collaborative, University of Toronto, Toronto, Ontario, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, University of Toronto, Toronto, Ontario, Canada; University Health Network, Toronto, Ontario, Canada
| | - Raphael Ximenes
- COVID-19 Modelling Collaborative, University of Toronto, Toronto, Ontario, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, University of Toronto, Toronto, Ontario, Canada; University Health Network, Toronto, Ontario, Canada
| | - Stephen Mac
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; COVID-19 Modelling Collaborative, University of Toronto, Toronto, Ontario, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Beate Sander
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; COVID-19 Modelling Collaborative, University of Toronto, Toronto, Ontario, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, University of Toronto, Toronto, Ontario, Canada; Public Health Ontario, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Harindra C Wijeysundera
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
10
|
Paschali A, Anagnostopoulos C. Nuclear Cardiology practice in COVID-19 era. Hell J Nucl Med 2020; 23 Suppl:26-30. [PMID: 32860393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 08/03/2020] [Indexed: 06/11/2023]
Abstract
The Coronavirus Disease 2019 (COVID-19) pandemic is the biggest shock in decades to the well developed healthcare system and resources worldwide. Although there was a wide variation in the level of preparedness, the transition was tough even for the most renowned healthcare systems. Increasing the capacity and adapting healthcare for the needs of COVID-19 patients is described by the WHO as a fundamental outbreak response measure. However, while the system is preoccupied with a pandemic infection, patients suffering from other illnesses are in high risk to get infected, also being compromised by the imperative shift in medical resources and significant restrictions on routine medical care. For example patients with cardiovascular disease and others referred for nuclear cardiology procedures are frequently greater than 60 years of age and have other comorbidities (e.g. hypertension, diabetes, chronic lung disease, and chronic renal disease) that place them at a high-risk for adverse outcomes with COVID-19, providing unique challenges for their management in healthcare facilities, as well as for the care of health care personnel. Numerous medical specialty societies and governmental agencies issued guidelines aiming at the specification of preventive measures and amendments in everyday clinical practice during the escalation and peak of the pandemic. In accordance, the American Society of Nuclear Cardiology (ASNC) and the Society of Nuclear Medicine and Molecular Imaging (SNMMI), issued a common statement in late March 2020, which was provided as an initial response to this pandemic, offering specific recommendations for adapting nuclear cardiology practices at each step in a patient's journey through the lab-for inpatients, outpatients and emergency department patients. One of the main recommendations was cancelling or delaying of all non-urgent nuclear cardiology studies. As COVID-19 follows a different time course in different geographic regions and lockdowns begin to lift in many countries, the issue of re-establishment of non-emergent care, in nuclear cardiology laboratories amongst others, has to be addressed in a watchful and balanced way, keeping in mind that the COVID-19 crisis is far from over. Furthermore measuring what is happening in the current crisis is essential to ensuring preparedness for a possible next wave of the pandemic. Recently the ASNC, SNMMI, the International Atomic Energy Agency (IAEA) and the Infectious Disease Society of America (IDSA), issued an information statement which describes a careful approach to reestablishment of non-emergent care in nuclear cardiology laboratories reflecting diverse settings from the United States and worldwide. In the same spirit it is also the reintroduction guidance issued by North American Cardiovascular Societies. In this paper we provide a synopsis of the basic steps of adapting nuclear cardiology practice in the era of COVID-19 in order to balance between the risk of viral transmission while also providing crucial cardiovascular assessments for our patients.
Collapse
Affiliation(s)
- Anna Paschali
- PET/CT Oncology Center 'Theageneio', Al Symeonidis 2 str, P.C 54007 Thessaloniki, Greece.
| | | |
Collapse
|
11
|
Ghio S, Ferlini M, Scelsi L, Ferrario M, Camporotondo R, Vicentini A, Magrini G, Visconti LO. [COVID-19 pandemic: the need to reorganize a Cardiology Department in a hospital of the Lombardy Region, Italy]. G Ital Cardiol (Rome) 2020; 21:358-359. [PMID: 32310923 DOI: 10.1714/3343.33134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
| | | | | | | | - Rita Camporotondo
- U.O.C Unità Coronarica - Ricerca e Sperimentazione Cardiologica, Dipartimento Scienze Mediche e Malattie Infettive, Fondazione IRCCS Policlinico San Matteo, Pavia
| | | | | | - Luigi Oltrona Visconti
- U.O.C. Cardiologia - U.O.C Unità Coronarica - Ricerca e Sperimentazione Cardiologica, Dipartimento Scienze Mediche e Malattie Infettive, Fondazione IRCCS Policlinico San Matteo, Pavia
| |
Collapse
|
12
|
Chambers JB, Parkin D, Rimington H, Subbiah S, Campbell B, Demetrescu C, Hayes A, Rajani R. Specialist valve clinic in a cardiac centre: 10-year experience. Open Heart 2020; 7:e001262. [PMID: 32399252 PMCID: PMC7204551 DOI: 10.1136/openhrt-2020-001262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/12/2020] [Accepted: 03/16/2020] [Indexed: 11/06/2022] Open
Abstract
Aims Guidelines recommend specialist valve clinics as best practice for the assessment and conservative management of patients with heart valve disease. However, there is little guidance on how to set up and organise a clinic. The aim of this study is to describe a clinic run by a multidisciplinary team consisting of cardiologists, physiologist/scientists and a nurse. Methods The clinical and organisational aims of the clinic, inclusion and exclusion criteria, and links with other services are described. The methods of training non-clinical staff are detailed. Data were prospectively entered onto a database and the study consisted of an analysis of the clinical characteristics and outcomes of all patients seen between 1 January 2009 and 31 December 2018. Results There were 2126 new patients and 9522 visits in the 10-year period. The mean age was 64.8 and 55% were male. Of the visits, 3587 (38%) were to the cardiologists, 4092 (43%) to the physiologist/scientists and 1843 (19%) to the nurse. The outcomes from the cardiologist clinics were cardiology follow-up in 460 (30%), referral for surgery in 354 (23%), referral to the physiologist/scientist clinic in 412 (27%) or to the nurse clinic in 65 (4.3%) and discharge in 230 (15%). The cardiologist needed to see 6% from the nurse clinic and 10% from the physiologist/scientist clinic, while advice alone was sufficient in 10% and 9%. Conclusion A multidisciplinary specialist valve clinic is feasible and sustainable in the long term.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Anna Hayes
- Guy's and St Thomas' Hospital, London, UK
| | | |
Collapse
|
13
|
Affiliation(s)
- Giulio G Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (G.G.S., E.A., G.C.)
- Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy (G.G.S., E.A., G.C.)
| | - Elena Azzolini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (G.G.S., E.A., G.C.)
- Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy (G.G.S., E.A., G.C.)
| | - Gianluigi Condorelli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (G.G.S., E.A., G.C.)
- Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy (G.G.S., E.A., G.C.)
| |
Collapse
|
14
|
Affiliation(s)
- Pedro Puech-Leão
- Instituto Central (ICHC) e Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | | | | |
Collapse
|
15
|
Abdul Kader MAS. Strengthening acute coronary syndrome referral network: Insights from initiatives of Penang General Hospital cardiology centre. Med J Malaysia 2019; 74:355-358. [PMID: 31424052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The importance of networking for the management of acute coronary syndrome (ACS) has been emphasised in the 2012 guidelines by the European Society of Cardiology (ESC) on ST-segment elevation myocardial infarction (STEMI). In Penang, the ACS referral network has the Penang General Hospital (PGH), a percutaneous coronary intervention (PCI)- capable hospital, with 14 other hospitals referring their patients for PCI to PGH on a daily basis. In one of its review regarding the referral methodology in the network, PGH's Cardiology centre observed gaps in the referral systems, which was leading to poor quality of referrals. To address these issues, the PGH Cardiology centre developed a standardised protocol and conducted a one-day workshop to educate medical officers about the standardised protocol. This commentary piece is a proof of this concept, and aims to share the experience and provide an overview on the initiatives by the PGH, which has resulted in improved quality of PCI referrals.
Collapse
Affiliation(s)
- M A S Abdul Kader
- Penang General Hospital, Department of Cardiology, Pulau Pinang, Malaysia.
| |
Collapse
|
16
|
McLachlan A, Aldridge C, Lee M, Harper C, Kerr A. The development and first six years of a nurse-led chest pain clinic. N Z Med J 2019; 132:39-47. [PMID: 30703778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
AIM Chest pain is a common symptom that creates significant anxiety for patients until a diagnosis can be offered. However, hospital cardiology services can struggle to cope with referral demands from primary care. The aim of this paper is to describe the development and implementation of a nurse-led chest pain service, its care processes and clinical outcomes to show feasibility, safety and sustainability. METHOD We retrospectively analysed referral, demographic, cardiovascular risk, management and clinical outcome data relating to patients assessed in the nurse-led chest pain clinic in a large metropolitan district health board. RESULTS Between January 2010 to December 2016, 3,587 patients attended the clinic, median 2.6 weeks (IQR 2-3) from referral to attendance. 1,921 (54%) were male and 2,059 (57%) were less than 60 years old. Most patients, 3,059 (85%), had an exercise tolerance test (ETT) and of those, 294 (10%) were positive, 572 (18%) non-diagnostic and 2,193 (72%) negative. Cardiovascular disease (CVD) prevention medication was added or modified for 1,150 (32%) patients, all patients who smoked were offered cessation support and all patients were provided with tailored lifestyle advice depending on their absolute CVD risk. Of the 319 (9%) referred for a diagnostic coronary angiogram, 205 (64%) had important coronary disease. The majority of patients, 2,088 (58%) were able to be discharged without any further investigation planned. Over a median follow-up period of 3.6 years, we identified 14 (0.4%) cardiac-related deaths, median (IQR) 2 (1-4) years from review to death. CONCLUSION The nurse-led clinic offers an enhanced prevention focus that is sustainably managing large numbers of patients with outcomes similar to international studies and within recommended local timeframes.
Collapse
|
17
|
Freund Y, Gorlicki J, Cachanado M, Salhi S, Lemaître V, Simon T, Mebazaa A. Early and comprehensive care bundle in the elderly for acute heart failure in the emergency department: study protocol of the ELISABETH stepped-wedge cluster randomized trial. Trials 2019; 20:95. [PMID: 30704508 PMCID: PMC6357377 DOI: 10.1186/s13063-019-3188-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 01/09/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Acute heart failure (AHF) is one of the most common diagnoses for elderly patients in the emergency department (ED), with an admission rate above 80% and 1-month mortality around 10%. The European guidelines for the management of AHF are based on moderate levels of evidence, due to the lack of randomized controlled trials and the scarce evidence of any clinical added value of a specific treatment to improve outcomes. Recent reports suggest that the very early administration of full recommended therapy may decrease mortality. However, several studies have highlighted that elderly patients often received suboptimal treatment. Our hypothesis is that an early care bundle that comprises early and comprehensive management of symptoms, along with prompt detection and treatment of precipitating factors should improve AHF outcome in elderly patients. METHODS/DESIGN ELISABETH is a stepped-wedge, cluster randomized controlled, clinical trial in 15 emergency departments in France recruiting all patients aged 75 years and older with a diagnosis of AHF. The tested intervention is a care bundle with a checklist that mandates detection and early treatment of AHF precipitating factors, early and intensive treatment of congestion with intravenously administered nitrate boluses, and application of other recommended treatment (low-dose diuretics, non-invasive ventilation when indicated, and preventive low-molecular-weight heparin). Each center is randomized to the order in which they will switch from a "control period" to an "intervention period." All centers begin the trials with the control period for 2 weeks, then after each 2-week step a new center will enter the intervention period. At the end of the trial, all clusters will receive the intervention regimen. The primary outcome is the number of days alive and out of the hospital at 30 days. DISCUSSION If our hypothesis is confirmed, this trial will strengthen the level of evidence of AHF guidelines and stress the importance of the associated early and comprehensive treatment of precipitating factors. This trial could be the first to report a reduction in short-term morbidity and mortality in elderly AHF patients. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT03683212. Prospectively registered on 25 September 2018.
Collapse
Affiliation(s)
- Yonathan Freund
- Sorbonne Université, Paris, France
- Emergency Department, Hôpital Pitié-Salpêtrière, Paris, France
- Service d’accueil des urgences, Hôpital Pitié-Salpêtrière, 83 boulevard de l’hôpital, 75013 Paris, France
| | - Judith Gorlicki
- Emergency Department, Hôpital Avicenne, Université Paris 13, Sorbonne Paris Cité, Bobigny, France
| | - Marine Cachanado
- Clinical Research Platform, Hôpital Saint-Antoine, Paris, France
| | - Sarah Salhi
- Clinical Research Platform, Hôpital Saint-Antoine, Paris, France
| | - Vanessa Lemaître
- Clinical Research Platform, Hôpital Saint-Antoine, Paris, France
| | - Tabassome Simon
- Sorbonne Université, Paris, France
- Clinical Research Platform, Hôpital Saint-Antoine, Paris, France
| | - Alexandre Mebazaa
- Department of Anaesthesiology and Critical Care Medicine, Saint Louis and Lariboisière University Hospitals and INSERM UMR-S 942, Paris, France
| |
Collapse
|
18
|
Abstract
The populations of Asian countries are expected to age rapidly in the near future, with a dramatic increase in the number of heart failure (HF) patients also anticipated. The need for palliative and end-of-life care for elderly patients with advanced HF is currently recognized in aging societies. However, palliative care and active treatment for HF are not mutually exclusive, and palliative care should be provided to reduce suffering occurring at any stage of symptomatic HF after the point of diagnosis. HF patients are at high risk of sudden cardiac death from the early stages of the disease onwards. The decision of whether to perform cardiopulmonary resuscitation in the event of an emergency is challenging, especially in elderly HF patients, because of the difficulty in accurately predicting the prognosis of the condition. Furthermore, advanced HF patients are often fitted with a device, and device deactivation at the end of life is a complicated process. Treatment strategies should thus be discussed by multi-disciplinary teams, including palliative experts, and should consider patient directives to address the problems discussed above. Open communication with the HF patient regarding the expected prognosis, course, and treatment options will serve to support the patient and aid in future planning.
Collapse
Affiliation(s)
- Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akinori Sawamura
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| |
Collapse
|
19
|
Nallamothu BK, Guetterman TC, Harrod M, Kellenberg JE, Lehrich JL, Kronick SL, Krein SL, Iwashyna TJ, Saint S, Chan PS. How Do Resuscitation Teams at Top-Performing Hospitals for In-Hospital Cardiac Arrest Succeed? A Qualitative Study. Circulation 2018; 138:154-163. [PMID: 29986959 PMCID: PMC6245659 DOI: 10.1161/circulationaha.118.033674] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 04/12/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND In-hospital cardiac arrest (IHCA) is common, and outcomes vary substantially across US hospitals, but reasons for these differences are largely unknown. We set out to better understand how top-performing hospitals organize their resuscitation teams to achieve high survival rates for IHCA. METHODS We calculated risk-standardized IHCA survival to discharge rates across American Heart Association Get With The Guidelines-Resuscitation registry hospitals between 2012 and 2014. We identified geographically and academically diverse hospitals in the top, middle, and bottom quartiles of survival for IHCA and performed a qualitative study that included site visits with in-depth interviews of clinical and administrative staff at 9 hospitals. With the use of thematic analysis, data were analyzed to identify salient themes of perceived performance by informants. RESULTS Across 9 hospitals, we interviewed 158 individuals from multiple disciplines including physicians (17.1%), nurses (45.6%), other clinical staff (17.1%), and administration (20.3%). We identified 4 broad themes related to resuscitation teams: (1) team design, (2) team composition and roles, (3) communication and leadership during IHCA, and (4) training and education. Resuscitation teams at top-performing hospitals demonstrated the following features: dedicated or designated resuscitation teams; participation of diverse disciplines as team members during IHCA; clear roles and responsibilities of team members; better communication and leadership during IHCA; and in-depth mock codes. CONCLUSIONS Resuscitation teams at hospitals with high IHCA survival differ from non-top-performing hospitals. Our findings suggest core elements of successful resuscitation teams that are associated with better outcomes and form the basis for future work to improve IHCA.
Collapse
Affiliation(s)
- Brahmajee K Nallamothu
- Departments of Internal Medicine (B.K.N., J.E.K., J.L.L., S.L. Krein, T.J.I., S.S.)
- University of Michigan Medical School, Ann Arbor. Veterans Affairs Ann Arbor Center for Clinical Management Research, MI (B.K.N., S.L. Krein, T.J.I., S.S.)
| | | | | | - Joan E Kellenberg
- Departments of Internal Medicine (B.K.N., J.E.K., J.L.L., S.L. Krein, T.J.I., S.S.)
| | - Jessica L Lehrich
- Departments of Internal Medicine (B.K.N., J.E.K., J.L.L., S.L. Krein, T.J.I., S.S.)
| | | | - Sarah L Krein
- Departments of Internal Medicine (B.K.N., J.E.K., J.L.L., S.L. Krein, T.J.I., S.S.)
- University of Michigan Medical School, Ann Arbor. Veterans Affairs Ann Arbor Center for Clinical Management Research, MI (B.K.N., S.L. Krein, T.J.I., S.S.)
| | - Theodore J Iwashyna
- Departments of Internal Medicine (B.K.N., J.E.K., J.L.L., S.L. Krein, T.J.I., S.S.)
- University of Michigan Medical School, Ann Arbor. Veterans Affairs Ann Arbor Center for Clinical Management Research, MI (B.K.N., S.L. Krein, T.J.I., S.S.)
| | - Sanjay Saint
- Departments of Internal Medicine (B.K.N., J.E.K., J.L.L., S.L. Krein, T.J.I., S.S.)
- University of Michigan Medical School, Ann Arbor. Veterans Affairs Ann Arbor Center for Clinical Management Research, MI (B.K.N., S.L. Krein, T.J.I., S.S.)
| | - Paul S Chan
- Department of Internal Medicine, Saint Luke's Health System, Kansas City, MO (P.S.C.)
| |
Collapse
|
20
|
Abstract
A reduction in the number of return patients attending general cardiology clinics, if achievable without harm, would improve access for newly referred patients. Outpatient clinic letters (525) sent to general practitioners over a threemonth period were reviewed. Simultaneously, physicians’ opinions were collected by questionnaire. A subset of 30 clinic patients who attended three local general practitioners were studied to identify how many were assessed in primary care, and how often, in a six-month period. The hospital records of these patients were reviewed to determine whether information about these visits to the general practitioner was documented in the hospital notes. From the outpatient clinics the discharge rates were only 26% and the reason for further clinic review was often not clear. The fact that many patients had no intervention or treatment change performed at the clinic (42%) indicates that patients are reviewed to assess symptom change rather than to receive further interventions. The use of fixed times for review appointment (six months or 1 year) suggests that the intervals are determined by habit rather than clinical indication. A high proportion of patients (28/30) were reviewed at least once in primary care by general practitioners between hospital clinic visits and 20/30 were seen three or more times. There was poor documentation of these consultations in the hospital case notes, and so hospital physicians may be unaware that symptoms are under regular review in primary care. This study suggests that a substantial proportion of current cardiology return outpatients do not require regular outpatient review. However, alternative management demands good communication and exchange of information between secondary and primary care, development of formal written discharge planning in outpatient letters and other forms of follow-up.
Collapse
Affiliation(s)
- Michelle L Hughes
- Redesign Office, Forth Valley Acute Hospitals NHS Trust, Falkirk and District Royal Infirmary, Falkirk FK1 5QE, UK
| | | | | | | | | |
Collapse
|
21
|
|
22
|
Kricke GS, Carson MB, Lee YJ, Benacka C, Mutharasan RK, Ahmad FS, Kansal P, Yancy CW, Anderson AS, Soulakis ND. Leveraging electronic health record documentation for Failure Mode and Effects Analysis team identification. J Am Med Inform Assoc 2017; 24:288-294. [PMID: 27589944 PMCID: PMC5391722 DOI: 10.1093/jamia/ocw083] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 04/26/2016] [Accepted: 04/30/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Using Failure Mode and Effects Analysis (FMEA) as an example quality improvement approach, our objective was to evaluate whether secondary use of orders, forms, and notes recorded by the electronic health record (EHR) during daily practice can enhance the accuracy of process maps used to guide improvement. We examined discrepancies between expected and observed activities and individuals involved in a high-risk process and devised diagnostic measures for understanding discrepancies that may be used to inform quality improvement planning. METHODS Inpatient cardiology unit staff developed a process map of discharge from the unit. We matched activities and providers identified on the process map to EHR data. Using four diagnostic measures, we analyzed discrepancies between expectation and observation. RESULTS EHR data showed that 35% of activities were completed by unexpected providers, including providers from 12 categories not identified as part of the discharge workflow. The EHR also revealed sub-components of process activities not identified on the process map. Additional information from the EHR was used to revise the process map and show differences between expectation and observation. CONCLUSION Findings suggest EHR data may reveal gaps in process maps used for quality improvement and identify characteristics about workflow activities that can identify perspectives for inclusion in an FMEA. Organizations with access to EHR data may be able to leverage clinical documentation to enhance process maps used for quality improvement. While focused on FMEA protocols, findings from this study may be applicable to other quality activities that require process maps.
Collapse
Affiliation(s)
- Gayle Shier Kricke
- Division of Health and Biomedical Informatics, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Matthew B Carson
- Division of Health and Biomedical Informatics, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Young Ji Lee
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - Corrine Benacka
- Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, IL, 60611, USA
| | - R. Kannan Mutharasan
- Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, IL, 60611, USA
| | - Faraz S Ahmad
- Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, IL, 60611, USA
| | - Preeti Kansal
- Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, IL, 60611, USA
| | - Clyde W Yancy
- Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, IL, 60611, USA
| | - Allen S Anderson
- Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, IL, 60611, USA
| | - Nicholas D Soulakis
- Division of Health and Biomedical Informatics, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| |
Collapse
|
23
|
Kogon B, Rosenblum J, Alsoufi B, Shashidharan S, Book W. The Evolution of an Adult Congenital Heart Surgery Program: The Emory System. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2017; 20:28-32. [PMID: 28007061 DOI: 10.1053/j.pcsu.2016.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 09/19/2016] [Accepted: 09/19/2016] [Indexed: 06/06/2023]
Abstract
The Emory Adult Congenital Heart (Emory University, Atlanta, GA) program was founded in 2001. In 2004, the surgical component transitioned from a pediatric facility to an adult facility. The aim of this article is characterize the program as a whole, outline changes in the program, and discuss the challenges of the transition process. Between 2001 and 2015, changes in program structure and personnel were evaluated. There has been significant growth of the program between 2001 and 2015. There are currently 19 half-day clinics per week, with 2,700 clinic visits per year. There are six cardiologists, three congenital cardiac surgeons, two sonographers, one advanced practice provider, and one social worker dedicated to the program. There are Accreditation Council for Graduate Medical Education-accredited adult congenital cardiology and congenital cardiac surgery fellowships. One thousand forty-four operations were performed between 2001 and 2015. There were 828 open-heart operations, of which 581 (70%) were re-operations. Over the study period, the number of yearly operations increased from 30 to 119, and the mean age at surgery increased from 22 to 35 years. Over time, more of the operations were performed at the adult hospital: increasing from 3% in 2001 to 82% in 2015, and more of the operations were performed by congenital cardiac surgeons: 87% (114 of 131) before the 2004 transition to 97% (881 of 913) afterward. The Emory Adult Congenital Heart program has undergone significant growth and change, including transition of the surgical component from the pediatric to the adult facility. While numerous obstacles have been overcome and great progress has been made, additional challenges remain.
Collapse
Affiliation(s)
- Brian Kogon
- Department of Cardiothoracic Surgery, Emory University, Atlanta, GA.
| | - Joshua Rosenblum
- Department of Cardiothoracic Surgery, Emory University, Atlanta, GA
| | | | | | - Wendy Book
- Division of Cardiology, Emory University, Atlanta, GA
| |
Collapse
|
24
|
Justo R, Smith AC, Williams M, Van der Westhuyzen J, Murray J, Sciuto G, Wootton R. Paediatric telecardiology services in Queensland: A review of three years’ experience. J Telemed Telecare 2016; 10 Suppl 1:57-60. [PMID: 15603611 DOI: 10.1258/1357633042614258] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Videoconferencing at 384 kbit/s for the transmission of echocardiograms has proved useful for the assessment of children with suspected cardiac disease, in regional areas of Queensland. A retrospective review of patient and management outcomes was conducted on cardiac teleconsultations performed at two regional hospitals during the period November 2000 to February 2004, inclusive. There were 106 echo studies. A subset of 72 cardiac teleconsultations performed between May 2001 and February 2004 was reviewed in detail. The median age of patients at the time of consultation was 3 months (range 1 day–1 7 years). Sixteen per cent of teleconsultations were classified as urgent and were conducted on the same day as referral. Following the videoconference, 90% of patients could be managed locally and reviewed by the paediatrician or visiting paediatric cardiologist during an outreach clinic. Six children (8%) had significant cardiac lesions that were initially managed locally, with subsequent elective transfer at the appropriate time for treatment. Only one child (1%) required urgent transfer to the tertiary centre for specialist care and surgery. Telecardiology was effective in accurately identifying congenital heart disease. Paediatric telecardiology is an evolving modality of assessment and communication, and is likely to result in continued improvements in patient care, patient outcomes and parental satisfaction, in provincial centres removed from the tertiary cardiac centre.
Collapse
|
25
|
Scalvini S, Zanelli E, Paletta L, Benigno M, Domeneghini D, De Giuli F, Giordano A, Glisenti F. Chronic heart failure home-based management with a telecardiology system: A comparison between patients followed by general practitioners and by a cardiology department. J Telemed Telecare 2016; 12 Suppl 1:46-8. [PMID: 16884578 DOI: 10.1258/135763306777978461] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A group of patients with chronic heart failure (CHF) were followed by general practitioners (GPs) with a telecardiology system, and a second group of patients were followed by a home-based telemonitoring (HBT) protocol with medical and nursing supervision. The 212 GP patients were older than the 226 HBT patients, mostly women, with CHF secondary to chronic hypertension, less self-sufficient and with a non-optimized therapy. The mean number of telephone calls was 2.6 per patient in the GP group and 16.6 per patient in the HBT group (P<0.001). These preliminary data suggest the applicability and the efficacy of both management models for CHF patients.
Collapse
Affiliation(s)
- Simonetta Scalvini
- Cardiology Division, S Maugeri Foundation, IRCCS, Gussago (Brescia), Rome, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
26
|
Abstract
Background: The clinical presentation of chest pain is a major problem for primary health care professionals. Rapid access chest pain clinics (RACPC) enable quick assessment, investigation and formation of a treatment plan for such patients without a waiting list. There has been a chest pain clinic in operation at Harefield Hospital since 1988. Until 2001, the cardiology registrars were responsible for the clinic. Beginning in January 2001, the management of the clinic was taken over by the Cardiology Nurse Consultant. This paper will describe the organisation and outcomes of the first 3 years of this nurse-run RACPC. Process: Patients are seen within 2 weeks of referral in line with the National Service Framework for Coronary Heart Disease [Department of Health. National service framework for coronary heart disease. Dept of Health; 2000. London.]. An electrocardiogram (ECG) is recorded on arrival in the clinic and the Nurse Consultant then examines the patients and decides if further investigation is required. Analysis of Results: Four hundred and fifty-four patients were seen in the clinic from January 2001–December 2003. Three hundred and twenty-four patients (71.4%) underwent exercise testing of which 54 (16.7%) had a positive result. One hundred and thirteen patients (24.9%) were referred for angiography. Of these, 75 (66.4%) had coronary heart disease. Thirty-three patients (29.2%) have undergone percutaneous coronary intervention (PCI) and 19 (16.8%) have required coronary artery bypass grafting (CABG). Twenty-three patients (20.4%) are being treated medically. Satisfaction with the service offered by the clinic was high, evidenced by the results of questionnaires sent to patients. Conclusion: This paper demonstrates that nurses can successfully run RACPCs without an increased risk of incorrect diagnosis. These clinics offer patients timely access to assessment of their chest pain and facilitate early diagnosis of cardiac disease. They are also well accepted by the patients attending the clinic.
Collapse
Affiliation(s)
- Alison Pottle
- Cardiology Nurse Consultant, Royal Brompton and Harefield NHS Trust, Harefield Hospital, Hill End Road, Harefield, Middlesex, UB9 6JH, UK.
| |
Collapse
|
27
|
Zhai YK. Research on the functions of developing telemedicine service and establishing regional medical conjoined system. J BUON 2016; 21:1061-1067. [PMID: 27837605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This article introduces the technical requirements, standards, operation models, the domestic development status and problems of developing telemedicine technology, the necessity of establishing regional medical system, and the conception of cloud model, respectively. Based on the analysis of cardiovascular treatment cases in our hospital, this article suggests that developing telemedicine service and establishing regional medical conjoint system is the necessary direction of the domestic medical development. As with all kinds of difficulties, one can learn from the success cases and formulate practical and feasible measures according to the practical reality of different areas in China.
Collapse
Affiliation(s)
- Yun-Kai Zhai
- Management Engineering School, Zhengzhou University, Zhengzhou, People's Republic of China
| |
Collapse
|
28
|
Melvan JN, Halkos ME. Multidisciplinary motion economy in the cardiothoracic intensive care unit. J Thorac Cardiovasc Surg 2015; 151:319-20. [PMID: 26602898 DOI: 10.1016/j.jtcvs.2015.09.089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 09/02/2015] [Accepted: 09/22/2015] [Indexed: 11/18/2022]
Affiliation(s)
- John N Melvan
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Ga.
| | - Michael E Halkos
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Ga
| |
Collapse
|
29
|
New service models proposed for cardiac disease services. Nurs Child Young People 2015; 27:6. [PMID: 26360159 DOI: 10.7748/ncyp.27.7.6.s3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
|
30
|
Schiff E, Dubretzki-Mery I, Attias S, Ben-Arye E, Kreindler G, Avneri O, Ben Ezra A, Arnon Z, Grinberg I, Rosenshein U. [Integration of complementary medicine in hospital departments: implementation model and research outline in the Cardiology Department]. Harefuah 2015; 154:35-67. [PMID: 25796673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Systematic integration of complementary medicine in hospital departments for inpatients is rarely discussed in the medical literature. Positive outcomes from trials in this setting should encourage evaluation of complementary medicine services in hospitals. OBJECTIVE To identify the potential role of complementary medicine in the Cardiology Department, characterize its implementation process, and conduct a feasibility study in this context. METHODS A narrative overview of the implementation process of complementary medicine in the Cardiology Department was used alongside a statistical analysis of a feasibility trial This was in order to determine the sample size for a larger pragmatic trial that will assess the effectiveness of complementary medicine, as compared to standard of care, in relieving common symptoms of patients hospitalized in the Cardiology Department. RESULTS Focus groups consisting of representatives from the Cardiology Department, and the Complementary Medicine Service identified areas for possible integration of complementary medicine in the Cardiology Department. A literature review was conducted in order to assess complementary medicine effectiveness and safety in this setting. Consequently, appropriate treatment protocols were developed. The Complementary Medicine team participated in cardiology patient rounds, and presentations on complementary medicine were provided to the cardiology staff. Treatment indications, and contraindications were mutually developed, and questionnaires to assess treatment effectiveness were developed. A feasibility trial was completed for 237 patients who were treated with complementary medicine. CONCLUSIONS Integration of complementary medicine in an inpatient setting is possible following a carefully structured implementation process that is shared by champions from the medical department and the Complementary Medicine Service. Results from the feasibility trial indicate the potential positive role that complementary medicine treatments have on common symptoms of inpatients at the Cardiology Department. There is a need for high quality trials that will assess the effectiveness of complementary medicine treatments in this setting.
Collapse
|
31
|
Liu CY, Lin YN, Lin CL, Chang YJ, Hsu YH, Tsai WC, Kao CH. Cardiologist service volume, percutaneous coronary intervention and hospital level in relation to medical costs and mortality in patients with acute myocardial infarction: a nationwide study. QJM 2014; 107:557-64. [PMID: 24570479 DOI: 10.1093/qjmed/hcu044] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND We explore whether cardiologist service volume, hospital level and percutaneous coronary intervention (PCI) are associated with medical costs and acute myocardial infarction (AMI) mortality. METHODS From the 1997-2010 Taiwan National Health Insurance Research Database of the National Health Research Institute, we identified AMI patients and performed multiple regression analyses to explore the relationships among the different hospital levels and treatment factors. RESULTS We identified 2942 patients with AMI in medical centers and 4325 patients with AMI in regional hospitals. Cardiologist service volume, performing PCI and medical costs per patient were higher in medical centers than in regional hospitals (P < 0.0001). However, the two hospital levels did not differ significantly in in-hospital mortality (P = 0.1557). Post hoc analysis showed significant differences in in-hospital mortality rate and in medical costs among the eight groups subdivided on the basis of hospital level, cardiologist service volume, and whether PCI was performed (P < 0.001 and P = 0.001, respectively). CONCLUSIONS These results highlight the importance of encouraging hospitals to develop PCI capability and increase their cardiologist service volume after taking medical costs into account. Transferring AMI patients to hospitals with higher cardiologist service volume and PCI performed can also be very important.
Collapse
Affiliation(s)
- C-Y Liu
- From the Department of Health Services Administration, China Medical University, Taichung, Department of Education, China Medical University Hospital, Taichung, Division of Cardiology, Department of Internal Medicine, China Medical University Hospital, Taichung, Management Office for Health Data, China Medical University Hospital, Taichung, Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, TaiwanFrom the Department of Health Services Administration, China Medical University, Taichung, Department of Education, China Medical University Hospital, Taichung, Division of Cardiology, Department of Internal Medicine, China Medical University Hospital, Taichung, Management Office for Health Data, China Medical University Hospital, Taichung, Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
| | - Y-N Lin
- From the Department of Health Services Administration, China Medical University, Taichung, Department of Education, China Medical University Hospital, Taichung, Division of Cardiology, Department of Internal Medicine, China Medical University Hospital, Taichung, Management Office for Health Data, China Medical University Hospital, Taichung, Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
| | - C-L Lin
- From the Department of Health Services Administration, China Medical University, Taichung, Department of Education, China Medical University Hospital, Taichung, Division of Cardiology, Department of Internal Medicine, China Medical University Hospital, Taichung, Management Office for Health Data, China Medical University Hospital, Taichung, Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
| | - Y-J Chang
- From the Department of Health Services Administration, China Medical University, Taichung, Department of Education, China Medical University Hospital, Taichung, Division of Cardiology, Department of Internal Medicine, China Medical University Hospital, Taichung, Management Office for Health Data, China Medical University Hospital, Taichung, Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
| | - Y-H Hsu
- From the Department of Health Services Administration, China Medical University, Taichung, Department of Education, China Medical University Hospital, Taichung, Division of Cardiology, Department of Internal Medicine, China Medical University Hospital, Taichung, Management Office for Health Data, China Medical University Hospital, Taichung, Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, TaiwanFrom the Department of Health Services Administration, China Medical University, Taichung, Department of Education, China Medical University Hospital, Taichung, Division of Cardiology, Department of Internal Medicine, China Medical University Hospital, Taichung, Management Office for Health Data, China Medical University Hospital, Taichung, Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, TaiwanFrom the Department of Health Services Administration, China Medical University, Taichung, Department of Education, China Medical University Hospital, Taichung, Division of Cardiology, Department of Internal Medicine, China Medical University Hospital, Taichung, Management Office for Health Data, China Medical University Hospital, Taichung, Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, C
| | - W-C Tsai
- From the Department of Health Services Administration, China Medical University, Taichung, Department of Education, China Medical University Hospital, Taichung, Division of Cardiology, Department of Internal Medicine, China Medical University Hospital, Taichung, Management Office for Health Data, China Medical University Hospital, Taichung, Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
| | - C-H Kao
- From the Department of Health Services Administration, China Medical University, Taichung, Department of Education, China Medical University Hospital, Taichung, Division of Cardiology, Department of Internal Medicine, China Medical University Hospital, Taichung, Management Office for Health Data, China Medical University Hospital, Taichung, Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, TaiwanFrom the Department of Health Services Administration, China Medical University, Taichung, Department of Education, China Medical University Hospital, Taichung, Division of Cardiology, Department of Internal Medicine, China Medical University Hospital, Taichung, Management Office for Health Data, China Medical University Hospital, Taichung, Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
| |
Collapse
|
32
|
Bakshi SMH. Business process re-engineering a cardiology department. World Hosp Health Serv 2014; 50:40-45. [PMID: 26502490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The health care sector is the world's third largest industry and is facing several problems such as excessive waiting times for patients, lack of access to information, high costs of delivery and medical errors. Health care managers seek the help of process re-engineering methods to discover the best processes and to re-engineer existing processes to optimize productivity without compromising on quality. Business process re-engineering refers to the fundamental rethinking and radical redesign of business processes to achieve dramatic improvements in critical, contemporary measures of performance, such as cost, quality and speed. The present study is carried out at a tertiary care corporate hospital with 1000-plus-bed facility. A descriptive study and case study method is used with intensive, careful and complete observation of patient flow, delays, short comings in patient movement and workflow. Data is collected through observations, informal interviews and analyzed by matrix analysis. Flowcharts were drawn for the various work activities of the cardiology department including workflow of the admission process, workflow in the ward and ICCU, workflow of the patient for catheterization laboratory procedure, and in the billing and discharge process. The problems of the existing system were studied and necessary suggestions were recommended to cardiology department module with an illustrated flowchart.
Collapse
|
33
|
Osborne A, Weston J, Wheatley M, O'Malley R, Leach G, Pitts S, Schrager J, Holmes K, Ross M. Characteristics of hospital observation services: a society of cardiovascular patient care survey. Crit Pathw Cardiol 2013; 12:45-48. [PMID: 23680807 DOI: 10.1097/hpc.0b013e318285c2b9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Little is known about the setting in which observation services are provided, or how observation patients are managed in settings such as accredited cardiovascular patient care centers. OBJECTIVE To describe the characteristics of observation services in accredited Cardiovascular Patient Care hospitals, or those seeking accreditation. METHODS This is a cross-sectional survey of hospitals either accredited by the Society of Cardiovascular Patient Care, or considering accreditation in 2010. The survey was a web-based free service linked to an e-mail sent to Cardiovascular Patient Care coordinators at the respective institutions. The survey included 17 questions which focused on hospital characteristics and observation services, specifically management, settings, staffing, utilization, and performance data. RESULTS Of the 789 accredited hospitals, 91 hospitals (11.5%) responded to the survey. Responding hospitals had a median of 250 inpatient beds (interquartile range [IQR] 277), 32.5 emergency department (ED) beds or hall spots, with an average annual ED census of 41,660 (IQR 30,149). These hospitals had an average of 8 (IQR 9) observation unit beds whose median length of stay (LOS) was 19 hours (IQR 8.1), with a discharge rate of 89.1% (IQR 15). There was an average of 1 observation bed to 3.8 ED beds. Observation units were most commonly administered by emergency medicine (48.5%), but staffed by a broad spectrum of specialties. Nonemergency medicine units had longer LOSs, which were not significant. Most common conditions were chest pain and abdominal pain. CONCLUSIONS Accredited chest pain centers have observation units whose LOSs and discharge rates are comparable to prior studies with utilization patterns that may serve as benchmarks for similar hospitals.
Collapse
Affiliation(s)
- Anwar Osborne
- Emory University, Society of Cardiovascular Patient Care, Atlanta, GA, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Clover B. Major London trusts unveil cancer and cardiac shake-up. Health Serv J 2013; 123:4-5. [PMID: 23516940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
|
35
|
Hassager C. [Good Danish logistics on patients with acute coronary syndrome]. Ugeskr Laeger 2013; 175:179. [PMID: 23347732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
|
36
|
Hu DY. [Medical humanities and scientific development]. Zhonghua Xin Xue Guan Bing Za Zhi 2013; 41:1-2. [PMID: 23651958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
|
37
|
Payton B. A foundation for collaborative practice: building agreements between radiology and cardiology. Radiol Manage 2013; 35:46-49. [PMID: 23577533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Radiologists and cardiologists now face the same (or similar) regulatory changes, which will demand a level of cooperation between these physicians far beyond that which currently exists. Multiple, viable physician collaboration options do exist, but more often than not that model comes to fruition in the form of a hospital sponsored clinical institute model with a co-management agreement. Ultimately, most institutes move beyond cardiovascular imaging and move to create clinical platforms whereby interventional radiologists, cardiologists, and surgeons jointly develop best practices for all cardiovascular services.
Collapse
|
38
|
McCrossan BA, Sands AJ, Kileen T, Doherty NN, Casey FA. A fetal telecardiology service: patient preference and socio-economic factors. Prenat Diagn 2012; 32:883-7. [PMID: 22718083 DOI: 10.1002/pd.3926] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Revised: 05/26/2012] [Accepted: 05/27/2012] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The aims of this study were to evaluate patients' opinions on a fetal cardiology telemedicine service compared with usual outpatient care, the effect of the telemedicine consultation on maternal anxiety and its impact on travel times and time absent from work. METHODS Prospective study over 20 months. Eligible patients attended for routine anomaly scan followed by fetal echocardiogram transmitted to the regional centre with live guidance by a fetal cardiologist, followed by parental counselling. All patients were offered a fetal cardiology appointment at the regional centre. Structured questionnaires assessing maternal satisfaction, travel times/days off and anxiety scores completed at time of both fetal echocardiograms. RESULTS Sixty-seven patients were recruited and 66 completed the study. Participants expressed very high satisfaction rates with fetal telecardiology, equivalent to face-to-face consultation. The telecardiology appointments were associated with significantly reduced travel times and days off work (p < 0.01). Expectant mothers expressed a clear inclination for a fetal cardiology appointment at the local hospital facilitated by telemedicine (p < 0.01). CONCLUSIONS Fetal telecardiology is highly acceptable to patients and is even preferred compared with travelling to a regional centre. There are additional socio-economic benefits that should encourage the development of remote fetal cardiology services.
Collapse
Affiliation(s)
- Brian A McCrossan
- Department of Paediatric Cardiology, Royal Belfast Hospital for Sick Children, Belfast, Northern Ireland, UK.
| | | | | | | | | |
Collapse
|
39
|
Hern R, Swafford R, Winters G, Aldrich TE. Access to heart disease and stroke care in Tennessee. Tenn Med 2012; 105:45-49. [PMID: 22662492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Tennessee is ranked fourth-worst in the United States for deaths caused by stroke and third-worst in the nation for cardiovascular deaths. Two recent surveys provide information about the geographic distribution of hospital-based, primary and secondary care promotion, and of emergency medical services for these disease conditions. This article is a synthesis of selected findings from these surveys to identify priority populations for interventions to reduce cardiac and stroke mortality in Tennessee. Twenty-three counties have a medical facility with a formal clinical pathway or system for implementing cardiovascular disease prevention strategies. Sixty-three of the state's 95 counties have no designated specialty center for an EMS service to transport cardiac and stroke patients. Fifty-six counties, comprising 38 percent of the state's population, lie between 20 and 50 miles from the nearest state-of-the-art stroke care. Twenty-one counties, containing nearly 10 percent of the state's population, are greater than 50 miles from advanced stroke care facility. Some health districts are faring better than the state proportion (86.8 percent) for people indicating they would call 911 for a suspected cardiac or stroke emergency, while many are performing much poorer. The Shelby district (Memphis) is much higher (p < 0.01), while Madison and South Central districts are well below the state's prevalence (p < 0.001). The fact that these "less-likely-to-call-911" areas are also in mostly rural settings poses priority challenges for public education. To combat this trend, coordinated efforts are in progress to incentivize the development of cardiac and stroke centers or, alternatively, the formation of regional collaborative networks affiliated with a specialty center.
Collapse
|
40
|
|
41
|
Korzhenkov NP, Kuzichkina SF, Shcherbakova NA, Kukhaleishvili NR, Iarlykov II. [Optimal rehabilitation of patients with coronary heart disease in outpatient setting]. TERAPEVT ARKH 2012; 84:18-22. [PMID: 22616527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The problem of invalid rehabilitation in Russia is an important state task and dictates necessity of design of an effective state program of primary prevention of cardiovascular diseases. Common global practice of medico-social model is based on complex detailed medico-social aid. Rehabilitation of postmyocardial infarction patients consists of three phases (stages): hospital posthospital (readaptation) and postreconvalescent (supportive). The program includes physical, psychological and pharmacological rehabilitation. Departments of readaptation and medico-social rehabilitation provide effective conduction of all kinds of rehabilitation. The Moscow North-East Regional Administration has a rich experience in organization of departments of readaptation and medico-social rehabilitation. The departments practice an individual approach to the patients and work in a close contact with bureaus of medico-social commission of experts. Management of patients by cardiologist, rehabilitation specialist and outpatient clinic's physicians provides uninterrupted staged rehabilitation, timely correction of pharmacotherapy, early patient referral to invasive investigations and treatment of coronary heart disease. A course of rehabilitative measures lasts 2 months. Setting up departments of medico-social rehabilitation in outpatient clinics provides more effective use of money assigned by the state for social support of invalids.
Collapse
|
42
|
Society of Chest Pain Centers meeting the needs of critical access hospitals. Crit Pathw Cardiol 2011; 10:196. [PMID: 22089279 DOI: 10.1097/HPC.0b013e31823de226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
|
43
|
Society of Chest Pain Centers offers system discount for hospitals seeking Cycle IV Chest Pain Center accreditation. Crit Pathw Cardiol 2011; 10:195. [PMID: 22089278 DOI: 10.1097/HPC.0b013e3182347e51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
|
44
|
Mawson A, Reynolds L. Patient pathway. Decongesting cardiology. Health Serv J 2011; 121:18-20. [PMID: 21608180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Anne Mawson
- University Hospitals of Coventry and Warwickshire Trust.
| | | |
Collapse
|
45
|
Porkhanov VA, Kosmacheva ED, Kruberg LK, Pozdniakova OA, Fedorchenko AN, Bukhtoiarov AI, Liaskovskiĭ KO, Tupikin RS, Volkolup OS, Usachev AA, Lazebnyĭ PA. [Three years experience of catheter treatment of patients with acute coronary syndrome in conditions of 24-hour work of endovascular service]. Kardiologiia 2011; 51:22-27. [PMID: 22117767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
In this work we have summarized 3-years experience of the treatment of acute coronary syndrome with the use of endovascular methods and presented organizational basis allowing to realize 24-hour work of the endovascular service, and algorithm of examination and treatment of patients admitted with diagnosis of acute coronary syndrome. During the analyzed period invasive interventions were carried out in 1417 patients (transluminal angioplasty - in 93, angioplasty with stenting - in 1356 patients) with mean door to balloon time 37.7 min. For stenting we used 925 standard metal stents and 584 drug eluting stents. Coronary artery bypass surgery was performed in 150 patients. Severe complications during hospital stay developed in 3% of patients. Fifteen patients died, 14 of them were admitted in a state of cardiogenic shock. Repeat coronary angiography in remote period was fulfilled in 170 patients with recurrence of angina. Restenoses were found in 31.2% of these patients, predominantly in those with implanted standard metal stents.
Collapse
|
46
|
Ruda MI. [Acute coronary syndrome: the system of organization of treatment]. Kardiologiia 2011; 51:4-9. [PMID: 21627606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
|
47
|
|
48
|
Thyagarajan S, Chavan A, Al-Sabbagh A, Latifi S, Kelsall AW. The provision of cardiology services in a non-cardiac paediatric intensive care unit setting. Arch Dis Child 2010; 95:1068. [PMID: 20605866 DOI: 10.1136/adc.2009.170720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
49
|
|
50
|
Escárcega RO, Pérez-Alva JC, Jiménez-Hernández M, Mendoza-Pinto C, Pérez RS, Porras RS, García-Carrasco M. Transradial percutaneous coronary intervention without on-site cardiac surgery for stable coronary disease and myocardial infarction: preliminary report and initial experience in 174 patients. Isr Med Assoc J 2010; 12:592-597. [PMID: 21090513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND On-site cardiac surgery is not widely available in developing countries despite a high prevalence of coronary artery disease. OBJECTIVES To analyze the safety, feasibility and cost-effectiveness of transradial percutaneous coronary intervention without on-site cardiac surgery in a community hospital in a developing country. METHODS Of the 174 patients who underwent PCI for the first time in our center, we analyzed two groups: stable coronary disease and acute myocardial infarction. The primary endpoint was the rate of complications during the first 24 hours after PCI. We also analyzed the length of hospital stay and the rate of hospital readmission in the first week after PCI, and compared costs between the radial and femoral approaches. RESULTS The study group comprised 131 patients with stable coronary disease and 43 with acute MI. Among the patients with stable coronary disease 8 (6.1%) had pulse loss, 12 (9.16%) had on-site hematoma, and 3 (2.29%) had bleeding at the site of the puncture. Among the patients with acute MI, 3 (6.98) had pulse loss and 5 (11.63%) had bleeding at the site of the puncture. There were no cases of atriovenous fistula or nerve damage. In the stable coronary disease group, 130 patients (99%) were discharged on the same day (2.4 +/- 2 hours). In the acute MI group, the length of stay was 6.6 +/- 2.5 days with at least 24 hours in the intensive care unit. There were no hospital readmissions in the first week after the procedure. The total cost, which includes equipment related to the specific approach and recovery room stay, was significantly lower with the radial approach compared to the femoral approach (US$ 500 saving per intervention). CONCLUSIONS The transradial approach was safe and feasible in a community hospital in a developing country without on-site cardiac surgery backup. The radial artery approach is clearly more cost-effective than the femoral approach.
Collapse
Affiliation(s)
- Ricardo O Escárcega
- Department of Internal Medicine, Temple University Hospital, Philadelphia, PA 19140, USA.
| | | | | | | | | | | | | |
Collapse
|