|Since Cardiology Associates in Mobile, Ala., acquired a GE LightSpeed VCT three years ago, they have performed more than 4,300 coronary CT angiography scans, and total procedure volume has grown 10 percent per year since the first year.|
Whether it’s the latest CT scanner, wireless ECG transmission from the field, or hybrid lab, facilities and practices are capitalizing on those technologies that will help them carve out a niche in the cardiovascular marketplace.
Competition is fierce within the cardiovascular industry and healthcare consumerism has become prevalent. While this consumerism does not translate into a patient deciding which stent or catheter should be used in a procedure, it does mean organizations have started to consider the patient, who is demanding quality and safe services provided in a timely, well-communicated way, as they work to gain a competitive edge. The newest technologies are simply expected as part of the entire care package, otherwise, patients could go “shopping” elsewhere. Cardiovascular Business spoke with a cardiology practice, a small community hospital and a health system hospital to find out how they are utilizing technologies to sustain a competitive edge.
64-slice CT and 3D EP mapping
Sixty-four-slice CT has helped Cardiology Associates, a 28-physician practice in Mobile, Ala., gain more referrals and increase market share, according to Vance Chunn, CEO and administrator. Since adopting GE Healthcare’s 64-slice LightSpeed VCT in April 2005, the practice has performed more than 4,300 coronary CT angiography scans, and total procedure volume has grown 10 percent per year since the first year, as Medicare and many insurers now cover cardiac CTA.
The application of 64-slice CT has spilled over into other areas of cardiology for Chunn’s practice, particularly in the electrophysiology (EP) and peripheral vascular arenas. Utilizing CT in EP procedures as a preliminary look at the anatomy shortens procedure time by creating a more accurate map of the heart. In peripheral vascular cases, CT speeds up interventional procedures by creating a roadmap of kidney or leg blockages.
Within EP, Chunn says another valuable technology has been EnSite 3D mapping software from St. Jude Medical. “Now the technology exists so that EP docs can go inside the heart and ablate certain areas more precisely than before,” he notes. In four to five hours, a cardiologist can make precise burns with ablation equipment and cure the problem of atrial fibrillation.
Shorter procedure times translate into increased volume, according to D. Scott Kirby, MD, of Cardiology Associates, who reports performing anywhere from 35 to 50 ablation procedures per month and has done more than 60 atrial fibrillation ablations this year alone.
The EnSite system maps the electrical activity of the heart, localizing and visualizing electrophysiology catheters in real-time, creating 3D displays of cardiac anatomy and arrhythmias and enabling the navigation of non-proprietary catheters without the use of fluoroscopy. “We are able to much more precisely locate, with single heartbeats, where the irregularities are, and go in and burn that area,” says Kirby.
“There are new technologies being developed all the time, but it is the combination of new technologies and the people who use them that make the difference,” Chunn concludes.
D2B times and hybrid labs
The NIH Heart Center at the 228-bed, acute-care Suburban Hospital in Bethesda, Md., provides cardiac surgery, elective and emergency angioplasty as well as inpatient, diagnostic and rehabilitation services to the surrounding Montgomery County. The arsenal of technology offered is provided in an environment that combines high tech with high touch, says Regina Deible, RN.
In the last month, the center has met its 90-minute door-to-balloon time 100 percent of the time. Since opening two years ago, the center has been running at 85 to 90 percent of the 90-minute parameters, according to Deible. She attributes this to the dedicated effort by a special collaborative team that reviews core measure data to identify shortcomings. “Couple this with prompt identification of a STEMI via notification from the field ECG monitors and quick cath lab access via a 24/7 ‘one-call-does-all’ physician phone line and you have the makings of a successful D2B program,” Deible says.
The growth of the cardiac program at Suburban is largely attributed to the combination of non-invasive imaging modalities, electrophysiology and hybrid labs that incorporate peripheral and interventional technology and procedures.
Larger facilities, i.e., 1,000 beds or more, are usually privy to the newest technologies as they enter the market. But not every small, community-based hospital has the capability to offer a full spectrum of technologies including 64-slice CT, cardiac MRI, 3D echo, a combined peripheral and cardiac lab and afib ablations with 3D mapping. “This is what sets us apart—we can offer the entire package,” Deible says.
With non-invasive imaging, any type of screening for cardiac or peripheral problems can be used to get patients into the cath lab before a disease progresses too far. “Whether you are looking at anatomy for LV function, finding a problem before the patient is in big trouble is the goal,” according to Deb Dewald, cath lab supervisor. With 3D mapping, atrial fibrillation ablation procedures have been cut down to one to three hours, meaning “you are much less likely to do damage and more likely to find the culprits,” Dewald says.
Additionally, the NIH center attributes its success to having a hybrid lab to treat the entire cardiovascular system, not just the coronaries. “Smaller hospitals don’t always have these technologies and that is a fantastic promotional piece,” Deible concludes.
Patient tracking and workflow
For WellStar Kennestone Hospital in Marietta, Ga., it is not so much the technology that gives its cardiac program the competitive edge, but how that technology is used. “The key here is that we are seeing the need to leverage technologies to manage workflow and optimize patient throughput,” says Candice Saunders, senior vice president and hospital administrator. “We are trying to see how we can use technology to manage other dimensions of patient care and do a better job of patient tracking and throughput.”
To do this, Kennestone worked with PatientFlow Technology to implement a plan to improve workflow in the cardiac cath lab. Using rigorous data analysis and queuing theory, the plan called for setting aside one or two of the existing four labs, depending on the day of the week, for urgent cases. This ensures that these patients are cared for in a timely manner, without causing delays or cancellations in the day’s elective cases, according to Pat Jansen, vice president, cardiac services.
Since the plan was implemented, average waiting times for urgent cases have dropped 50 to 60 percent. Additionally, they have seen a 90 percent reduction in overtime, from a total of eight and a half hours past prime time for all but emergent cases, to a total of only 40 minutes of overtime in June. “Having a scheduling system that allows us to flex and adjust to circumstances and physicians’ schedules is important to throughput,” Jansen adds. “We were able to offer one cardiologist elective pacemaker slots that met his schedule instead of simply telling him to just get in line.”
WellStar also employed telemetry ECG equipment for the ambulances so that they can transmit ECGs from the field to the ER. “For the first quarter of 2008, 100 percent of heart attack patients were treated in the cath lab within 90 minutes of arrival in the ER and we’re seeing lower times every month,” he says. “The wireless ECGs enabled us to meet that benchmark.”
No matter what the technologies are, the consensus seems to be that human resources are just as important. “We have to have the right people to deliver cardiac care. Our quality and safety—and the patient experience—really tie it all together,” Saunders says.