Drs. Lynne Stevenson and James Kirshenbaum.
The University HealthSystem Consortium (UHC), an alliance of the clinical enterprises of 88 academic health centers that supports clinical benchmarking and sharing of best practices across member institutions, recently ranked BWH number one in the area of congestive heart failure (CHF) performance and second in acute myocardial infarction (AMI) performance. As a top performer in these areas, BWH was invited to the national Knowledge Transfer meeting for academic health centers on January 29 to present the hospital’s “success story.” Lynne Warner Stevenson, MD, Mary Lou Moore, RN, and Carol Flavell, RNP represented the hospital at the meeting.
“On behalf of all of the staff of Advanced Cardiac Disease Section at BWH, which provides care for heart failure, heart transplantation, and mechanical circulatory support, we are honored to have our program highlighted for its quality and outcomes,” said Lynne Warner Stevenson, MD, co-director of the Cardiomyopathy/Heart Failure Program. “We look forward to sharing our strategy to improve management of this serious condition with national colleagues.”
The key difference at BWH is the shared commitment to heart failure, integrating care at all levels in and out of the hospital. Specially, trained heart failure nurses and dedicated faculty join together to tailor therapy, achieving individualized goals for each heart failure patient. The inpatient care links closely with the outpatient Cardiomyopathy Clinic, and pants participate actively in their own progress. Sustained relief of symptoms, prevention of complications, and enhancement of activity are the highest priorities. Having first access to the developing technologies such as resynchronization pacing and cardiac assist devices helps to ensure that the best therapy can be selected for each patient.
“We are quite excited that our efforts to coordinate acute myocardial infarction care at BWH amongst the Department of Emergency Medicine, the catheterization laboratory, and the cardiac care units have led to such success,” said James Kirshenbaum, MD, director of Acute Interventional Cardiology. “This approach has enabled us to either meet or exceed all AMI benchmarks and provide exemplary care to our patients.”
The Cardiac Catheterization Laboratory team works closely with the Department of Emergency Medicine to help coordinate rapid diagnosis and triage of AMI patients to both insure immediate initiation of appropriate pharmacological therapy and expedite transport to the cardiac cath lab for primary angioplasty. This team approach routinely achieves “door to balloon” times that are far superior to national standards. New rapid cath lab response systems implemented over the past year often allow AMI patients to be treated in half the time reported at other major medical academic centers. In addition, in collaboration with the Nursing staff of the coronary care and telemetry units, they have implemented protocols to help insure compliance with evidence-based guidelines during hospitalization and at time of discharge.
BWH currently gathers data on CHF, AMI, and pregnancy-related conditions as part of the Joint Commission’s ORYX initiative, which seeks to integrate outcomes and other performance measurement data into the accreditation process. AMI and CHF performance data is also shared across Partners HealthCare System, Inc acute care hospitals, to similarly promote sharing of best practices and to ensure uniform high levels of quality. This effort has been incorporated as part of the new Partners Signature Initiative #3, called “Uniform Quality.”
In addition, under the National Hospital Voluntary Reporting initiative, all U.S. hospitals have been asked to voluntarily report outcomes of ten quality measures relating to the care provided to patients. The ten measures are related to three disease areas—AMI, heart failure and pneumonia. Beginning later this spring, the new measures, including BWH’s 2003 quarter two results, will be available online to the public by visiting (www.cms.hhs.gov).
On the local level, BWH also gathers and reports cardiac surgery and cardiac cath lab performance data to the Massachusetts Department of Health’s (DPH) Division of Health Care Quality as part of the state’s “Special Project: Primary Angioplasty.” The project aims to provide DPH with relevant information to assist in its assessment of the safety and efficacy of the performance of primary angioplasty and cardiac surgery in community hospitals, versus academic centers.
“There is a lot of momentum both at the national and local level around quality measurement, particularly in the area of cardiac health,” said Michael Gustafson, MD, MBA, executive director, BWH Center for Clinical Excellence. “It is wonderful to see BWH recognized as a top performer in heart failure and AMI. And as we move forward with our Quality Measurement Program and the five Partners Signature Initiatives, we will continue to see tremendous improvement.”