Strategies for Cardiology Service Line Directors
Topping the list of must haves when rolling out a new complex PCI program are a solid mission to offer leading-edge technology, top-down administrative support, physician and nursing leadership, a quest for quality, and a well-oiled team. And in the case of the 194-bed San Juan Regional Medical Center in Farmington, N. M., independence was on the list too as this rural hospital must be self-reliant in caring for emergent patients. Abiomed’s Impella 2.5 miniature temporary heart pump is key to helping them help patients. Their innate confidence fueled by ongoing training and protocols has served the heart team well, and their advice is solid for care providers in urban, suburban, and rural settings seeking to offer quality care while maintaining a healthy bottom line.
Hear more from the team at San Juan Regional Medical Center, watch Episode 1: From the Ground Up: Building a Better Interventional Program from the series, Strategies for Cardiology Service Line Directors.
San Juan Regional Medical Center launched its dedicated cardiac care unit in 2006. They started out slowly and methodically, training staff, building protocols, solidifying their team, and watching their data, says Barbara Charles, RN, BSN, the Cardiology Service Line Director. Six patient rooms grew to 24 when the hospital opened a new wing in 2010 and became a primary PCI hospital and ST-Elevation Myocardial Infarction (STEMI) receiving center. They currently staff 16 beds. To expand their offerings further, they brought on Impella in 2011. In 2015, they treated 65 STEMI patients and placed 29 Impella heart pumps.
The vision to start an interventional cardiology program without surgical backup was the brainchild of a San Juan Regional administrator a dozen years ago. “We needed to expand what we could do here to avoid lengthy transfers and poor outcomes,” recalls Charles who at the time was manager of the Cardiology Unit, Cardiac Cath Lab and Cardiac Rehab. They hired a consulting firm to analyze volume and sustainability to see if a Protected PCI program was feasible and explored the risks and benefits of such a program without surgical backup. They then sought help to create a plan and connect them with doctors who could make it happen—and gave the doctors and heart team a blank slate to dictate priorities.
“It was a big leap to go from not performing PCI to performing PCI without surgical backup,” Charles recalls. “That kicked off in the fall of 2007 when we formed the heart center as it is known today.”
Charles Wilkins, MD, was named chief of cardiology and together with his partner, Luther Weathers, MD, both transplants from Texas, they packed their bags and vast knowledge base and leadership skills and headed north to Farmington.
What appealed to Wilkins most about the move? “The willingness of administration to work with us to allow us to build a program from the ground up and do it the right way.”
Building from the ground up meant setting up a program that was quality driven and utilized guideline-based best practices. One of Wilkins’ stipulations was participation in national registries to prove outcomes were satisfactory. He told administration early on that the PCI program wasn’t going to be a rainmaker or a profit center, only doing the cases they needed to. “They said ‘that's fine,’” he recalls. “It's a small town so if you have bad outcomes, that will get around. Today, our volumes are growing, we participate in four national registries, our data show excellent outcomes, and we’re an accredited chest pain center.”
Back in 2011, with both Impella and the interventional program both at a young age, the heart team knew it needed to become independent quickly, “especially if we were going to utilize Impella for the shock patient,” Charles recalls. “I'm not going to be able to call Abiomed and get a rep here in 5 minutes, so I think because we are so used to that, it's just how we approach things. The physician relationship with the team both in the cath lab and the cardiology unit was already strong, with lots of trust, and good communication. The cardiologists had already been engaged in staff training and education and growing the team before we embarked upon Impella, so it just perpetuated.”
To become independent, they needed to train and retrain. Training physicians and cath lab staff on Impella was priority one, beginning with the team completing a series of higher-risk PCI cases.