Collaboration Pushes Cardiovascular Quality to New Heights

UH Harrington Heart & Vascular Institute posts best-ever procedural outcomes

UH Harrington Heart & Vascular Update | February 2024

Engagement of every member of the team, across the system and across specialties, has resulted in unprecedented quality outcomes for University Hospitals (UH) Harrington Heart & Vascular Institute. This engagement has been strengthened by transparency in sharing quality data, regular systemwide quality meetings, and interdisciplinary discussions and planning on complex cases. 

The results of sustained efforts have been seen in interventional cardiology, cardiac transplantation, cardiac surgery, left atrial appendage closures, ventricular assist devices and aortic aneurysms.

“An uncompromising yet human-centered focus on quality has produced dramatic improvements in quality for patients receiving care at Harrington HVI,” said Diane Gorbey, MSN, MBA, Director of Quality for UH Harrington HVI. “Under Dr. Mehdi Shishehbor’s leadership, we’ve really crossed specialty lines to focus on each patient and do the best thing we can for each of them. Another key component is the emphasis on process improvement and learning rather than pointing fingers when there is an adverse event.”

UH Harrington Heart & Vascular Institute ranks better than the national benchmarks for its past three years of systemwide metrics for post percutaneous coronary intervention (PCI) in:

• Low mortality rates
• Reducing strokes
• Decreasing adverse bleeding events and acute kidney injuries

Collaboration Between, Within Departments

The institute’s Interventional Cardiovascular Center posted its best-ever mortality results for percutaneous coronary intervention, which includes patients with heart attacks and those receiving stents. Harrington HVI worked closely with Emergency Departments, EMS and hospital leadership to move STEMI patients more quickly to the cardiac catheterization lab, reducing door-to-balloon times, performing at 75th to 90th percentile at 55 minutes across the system. By developing processes collaboratively with the ED on evaluation of patients, Harrington HVI brought together different specialty providers for evaluation of patients with agreed-upon metrics.

“We have an excellent relationship with our colleagues in emergency medicine and together we have been able to develop protocols that have streamlined the care of our STEMI patients from the prehospital setting to the cardiac catheterization lab,” said William Wolf, MD, Division Chief of Cardiology at UH Ahuja Medical Center. Added Charles O’Shaughnessy, MD, Medical Director of the Cardiac Catheterization Labs at UH Elyria Medical Center: “The team effort has led to remarkably low door-to-balloon times at UH compared to the national average. Multiple studies have demonstrated patients have better outcomes, resulting in lower mortality rates for patients that can obtain quick intervention for their myocardial infarction.”

Greg Stefano, MD, Division Chief of Cardiology at UH Geauga Medical Center, added: “We are proud to offer acute MI care to patients across Northeast Ohio in the fastest way possible while maintaining the highest quality.”

For the sickest patients, those who need cardiac transplantation or ventricular assist devices, the team revamped its entire process after an intensive review. Building a collaborative and integrated team, unifying protocols, and having a multidisciplinary approach in every step were the keys to success, according to Yasir Abu-Omar, MD, DPhil, FRCS, Surgical Director of UH Harrington HVI’s Advanced Heart Failure and Transplant Center.

“I am truly proud to partner with such highly skilled professionals in the Harrington HVI,” said Dr. Abu-Omar.

From selecting appropriate patients, to requiring that two surgeons operate in every case, to the whole team rounding on every transplant and VAD case, the Advanced Heart Failure Center has delivered the best-ever outcomes in the history of UH, with 100% survival for first-year post-transplant. Patients are now seen earlier in the disease process, thanks to the innovative Shock Team approach, through which patients can be assessed for advanced treatments quickly and effectively, before there is irreversible damage. 

“With a single phone call, providers have access to our multidisciplinary Cardiogenic Shock Team 24/7; it’s truly remarkable,” said Michael Zacharias, DO, FHFSA, FACC, Associate Clinical Chief of Cardiology and Medical Director of the Mechanical Circulatory Support Program.

Innovation A Critical Part of Quality

Innovation can be procedural. In left atrial appendage occlusion (LAAO), Steven Filby, MD, is a national leader in the use of intracardiac ultrasound for the procedure, whereas most other centers are forced to rely on an additional transesophageal echocardiogram (TEE) procedure. At UH, LAAO outcomes are among the best in class for procedural success and low rates of complications with no strokes or mortalities for the past three years, performing greater than the 90th percentile benchmark in the National Cardiovascular Data Registry.

Innovation also can be in care delivery, as with cardiac surgery. Marc Pelletier, MD, MSc, FRCSC, Chief of the Division of Cardiac Surgery, has structured teams such that patients at any of the five locations in the system that perform cardiac surgery benefit from the same high level of care from experienced surgeons, first assists and perfusionists. UH posted its best-ever outcomes in CABG across the system, with 99.1% 30-day survival, compared to the Society of Thoracic Surgeons 97.6% 30-day survival in 2022.

Collaboration and trust are key, Diane added. Interventional cardiologists, cardiac surgeons and vascular surgeons present complex cases on a weekly call. Doctors look at imaging and discuss whether the patient is best managed medically, by PCI or surgery, or perhaps a hybrid approach. And if a physician needs assistance while in a case, they are encouraged to call on a colleague if they believe they can lend a hand.

“We are here as a system,” said Diane, noting the abundant wealth of expertise within Harrington HVI. “We don’t want anyone to feel alone, whether mid-case, before a case, or anywhere along the way.”

Transparency in Quality Reporting

Quality metrics in all procedural areas are shared with all providers, medical directors and nursing leaders. Therefore, successes can be celebrated and issues dealt with in real time. Providers tend to read these closely, and it fosters healthy competition and transparency.

“There should be no surprises when the data comes out,” Diane said. “We’re using everybody’s expertise to raise the bar. Similarly, adverse events are evaluated in a standard manner, regardless of who the operator was or where the procedure was performed.”

Ravi Ramani, MD, MMM, Chief Quality Officer of Harrington HVI, noted collaboration improves quality.

“We make every effort to improve the process and avoid blaming individuals,” Dr. Ramani said. “This approach encourages people to be part of the solution.”