By Becky Wiese
The word “team” often has to do with sports — a group working together to achieve a goal: to win. They focus on the opponent for a couple of hours, do their best, then call it a day, log a W or L, and move on to the next opponent.
That model doesn’t work quite as well for cardiovascular teams. They certainly work together to achieve a goal, that being the improved health of their patient, but the entire team doesn’t “play” at the same time. A better analogy might be a journey. Unique teams make up the different stops along a journey to health and healing.
Case in point is the award-winning Cardiovascular Team at OSF St. Joseph Medical Center. The awards and recognition in 2016 alone are impressive and especially meaningful during the 25th year of the OSF St. Joseph Open Heart Program.
- Named as one of Truven Health Analytics’ 50 Top Cardiovascular Hospitals for achieving superior clinical outcomes in cardiovascular care.
- Certification by the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) for the commitment to improving quality of life by enhancing standards of care. This peer-reviewed accreditation process involved extensive documentation of the program’s practices and recognizes leaders in the field of cardiovascular and pulmonary rehabilitation.
- Recognition by Healthgrades for clinical excellence in Vascular and other surgeries—winning the 2016 Healthgrades Vascular
- Surgery Excellence Award for performing at a 5-star level, ranking OSF among the top 1% in the country. Superior outcomes were analyzed over a three year period for superior outcomes in abdominal aortic aneurysms, carotid surgery and peripheral vascular bypass surgery.
- Listed among the Becker’s Hospital Review’s 2016 “100 Hospitals and Health Systems with Great Heart Programs,” which recognizes national leaders in various aspects of cardiovascular care.
In other words, the final product from this particular team is more often than not a healthier, well-cared-for heart patient.
A team made up of teams
Caring for the cardiac health of a patient involves a number of teams, each a subset in the cardiovascular care umbrella. Where patients come under that umbrella, for the most part, rests on their own shoulders based on how well they care for their health.
For example, patient A may have hereditary heart disease concerns, so she may see a cardiologist, before a health crisis happens. Patient B may have experienced numbness, tingling, and shortness of breath while shoveling snow, so he came in through the Emergency Department at the hospital.
Regardless of where patients enter the cardiac care sequence at St. Joseph, they will be treated by some of the best in the profession during the entire process of their return to health.
The physicians (interventional cardiologists — Drs. Yogesh Agarwal and Murali Senapathi), technicians, and nurses in the Cardiac Catheterization Lab (“Cath Lab”) not only perform diagnostic procedures, but also can take more minor, less invasive actions, which might be all the patient needs. “For example,” explains Laura Evey, a cardioradiographer in the Cath Lab, “a patient might come in after having some questionable results on a stress test — chest pain, shortness of breath — and we can go in and see if there are blockages in the vessels around the heart.”
“If that’s the case,” Jen Patterson, a Cath Lab RN, goes on to say, “we can often put in a stent or a balloon right there in the Cath Lab. We’ll keep the patient overnight in the comprehensive care center, but that might be all the intervention needed.”
Well, maybe all the medical intervention needed. The patient may also need to see the Rehab Team to solidify the results of the procedure done in the Cath Lab. The stent or balloon may have fixed the immediate issue, but in rehab, the patient will receive tools to maintain changes and make lifestyle modifications in their food choices, exercise program, and help with smoking cessation strategies if necessary.
The Rehab Team does extensive educational activities with patients.
Sometimes the results in the Cath Lab indicate the need for more significant intervention. If the cath shows blockage and/or a high degree of disease, the patient might need surgery. Most of the time, surgery is scheduled, but sometimes emergency surgery is necessary if a patient codes in the Cath Lab, has blockage in the left main artery (the “widow maker”), or comes in through the Emergency Department in full arrest.
The surgical team, led by OSF St. Joseph’s cardiothoracic surgeons, Dr. Brad Smith and Dr. Jesse VanLe, performs many different types of cardiovascular surgeries. “Surgery is usually necessary for ongoing, advanced disease,” says Jennifer Schmid, an OR nurse. “We do a lot of different surgeries, including coronary artery bypass, abdominal aortic aneurysm repair, pacemakers, valve replacement, carotid artery, minimally invasive lung surgeries including video-assisted lung resection and muscle sparing thoracotomy.”
Once a patient is out of surgery, the Cardiac ICU team takes over. They focus on the process of bringing the patient to a point of stability after what can be a very intensive event. “Once a patient is out of surgery, we watch for things like fluid shifts, blood pressure changes, and bleeding,” says Ted Hocking, an ICU nurse. Post-surgical benchmarks include becoming more lucid after being anesthetized, coming off the ventilator, taking out chest drains, sitting up, and walking.
“We can be fairly confident about the patient staying stable about 8 to 12 hours post surgery,” Hocking explains. “During that time is when a lot of explaining about the recovery process and educating them about what is going on takes place with the family.
Once a surgical patient is stable, someone from the Rehab Team will touch base with the patient (and/or the family) to set up rehab times. Rehab is important for full recovery, and the more compliant a patient is, the better the results. Patients work with physical therapists, respiratory therapists, and nurses to develop exercise regimens that are not only doable, but are fun. Exercises are done on treadmills, stationary bikes, elliptical machines, and other exercise equipment — in a combination that works best for the patient.
“The patients in rehab develop a special kind of camaraderie — they meet others in similar situations and help support each other regarding the lifestyle changes they need to make, whether it’s about their diet, exercise, or taking their meds,” says Patterson.
Special strategies to success
Although personnel may be at the top of the list for successful outcomes, a few strategies used at OSF St. Joseph also come into play. One of the strategies that creates a positive outcome for many patients is called “beating heart” surgery. Open heart surgery is often performed by putting the patient on a heart-lung machine — a machine which pumps the blood to maintain circulation and oxygen throughout the patient’s body during surgery.
A “beating heart” surgery, on the other hand, utilizes a stabilizing arm that holds part of the heart while it is undergoing the procedure — but the heart is still doing the circulating. The benefits of this strategy include faster recovery, better outcomes, less blood required during surgery, and faster extubation post surgery. At OSF St. Joseph, an astounding 90% of open heart surgeries are “beating heart”—one significant reason for their success. Another factor that will enable better efficiency and increased collaboration among teams is the Hybrid OR that opened in November. The Hybrid OR enables complex vascular, cardiac procedures, where two different procedures, catheter-based and open surgery, can be performed in the same room during the same surgery. For example, repairing of a ruptured abdominal aneurysm, a complex peripheral vascular bypass, a lower extremity bypass graft or a study and treatment for electrical heart issues. The high-tech equipment and specialized setup allows coordination of care, making the process easier for the patient because things can be done in one visit rather than two. This will enable OSF to continue to build upon their nationally recognized, excellent vascular surgical outcomes.
Caring for patients
The technology, the care strategies, the equipment, and the processes all affect the success of the Cardiovascular Team at OSF St. Joseph, but ask any one of the technicians, nurses, or staff and they’ll tell you the biggest reason why they have had so much success and recognition is simply because they care.
“The different parts of the team don’t always cross paths, but we work together — and we’re all passionate about what we do,” says Patterson.
“We work well as a team — the trust is there. We are often in high stress situations — life and death — and we know we can trust the others to do their part,” adds Laura Skaggs, an open heart surgical tech.
Even though the cardiovascular area can be highly stressful, there is remarkably low turnover. “The staff is dedicated and has been here a long time,” says Schmid. “We focus on the patient’s needs, have a strong sense of teamwork and collaboration, and go the extra mile for one reason: we care about the patients.”
Being able to go home knowing you’ve done everything possible to help improve someone’s life is a W in anyone’s book.
OSF St. Joseph Medical Center focuses on the Mission to serve persons with the greatest care and love in a community that celebrates the Gift of Life. Pictured is a group of the OSF family with a passion for making a difference in the lives of their patients and their families.
For more information, please contact 309-662-3311 or visit www.osfstjoseph.org
. Located at 2200 E. Washington St, Bloomington, IL.
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