Diversified treatment options and expanded eligibility for patients with heart valve diseases has led to a growing demand for care. Given that patients present with a range of conditions and severities, the number of tests and consultations needed to determine the appropriate course of treatment is time and resource intensive. It requires a multi-step pre-procedure process that relies on coordination between departments. To enhance operational efficiency and accommodate volumes, programs create standardized pre-procedure workflows with replicable steps for patient workup.
How Atrium’s standardized pathways optimize pre-procedure care
Atrium’s pre-procedure workflow (see pg. 11 of the PDF) consists of three disease-specific care pathways designed to organize patients based on workup needed prior to Valve Day. Valve Days are specific days of the week reserved for diagnostic testing and physician consults—consolidating everything into two patient visits. This process flow standardizes work to help staff anticipate workloads and allocate time and resources accordingly. As a result, patients have fewer doctor visits, and the heart team gains the predictability needed to manage growing volumes.
Elements of the optimized workflow
Condition specific care pathways
- “Fast track” patients who only need tests ordered and are ready for physician consult
- Mitral and more complex aortic stenosis patients who require additional review
- Straight surgical candidates who follow a predetermined CT surgery pathway
Consolidated Valve Days
- Day 1: Diagnostic testing & Interventional Cardiologist visit
- Day 2: CT surgery consult & consults with other subspecialties as needed
Reserved scheduling blocks
- Reserved imaging/testing access on Valve Days
- Blocks on imager calendars to create a work queue for case review
Atrium operationalizes Valve Days using reserved scheduling blocks
Valve Days are made possible by scheduling blocks that reserve access to necessary imaging and testing. Since capacity restraints can make it difficult to protect access to resources, Atrium had to make a case for why reserved access is crucial to patient outcomes and program success.
Tactics to make the case for reserved imaging and testing access
Use data to demonstrate need and potential impact
- Map out a sample patient pathway and pinpoint areas of inefficiency
- Quantify time lost to scheduling delays and highlight the timeline improvement potential of using scheduling blocks
- Compare current timelines to the 42-day national average
- Frame the ask as a patient-centered solution by explaining the correlation between care delays and adverse outcomes
Demonstrate commitment to a continued partnership
- Commit to monitoring utilization trends on a regular basis and adjust time blocks as necessary
- Guarantee to fill 8 patient imaging/testing appointment slots per week and release any slots that are not filled 72 hours in advance
By demonstrating the mutual benefits of collaboration, Atrium’s heart team was able to establish leadership-buy in and secure reserved access to weekly imaging blocks.
Atrium created an imager queue to enable access to real-time consultation
The heart team uses schedule blocks to hold time for cardiac imagers on Valve Days. They have a work queue in the EMR where imagers review and leave input during these blocks. The queue creates on-demand access to imager review, enabling the heart team to make timely, informed decisions. Many organizations wait until the next multidisciplinary conference to get input from imagers, creating unnecessary delays.
How Atrium continues to adjust processes to enhance efficiency
This work requires trial and adjustment. Programs should continually evaluate and adapt their processes to identify areas for improvement, increase workforce capacity, and continue to meet growing volumes.
Since creating their valve center process flow in August 2021, Atrium has identified areas for improvement and implemented new solutions.
Atrium Health’s Sanger Heart & Vascular Institute’s Valve Center Process Flow
Atrium Health’s Sanger Heart & Vascular Institute developed the below process flow to optimize pre-procedure patient workup.