An All-Star Team Approach to Cardiac Care at Vassar Brothers

AirStrip Case Study
An All-Star Team Approach to
Cardiac Care at Vassar Brothers
Medical Center
Through sophisticated
technology, a team approach to
care and a new model centered
on uniform adoption of best
practices to enhance overall
outcomes, cardiac specialists at
Vassar Brothers Medical Center
provide comprehensive cardiac
services to patients throughout
the Hudson Valley.
At Vassar Brothers Medical Center, a Health
Quest hospital, specialists in cardiology and
cardiac surgery unite to provide surgical and
noninvasive treatment options to patients of all
ages. Acknowledging the hospital’s superior
outcomes, Healthgrades has awarded Vassar
Brothers Medical Center its Cardiac Care
Excellence Award. The hospital has ranked
among the top 5 percent in the nation for
overall cardiac services for three consecutive
years (2011–13), is the recipient of
Healthgrades’ Cardiac Surgery Excellence
Award for six consecutive years (2008–13) and
has ranked among the top 5 percent in the
nation for cardiac surgery for five consecutive
years (2009–13).
Daniel O’Dea, MD, FACC, Chief of Cardiology at
Vassar Brothers Medical Center and President
of the Heart Center in Poughkeepsie, NY, says
these honors are a source of pride for Health
Quest physicians and each provider strives to
maintain award-winning standards of care.
“We work hard to achieve this recognition,” Dr.
O’Dea says. “It takes a tremendous amount of
institutional pride and a high level of diligence
on the part of the physicians and staff involved.
Each provider has to want to do the right thing
for each patient and sustain that drive. To use
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a gardening metaphor, it takes a bit of
watering to ensure the gains we’ve achieved
grow rather than wilt.”
“For any program to be successful, you
must have a good relationship between
cardiologists and the cardiothoracic
surgery team, which we’ve maintained
at Vassar Brothers Medical Center and
with cardiology groups in the area.
That’s what has sustained our
program’s success.”
— Mohan R. Sarabu, MD, FACS, FACC, Chief of
Cardiothoracic Surgery at Vassar Brothers Medical Center
An Eye for Research
At any given time, estimates Daniel O’Dea,
MD, FACC, Chief of Cardiology at Vassar
Brothers Medical Center and President of
the Heart Center in Poughkeepsie, NY,
Vassar Brothers Medical Center has five or
six open and enrolling clinical trials
examining new technologies, such as
defibrillators, pacemakers and stents, as
well as novel treatments for arrhythmia,
heart attacks and heightened cholesterol.
Each year, hundreds of patients enroll in
trials conducted in conjunction with leading
research institutions, such as the Cleveland
Clinic Lerner Research Institute, Duke
Clinical Research Institute, Harvard Clinical
Research Institute and the Mayo Clinic.
WIRELESS, IN-TRANSIT
COMMUNICATION
CHOLESTEROL CONTROL
WITHOUT STATINS
One of the seeds sown in the hospital’s cardiac
program is faster delivery of care brought
about by technology investments. Among the
more innovative technological additions to
Vassar Brothers Medical Center’s cardiac
treatment battery is a device used before
patients even set foot on its premises.
Equipped on local ambulances, AirStrip ONE
Cardiology is a wireless system that allows
emergency medical technicians (EMTs) to send
electrocardiogram (EKG) readings to the
emergency room from the field. Previously,
EKG readings were available only at patients’
bedsides, so specialists tasked with performing
balloon angioplasty had to wait until after
patients were delivered to the hospital to
obtain the results and accordingly prepare for
the procedure.
Patients using statins may suffer from
slightly higher risk for Type 2 diabetes, liver
injury, memory loss and muscle damage,
according to the U.S. Food and Drug
Administration. These patients may benefit
from two currently ongoing clinical trials —
Accelerate and Odyssey — that study
alternatives for patients with high
cholesterol who can’t tolerate side effects
caused by statin medications.
“These medications hold promise to provide
patients who are intolerant of statin therapy
with an alternative that hopefully translates
into lower cholesterol levels and reduces
the incidence of heart attacks, strokes and
death,” says Dr. O’Dea.
“From wherever EMTs take care of patients —
in the field or in the ambulance — EKG
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electrodes attached to the patient send this
information to the hospital,” says Dr. O’Dea.
“Patients may be 15 to 20 minutes away, but
we’re receiving this information. While the
ambulance is transporting the patient to us,
the cardiac team responsible for opening the
artery and restoring blood to the heart is
already assembling at the hospital. When the
patient arrives, the team is ready to proceed.”
This technology reduces the time from when
the patient enters the doors of the hospital to
when he or she receives balloon angioplasty by
an average of 15 minutes, making the average
door-to-balloon time 60 minutes. (The national
standard per the American Heart Association is
90 minutes or less.) Dr. O’Dea notes this
shortened time reduces the incidence of heart
failure.
GUIDED BY MAGNETS
Within Vassar Brothers Medical Center’s walls,
electrophysiologists take advantage of leadingedge technology to perform ablation and other
catheterization procedures.
Magnetic navigational tools provide
electrophysiologists more precise methods for
directing catheters to ablation focal points to
treat abnormal electrical pathways and
manipulating catheters through arteries,
according to Dr. O’Dea. Compared to
traditional methods, which require
electrophysiologists to stand bedside for the
entirety of the procedure and direct the
catheter under X-ray guidance, magnetic
navigation provides a less grueling procedure
that exposes patients to less radiation.
“Magnetic technology requires taking one
electrocardiographic image that we match up
to the magnetic system, eliminating the need
for X-ray guidance to move catheters from
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place to place in the body,” Dr. O’Dea explains.
“Electrophysiologists perform the procedure
while sitting at a console, and the procedure is
quicker and more precise. It is also safer
because the imaging provides 3-D visualization
as opposed to 2-D X-rays, reducing the risk of
untoward events.”
COLLABORATION ACROSS THE
CONTINUUM
When patients require more intensive
intervention, Dr. O’Dea explains, collaboration
between cardiologists and cardiothoracic
surgeons provides complete care for the entire
disease process.
“Cardiologists work in concert with cardiac
surgeons to ensure patients receive the best
care before and after surgery,” Dr. O’Dea says.
“Often, surgery alleviates the problem, but
doesn’t cure it, and the underlying disease is
still present — surgeons don’t remove diseased
arteries; they work around them. For many
cardiac conditions, patients require long-term
care to make certain the disease doesn’t
progress. We work diligently with
cardiothoracic surgeons to provide patients the
most appropriate operation at the right time as
well as excellent aftercare.”
The cardiothoracic surgery team at Vassar
Brothers Medical Center is comprised of
cardiothoracic surgeons, physician assistants,
nurse practitioners, cardiothoracic and critical
care nurses, physical therapists, and
nutritionists. This team provides comprehensive
surgical treatment options, including aortic
aneurysm repair, coronary artery bypass graft
surgery, surgical ablation for cardiac
arrhythmias, valve surgery and redo heart
surgery, among others, according to Mohan R.
Sarabu, MD, FACS, FACC, Chief of
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Cardiothoracic Surgery at Vassar Brothers
Medical Center.
THE REALITY OF REOPERATIONS
In partnership with an expert team of
cardiologists who provide medical treatment
for all points on the care continuum, Vassar
Brothers Medical Center’s cardiothoracic
surgical team is committed to delivering
surgical excellence for all cardiac conditions,
including inevitable and complex redo cardiac
operations.
“The truth is that the majority of patients who
had heart surgery will almost certainly need a
second or third operation if they live long
enough,” Dr. Sarabu says. “We have the
expertise and capabilities to offer reoperations
for patients who may not be candidates for
these procedures at other places.”
Dr. Sarabu explains that when surgeons perform
heart surgery, scar tissue eventually forms
around the area of each cut made through skin,
fat, chest bone and pericardium to access the
heart. When a reoperation is needed, surgeons
must navigate through altered anatomical
planes because of scar tissue formation and be
prepared for complications, such as excessive
bleeding, which can result in higher risks for
morbidity and mortality.
According to Dr. Sarabu, reoperation
procedures comprise an estimated 10–15
percent of Vassar Brothers Medical Center’s
cardiothoracic surgery practice, and many of
these are not simple redo cardiac bypass
procedures. The hospital has excellent
outcomes in these reoperations.
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“Heart disease affects patients of all ages,” Dr.
Sarabu says. “When they need surgical
intervention for their conditions, many times,
it has to be a combination procedure. We
perform bypass and valve, double valve, bypass
and valve reoperations, or any other necessary
combination, including aortic aneurysm surgery.
This is the norm in this day and age, and even
though we perform high-risk operations on a
high-risk population, we have very good
outcomes.”
According to Dr. Sarabu, the decision between
repairing and replacing a valve depends on the
type of damage to the valve, the patient’s
general health, the condition of the damaged
valve, the presence of other health conditions
and the expected benefits of surgery. In all
cases, the team collaborates to determine the
most effective therapeutic option for each
diagnosis and creates an individualized plan for
every patient.
Vassar Brothers Medical Center has garnered
many accolades for low mortality rates and the
quality care maintained by its cardiology and
cardiothoracic surgery departments during the
years. Dr. Sarabu explains that only an expert
team of providers working together can achieve
such a high standard of care.
“It’s not a one-man show,” Dr. Sarabu
emphasizes. “Every procedure — surgical or
otherwise — needs to be a collective and
cooperative effort. We have expert
cardiologists at the forefront to diagnose these
complex medical conditions and use the right
tools to identify any underlying cardiac
problems and help surgeons plan for their
operations.
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“On top of that, we have a team of dedicated,
exceptionally trained physician assistants,
perfusionists and nurses in both the operating
room and the intensive care unit to take care
of our cardiology and cardiothoracic surgery
patients. The backbone of our cardiac services
is our team, and we have one that stands on
the leading edge of care.”
FOSTERING REPRODUCIBLE
SUCCESS
Key to the team approach across all Health
Quest facilities is a new Cardiovascular
Institute model, which aims to systematize
operational objectives, policies, priorities,
procedures and operational objectives based
upon national guidelines introduced by the
American College of Cardiology, American
Heart Association and the American Diabetes
Association, among others.
“We wanted to ensure what we’re doing
correctly at one hospital we’re duplicating at
every hospital,” Dr. O’Dea explains. “Then,
those best practices spill over into physicians’
practices and foster congruity between the
care provided within hospitals and physicians’
offices.”
Under the auspices of the Cardiovascular
Institute’s approach, an inclusive system of
checks and balances ensures patients receive
the appropriate treatment and medications.
Clerks, nurses, physical therapists and
respiratory therapists all know medical
protocols, so patients should always receive the
most appropriate treatment.
READY FOR ANYTHING
In tandem with the protocols initiated through
the Cardiovascular Institute, individualized
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The Area’s Only Expert for
Heart Failure
Although innovative technologies and
procedures available to physicians within
Vassar Brothers Medical Center have helped
establish it as a leading tertiary-care center
in the area, the unique capabilities of James
Lyons, MD, board-certified congestive heart
failure expert, distinguish it from other area
hospitals.
To best utilize Dr. Lyons’ specialization,
Vassar Brothers Medical Center is developing
a comprehensive heart failure program
through which patients can receive
aggressive treatment — including left
ventricular assist implantation — optimal
medical therapy and referrals for complete
heart transplant. Such aggressive treatment
aims to keep patients out of the hospital
and, if they should require transplant or
other serious inpatient interventions,
prevent future rehospitalization.
cardiac care tailored to each patient is of
utmost importance, Dr. Sarabu notes.
“Access to the right tools is a necessity for any
cardiothoracic surgery program to be
successful,” Dr. Sarabu says. “In addition,
surgeons must obtain all the appropriate
information to best execute their skills as each
patient’s needs dictate. You can’t simply treat
every patient based only on the protocols. You
have to treat the particular needs of the
patient and his or her condition. Every patient
is unique and has unique attributes.”
Patients with congestive heart failure
demonstrate the necessity for individually
tailored care. Whether due to previous heart
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attacks, valve leaks or stenosis, damage to the
heart muscle can impair its ability to
successfully pump blood through the body.
When blood pools in the heart or lungs and the
rest of the body receives less blood, many
organ systems may suffer.
Cardiologists and surgeons must examine the
way congestive heart failure impairs any organ
in the body and incorporate that information
into making an accurate diagnosis and
determining the best surgical approach to treat
the disorder, Dr. Sarabu says. For example, if
congestive heart failure has impaired a
patient’s kidney function, providers may use
medications and/or dialysis to treat it
preoperatively and during the postoperative
period.
Dr. Sarabu notes that situations such as this
exemplify the necessity for surgeons to be
holistically involved in patient care.
“As surgeons, we not only perform the
operation, but we must get involved with every
system and component of the body,” Dr.
Sarabu says. “This is the only way to treat the
patient’s condition and ensure we act
appropriately when an organ is affected by
impaired heart function. If surgeons perform
operations without incorporating every other
part of the body in patient care, then these
operations would certainly result in bad
outcomes.”
DEMONSTRATED COMMITMENT
As Health Quest’s Cardiovascular Institute
develops, the system’s award-winning standard
of care and resultant positive outcomes will
surely continue its upward trajectory. Behind
all the advanced technology and years of
medical training, a very simple concept guides
each physician’s philosophy of care.
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“We have the right ingredients to provide the
best care possible,” Dr. Sarabu says. “We have
every tool necessary to provide any cardiac
surgery at Vassar Brothers Medical Center. Our
expert cardiologists, dedicated
anesthesiologists, physician assistants,
perfusionists and excellent nursing staff play an
equally important role in producing great
outcomes and ensuring we are prepared for
almost any component directly or indirectly
involved in patient care. We take care of our
patients as we would our own family
members.”
Source:
MD News July 2013, Mid Hudson Edition
http://midhudson.mdnews.com/articles/Local
Article?id=36440
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