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35 QUALITY IMPROVEMENT & MEASUREMENT How Healthgrades' best hospitals for cardiac care are working to improve outcomes By Kelly Gooch A multidisciplinary team approach, a program for coronary artery bypass surgery patients and professional develop- ment of critical care nursing staff are among the initiatives hospitals and health systems have implemented to improve clinical outcomes in heart care. For a closer look at these efforts, Becker's Hospital Review asked organizations on Healthgrades' list of top hospitals for cardiac care to share how they are working to improve clinical outcomes in heart bypass surgery, coronary interventional procedures, heart attack treatment, heart failure treatment and/or heart valve surgery. eir responses are presented below, alphabetically. Editor's note: Responses were lightly edited for length and clarity. Sabet Hashim, MD. Chair of Cardiac Surgery and Co-Physician in Chief of the Hartford (Conn.) HealthCare Heart & Vascular Insti- tute: About two years ago, the heart and vascular institute developed a new program called Enhanced Recovery Aer Cardiac Surgery for coronary artery bypass surgery patients. e goals were clear: reduce narcotic use, reduce the rate of postoperative atrial fibrillation, reduce a patient's length of stay and improve patient satisfaction. e initiative was organized by cardiac surgeons, cardiac anesthesiolo- gists, pharmacists, advanced practitioners and nurses — a multidis- ciplinary team that always kept the patient in mind. Together, we implemented an algorithm that defined, on a day-to-day basis, the milestones to be achieved with documentation of any deviation from the expected care. We focused on preventing atrial fibrillation, elimi- nation of fluid retention and reduction of postoperative pain. For pain management, we used a new combination that includes low-dose narcotics with oral Tylenol and anti-inflammatory agents. e program has been incredibly successful in reducing narcotic use while also improving patient satisfaction. Our data was presented at the Society of oracic Surgeons' annual national meeting and has shown other success, including a significant reduction in the rate of postoperative atrial fibrillation, intensive care unit length of stay, as well as the total postoperative length of stay. Dean Kereiakes, MD. Medical Director of the Christ Hospital Heart and Vascular Center (Cincinnati): e care here in heart and vascular has been driven by clinical research. Clinical research drives quality, and excellence in patient care at the Christ Hospital through innovation and technology. We create programs for patient care around specific disease entities like heart failure, women's heart health, complex coronary intervention, and we design those programs with a credible physician champion, enable them with infrastructure support, meaning a clinical coordinator/navigator and dedicated advanced practice providers who are disease-focused. Each of those miniature Centers for Excellence are then matrixed with the Lindner Research Center at the Christ Hospital for access to leading-edge technologies. So when we decided to focus on women's heart health, we hired Odayme Quesada, MD, an established clinical researcher from the Barbra Streisand Women's Heart Center at the Smidt Heart Institute at Cedars-Sinai in Los Angeles, and we enabled her with a superstar nurse practitioner, specialized scheduler, and we've already got mul- tiple clinical research trials on microvascular disfunction, microvas- cular angina, and Dr. Quesada has a $1 million National Institutes of Health grant. Also, to stabilize critical care nursing units, like cardiovascular in- tensive care unit, cardiovascular operating room and catheterization labs, we raised philanthropic gis to underwrite educational and professional development of our critical care nursing staff to under- write their credentialing, certification, professional society member- ship, and created a clinical ladder based on those objectives. If they satisfy certain objectives, they get a salary bonus. So we invest in and incentivize our nursing staff. Our turnover rate in the cardiovascular ICU was between 30 percent and 35 percent. Now, for three years in a row, we have a documented turnover rate well below the national average at 10 percent or less. at philanthropic investment resulted in a huge increase in quality. When you retain these people, and they get smarter and better, everybody wins. Farhan Khawaja, MD. Interventional Cardiologist and Presi- dent of Orlando (Fla.) Health Heart and Vascular Institute: One quality initiative that we performed over the last year was a total care redesign of our heart failure services. To strengthen our existing initiatives and add new strategies to reduce readmission rates, we set out to design a more comprehensive program that addresses these patients throughout the care continuum. We now have a system of seamless transition from the hospital to home that includes rapid follow-up in our advanced practice provider heart failure clinics, re- mote patient monitoring, social work, pharmacy and multiple other resources available to our patients. Srinivas Murali, MD. Chair of the Allegheny Health Network Department of Cardiovascular Medicine and Stephen Bailey, MD. Director of Cardiac Surgery at Allegheny General Hospital (Pittsburgh): At Allegheny General Hospital, we've implemented a multidisciplinary team approach to ensure the best patient-centered, evidence-based clinical practice throughout all programs under the AHN Cardiovascular Institute. We mobilize highly specialized clinicians from across all cardiovascular health disciplines to design effective care pathways for patients living with complex heart and vascular diseases. To further sustain this success, we also measure our performance against a rigorous quality assessment program that allows for outcomes tracking in real time. e integrated program offers full visibility into quality metrics, which in turn, allows our teams to identify areas of success and opportunities for improvement and innovation. By leveraging our multidisciplinary heart specialist teams and informed decision-making, we're able to drive high-qual- ity clinical outcomes and an exceptional overall experience for our cardiac patients. Oana Madalina Petrescu, MD. Cardiologist with the Swedish Heart and Vascular Institute (Seattle): One key initiative of the Swedish Heart and Vascular Institute this year is our quality care initiative. It is part of the greater effort to create meaningful impact at the patient level in order to improve outcomes in patients with valvular heart disease and reduce cost of care. Our efforts in this space include artificial intelligence and smart data capture; standard-