CVForward > Lessons Learned from Building a Destination Structural Heart Clinic
The structural heart program at Piedmont Healthcare is one of the industry’s biggest success stories. Previously, Josh Roberts shared 5 Steps to Building a Destination Structural Heart Clinic describing how they went about creating that program. In this article, Roberts shares some valuable lessons that Piedmont Healthcare learned along the way.
A big reason for the success of Piedmont is that from the beginning, getting the patient out of the hospital was a central focus. At the start of the program, average LoS for a patient having a TAVR was 5 days. This required resources and staff, and was a key barrier to the financial viability of the program.
At the start of the program, Piedmont planned a clear patient pathway, with a dedicated group that included process engineers and clinical teams. They laid out order sets, support staff recommendations, and built the pathway into their EMR so they could track compliance. They built in procedures to ensure that when a patient fell off the pathway, they knew how to get the patient back on track. At the heart of all of this was a team that was passionate about finding innovative ways to reduce LoS.
Today, through collaboration among nursing floors, ICUs, the cath lab, the OR, and more, Piedmont’s TAVR LoS stands at 1 day.
It seems obvious, but Roberts still lists this as a factor that was absolutely critical to Piedmont’s success.
In fact, on multiple levels, they had the right physicians in place:
From the very start, Piedmont committed to the concept of physicians who were engaged as leaders. Being clear about that up front has led to the entrepreneurial spirit that has been critical to the program’s growth and success.
At the start of the program, Piedmont quickly found they were not as coordinated as they needed to be. This can be a stumbling block, but is also an opportunity for efficiency and collaboration.
Robert’s recommendation would be to get all the players involved aligned, so there is a clear understanding of why the patient was selected and what the approach will be. The team meets weekly to discuss the patient’s specifics. Also, they have monthly strategic/operational standing meetings with clear owners, action items, and due dates.
The hospital infrastructure is a resource that Piedmont found was overtaxed when they were getting their program off the ground. They had only one hybrid OR and found they had to work around that with other service lines. They also had to quickly come to terms with the fact that many of their procedures shut down TWO cath labs.
Roberts strongly recommends a well thought-out plan for how resources will be utilized when embarking on a structural heart program. At Piedmont, structural heart procedures are typically performed on Tuesday, Wednesday and Friday each week.
The success of the program will depend on having physicians who are ready and eager to be on the frontlines for creating awareness. Piedmont interventional cardiologists went out all over the state. They met with other hospitals and physician groups to tell them about the program and what it had to offer.
Not all physicians are eager to take this task on—but Roberts recommends making it a core consideration when you start a program.
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A private, not-for-profit organization serving nearly 2 million patients across Georgia, Piedmont is transforming healthcare, creating a destination for the best clinicians and a one-of-a-kind experience that always puts patients first. Today, more than 110 years since it was founded, Piedmont is known as a leading health system in cancer care, treatment of heart disease, and organ transplantation with 7 hospitals, 19 urgent care centers, 94 physician practice locations, and 1615 Piedmont Clinic members. Our 16,500 employees dedicate themselves to making a positive difference in every life we touch, and our commitment doesn’t stop there. In FY 2016, Piedmont provided more than $142 million in uncompensated care and invested an additional $9.6 million in community benefit programming, in an effort to better the health and well-being of the people in the communities we serve.
By Marie-France Poulin, MD; Hussam Suradi, MD; and Clifford J. Kavinsky, MD, PhD
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