Blog Post

Sentara Heart Hospital's secrets to success for complex CAD patient care coordination

October 20, 2017

    Coronary artery disease (CAD), which affects 15.5 million U.S. adults, is the leading cause of death in America. Despite many efforts to reduce the burden of this disease through innovations in medical therapies, revascularization techniques, and technological innovations, hospitals continue to face significant challenges treating these patients.

    In particular, patients with complex CAD characterized by left-main coronary disease or multi-vessel blockages have proven particularly challenging to treat due to patient under-identification, clinical complexity compounded by a lack of standardized treatment practices, and resource-intensiveness.

    We recently spoke with six health systems who addressed this challenge head on via improved care coordination. These hospitals described how care coordination for complex CAD patients increases patient capture via provider education, enhances quality through better episodic care management, and reduces costs by enabling top-of license care.

    One hospital's story: Using coordinators backed by decision-making protocols

    Sentara Heart Hospital, a 150-bed destination heart hospital in the Middle Atlantic, uses three cross-trained coordinators and a standardized decision-making protocol to manage patients for the duration of their treatment.

    Before Sentara implemented these care coordination efforts, complex CAD patients waited in the hospital for extended periods of time and visited multiple cardiologists and surgeons before settling on a treatment plan. To streamline care, Sentara implemented the Complex High-Risk Indicated Patients (CHIP) work-up method, which formalizes the decision-making process for complex CAD patients' revascularization options.

    Care coordinators—advanced practice providers (APPs) who are cross trained in structural heart and complex CAD services—lead the CHIP work-up for each patient. As part of this process, they conduct a full assessment and present their findings at weekly Heart Team meetings. Together, members of the Heart Team determine the best option for revascularization. Since Sentara has just one interventional cardiologist who performs complex CAD interventions, having coordinators practice top-of-license care is critical to managing patients efficiently.

    In addition to leading the CHIP work-up, the coordinators also:

    • Schedule the procedures;
    • Scrub in to assist with procedures;
    • Round on patients during the inpatient stay;
    • Engage the referring physicians in the decision-making process, keeping them informed of their patients' progress;
    • Ensure patients have all necessary medications prior to discharge; and
    • Arrange follow-up appointments with patients' primary cardiologists. 

    As a result of implementing the CHIP work-up method and relying heavily on APPs for managing patients' care pathways, Sentara has experienced an increased volume of complex CAD referrals, amounting to 60 patients since program inception. A physician survey revealed that referring cardiologists appreciate how efficiently Sentara triages their patients, and are satisfied with patient outcomes.

     

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