CVForward  >  Lessons Learned from Building a Destination Structural Heart Clinic



Josh Roberts

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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.
3 Things They Did Right

1) Focus on reduced length of stay

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.

“We’re actually showing a profit on TAVR and our structural heart programs overall. A lot of it is due to length of stay reduction.”

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.

2) Hire the right physicians

It seems obvious, but Roberts still lists this as a factor that was absolutely critical to Piedmont’s success.

“One of the things that was very fortunate on our end was that our surgical team was really supportive of it, and saw the value of a structural heart program.”

In fact, on multiple levels, they had the right physicians in place:

  • Leadership: The lead surgeons, Drs. Jim Kauten and Morris Brown, were both deeply invested in the program from the start
  • Interventional cardiology: The physicians in place were committed to a focus on structural heart as a specialty. They saw the opportunity and the amazing advancements occurring in the field, and from the start wanted this to be their professional focus
  • Imaging: Another essential component: Piedmont has a group of highly talented, non-invasive imagery specialists that wanted to be involved and wanted to work with the team

3) Be clear about the mission and vision

“We are very clear about our mission and our vision. We want to be the destination center for heart and vascular care.”

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.

3 things they could have done better

1) Improve team coordination

“Mistake Number One would be lack of coordination among the care delivery team.”

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.

2) Have the resources in place

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.

3) Make outreach a priority

“Make sure you have a really good plan on how you’re going to do outreach in order to build a referral pathway.”

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.

 As Roberts reflects on where Piedmont’s program is today, he considers what they’ve learned:

“Four or five months ago we had a major complex vascular case, we had multiple open heart surgeries, three structural heart cases and a heart transplant going on. That day all those docs scrubbed into three or more different cases—and all those docs coordinated efforts to take care of all those patients. It was a huge team effort among the physicians and it all worked phenomenally. There were no bad outcomes. There were no delays. From a center of our size and the complexity, that is just phenomenal.”



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About Piedmont Healthcare

A private, not-for-profit organization with nearly 660 locations serving nearly 2 million patients across Georgia, Piedmont is transforming healthcare, creating a destination known 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 11 hospitals, 24 urgent care centers, 28 Piedmont QuickCare locations, 555 Piedmont Clinic physician practice locations and more than 2,000 Piedmont Clinic members. Our 22,000-plus employees dedicate themselves to making a positive difference in every life we touch and our commitment doesn’t stop there. In FY 2018, Piedmont provided nearly $225 million in uncompensated care community benefit programming in an effort to better the health and well-being of the people in the communities we serve. For more information, visit

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