Cardiovascular Rounds

News, resources, and analysis from the Cardiovascular Roundtable

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How Carolinas HealthCare System cut its CABG readmission rate in half

by Julie Bass April 6, 2016

In 2014, Carolinas HealthCare System—a system across North and South Carolina including three hospitals in the Charlotte region that comprise the Sanger Heart & Vascular Institute—launched a comprehensive CV procedural readmission reduction initiative in preparation for greater scrutiny for these conditions. Their data-driven, multidisciplinary, and cross-continuum approach has yielded great success already: just one year after beginning the initiative, Sanger Heart & Vascular Institute (SHVI) reduced 30-day CABG readmissions to any site from 15.3% to 7.1% combined across all three hospitals.

At the recent Cardiovascular Roundtable meeting in Atlanta, two members of SHVI CV leadership team—Tom Draper, Assistant VP of Surgical Services and President-Elect of the AACVPR, and Stephen Wright, Assistant VP for Invasive Cardiology Services—joined us for a panel discussion to provide insight into their efforts for reducing procedural readmissions and answer member questions.

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Pharmacists: The player you need on your CABG readmission team

by Julie Bass April 4, 2016

A recent study in the Journal of Evaluation in Clinical Practice reported that over one-third of seniors are given improper prescriptions upon hospital discharge for cardiology and internal medicine services. As if that’s not concerning enough, another study in the American Journal of Health-System Pharmacy found that as of 2014, only 18% of pharmacy teams played a role in post-discharge medication management or reconciliation—the comprehensive evaluation of a patient’s medication regimen at care transitions (e.g., admission, transfer, discharge).

Effective medication reconciliation (med-rec) is critical for patient safety, appropriate medication use, improving medication adherence, and reducing preventable readmissions. Recognizing an opportunity to boost medication management and adherence in CV surgery patients, New Hanover Medical Center in Wilmington, N.C., developed a strategy to hardwire pharmacist support pre- and post-discharge.

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How much can your CV service line save from better observation care?

by Julie Bass March 29, 2016

Observation use has become increasingly common, growing over 96% since 2006. There are several potential drivers for this increase, including ambiguity in appropriateness of admission, concern over inpatient payment denials, and avoiding CMS readmission penalty.

While observation offers an opportunity for programs to identify the most appropriate treatment and care setting for a patient—avoiding unnecessary admissions—inefficient observation management can lead to excessive costs as well as patient dissatisfaction.

Optimizing observation services is particularly pertinent for CV programs, as over a quarter of observation cases are for CV-related issues. In fact, we calculated just how much hospitals can save by decreasing observation length of stay for common CV conditions—and it’s a lot.

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Depression and CV disease: How deep a connection is there?

by Marissa Schwartz March 23, 2016

From debates over appropriate treatment to proposals for universal screening, mental health has held the national spotlight in recent months. As hospitals and health systems increasingly adopt risk-based approaches to treatment, they are also paying more attention to how improvements in mental health can lead to better outcomes in other disease states. Given the strong ties between mental health conditions and CV disease, CV leaders should follow suit.

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TAVR news: Medtronic launches trial, FDA expands SAPIEN XT use

by Marissa Schwartz March 16, 2016

TAVR volumes are growing, trial indications have expanded to low-risk patients, and outcomes appear to be improving.

CV leaders are inundated with information about TAVR, so keeping abreast of the latest news and most important updates can be challenging. Read on to understand two key updates for programs: a new real-world trial for CoreValve’s Evolut R device, and coverage expansion of SAPIEN XT for use in pulmonary valve replacement.

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Quick poll: Who creates cardiac monitor reports?

by Aaron Mauck March 14, 2016

Here at the Cardiovascular Roundtable, we receive a lot of questions about how to best structure the CV care team to ensure top-of-license care. One recent question we received from a member that piqued our interest concerned the staff responsible for creating the reports from cardiac monitor recordings (e.g., mobile cardiac outpatient telemetry, Holter monitors, event monitors).

So we would like to put the question to you. 

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Use data to solve your greatest readmission mysteries

by Julie Bass March 9, 2016

When developing a readmission reduction strategy, one of the greatest challenges for CV leaders can be knowing where to focus their limited resources.

For CV procedural readmissions, the medical evidence is largely consistent on the root causes driving patients back to the hospital, giving CV leaders at least a starting point for where to target their efforts. However, for medical and procedural readmissions alike, there is no silver bullet readmission reduction strategy.

Programs must therefore use a data-driven approach to identify the greatest opportunities for improvement across the care continuum at their own institution, and use proven strategies to target these gaps in care.

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Q&A: Inside New Hanover's CABG readmission reduction program

by Julie Bass February 29, 2016

New Hanover Regional Medical Center, a 650-bed teaching hospital in Wilmington, N.C., has developed a comprehensive cardiac surgery readmission reduction initiative that is data-driven, multidisciplinary, and resource-efficient. And not to mention effective: in the first year since implementing its targeted strategy, the organization reduced 30-day, same-site CABG readmissions from 10% to 6.9%.

At the recent Cardiovascular Roundtable national meeting in Chicago, three members of NHRMC’s CABG readmission reduction leadership team—David Parks, VP of Cardiac and Clinical Support Services, Janet DeLucca, Administrator for Cardiac Services, and Dr. Peter Kane, CV Surgeon—joined us for a panel discussion to discuss their efforts and answer your questions.

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