Tectonic shifts in healthcare delivery demand a broad collective skillset measured out among cardiologists, nurses, cardiology service line directors and practice administrators. Priorities need to focus on training and outreach from clinical, operational and financial perspectives as well as strengthening the heart team. Prairie Heart and Vascular Institute in Springfield, Ill., is part of one health system that is leading the way. Working from a mission and vision combining patient care with provider education—similar to the model in place at large academic medical centers—the practice is a judicious yet eager adopter of leading-edge technologies such as Abiomed’s Impella 2.5 heart pump, the smallest and least invasive percutaneous ventricular support blood pump. Care and caregiver collaboration is a constant. In short, Prairie daily demonstrates best practices that many other heart teams would do well to emulate.
Formed in 1979 as a regional referral center in Springfield, Ill., by cardiovascular pioneer James Dove, MD, Prairie Cardiovascular Consultants Ltd. has been expanding its reach ever since. It spawned and is now part of the Prairie Heart Institute, which serves the entire southern half of Illinois from 48 locations with more than 70 board-certified cardiologists. The organization optimizes its clinical expertise and referrer outreach by sustaining a dual emphasis on ongoing skills improvement and selective technology adoption. Its hub and spoke model keeps patients in their communities and supports physicians, cardiologists and nurses. When patients need complex interventions, they head to Prairie, then optimally head back home for followup care via the Prairie web of caregivers.
It’s a model that has enabled referrer outreach to grow steadily year after year: From its humble beginnings at a single site, it has built its business to where it now logs around 180,000 unique patient visits per year.
Training, too, has been a key and ever-evolving component of Prairie’s mission. Prairie Cardiovascular runs sought-after fellowship programs not only for new and seasoned physicians from around the U.S. but also for advanced practice providers (APPs), including physician assistants as well as nurse practitioners.
A center of excellence for coronary, cardiac and vascular procedures, Prairie handles every aspect of heart care. Its expertise spans from critical limb ischemia to abdominal aortic aneurysms, from atrial septal defect and patent foramen ovale to TAVR (four per week), and from structural heart disease to high-risk PCI.
The latter exemplifies scenarios in which Prairie regularly brings all its human know-how and high-tech tools to bear on challenging clinical cases. About eight years ago, the practice became an early adopter of the first in Abiomed’s Impella line of small heart pumps. Today Prairie doctors are regularly performing Protected PCI with the recently FDA-approved Impella 2.5, saving the lives of high-risk patients who require hemodynamic support during their coronary interventions.
The Impella 2.5, which can be inserted via standard catheterization through the femoral artery, stabilizes hemodynamics, unloads the left ventricle, perfuses the end organs and allows for recovery of the native heart.
“We consider the Impella an integral part of our high-risk interventional program,” says Jeffrey Goldstein, MD, who holds several leadership positions at Prairie and runs the vascular and fellowship program.
Jack Hall, MD, director of Prairie’s coronary artery chronic total occlusion (CTO) service, has much firsthand experience with Impella, as he runs the practice’s high-risk PCI program. He emphasizes the importance of selecting the right patients, knowing when to use the technology, following through with attentive care post-procedure and, perhaps most important, approaching Prairie’s work as an all-hands-on-deck endeavor.
“It’s not just about the patient and the physician inserting the Impella. It’s about your cath lab staff, it’s about the staff before the patient goes to the cath lab and it’s about the staff after the patient leaves the cath lab,” Hall says. “Educating all those people in what we’re doing and why we’re doing it” is critical. “As an interventional cardiologist, I’m only as good as the weakest person on the team and throughout that chain. At Prairie, we really focus the entire team on getting better and doing better, and that’s through education, communication