Volume 18, No. 1, Winter 2010
You think breaking the four-minute mile barrier was something? Sure Englishman Roger Bannister was already a physician when he set the record in 1954. But he didn’t help save any lives with that particular achievement.
Not so with the Interventional Cardiology program at Cape Cod Hospital, which recently set what may be an unofficial record in one of its own events, the door-to-balloon team race.
The event involves a procedure once known as angioplasty, but now bearing the more impressive title of emergency percutaneous coronary intervention (PCI). Simply put, a balloon to open up a blockage is inserted into the involved artery. American College of Cardiology guidelines say that most lives are saved if the door-to-balloon time is 90 minutes or less.
The Cape Cod Hospital team, however, on this occasion turned the trick in an amazing 12 minutes, an achievement that in track would have had officials checking their stopwatches and scheduling tests for performance-enhancing drugs.
In a Belichickian statement, however, the Director of Interventional Cardiology, Dr. Richard Zelman, just said the achievement represented “a tremendous community effort.”
The CCH Cardiac Catheterization Lab also is ahead of the curve as one of the first programs to perform a new procedure using a device approved, but not yet on the market.
It’s called a Channel Dilator, a specialized microcatheter used to open blood vessels that have been blocked for at least six months (in doctor terms, chronic total occlusions in coronary arteries). This enables interventional cardiologists at CCH to successfully open the most technically challenging lesions with increased frequency.
Basically, the procedure uses a wire no bigger than a human hair to travel upstream via the tiny collateral blood vessels that form as a result of the blockage. The interventional cardiologist snakes the wire through the miniscule vessels to reach the other side of the blockage. It effectively links one circulation to another, Dr. Zelman explains.
Once the two circulations are connected, drug-coated stents are implanted to open the blockage.
According to Dr. Zelman, the procedure and device are so new, none of the interventional cardiologists in Boston are yet using them.
Dr. Zelman and Dr. Alanna Coolong, a fellow Interventional Cardiologist, do the majority of PCI procedures at CCH. Dr. David Leeman, a Beth Israel Deaconess Medical Center cardiologist, assists at the hospital at times.
The large elderly population on Cape Cod, together with the fact that there are usually just two interventional cardiologists performing emergency and diagnostic PCIs at CCH, means Dr. Coolong and Dr. Zelman probably do more of these procedures annually than most of their Boston counterparts.
The dramatic leaps made in interventional cardiology over the last 10 years probably will not be seen again in such a short period of time, Dr. Zelman says, but he adds, “Every time we think we’ve come to the last frontier, there’s another ahead of us.”
As part of its policy of revolving staff members taking over as chief and medical director of the Cape Cod Hospital Emergency Department, Dr. Kevin Bresnahan has stepped down with the conclusion of his four-year term and turned the reins over Dr. Craig Cornwall.
Dr. Cornwall takes over at a very successful time in the department’s evolution, which was recognized recently by a major rating service as among the top five percent of hospitals nationwide in the area of patient satisfaction.
As a result of process improvements implemented last year, the department’s patient load in November increased by more than 18 percent compared to the previous year. Yet, of those patients, 94 percent were placed in a bed in 25 minutes or less and 89 percent saw a physician 40 minutes or less. The average wait time for a bed was 5.2 minutes; average for a physician was 18.2 minutes.
Overall, all patients are assessed by a nurse immediately, the average waiting room time is under 25 minutes and the average time to see a physician is under 35 minutes.
“It’s a tremendous accomplishment,” said Chief Operating Officer Michael Lauf. “It’s a great testament to the work of Dr. Kevin Bresnahan, Deb Robinson and the entire ED team at Cape Cod Hospital.”
“With the performance improvement initiatives of the past years,” Dr. Bresnahan wrote, “This has truly been a transformational time in the ED. It has been exciting to be part of this change.”
The improvement in the Emergency Department has been part of a concerted system-wide program to upgrade quality and safety practices instituted by Cape Cod Healthcare’s new leadership.
The Centers for Medicare and Medicaid Services already has a best practices program covering what is referred to as “Core Measures.” These involve treatment for surgeries, acute myocardial infarction, heart failure and pneumonia. They carry rewards…and punishments.
CCHC’s Quality and Safety program has expanded that program to examine outcomes and safe practices, patient satisfaction and mortality/morbidity at Cape Cod and Falmouth Hospitals.
“This is the most extensive scorecard I’ve ever been a part of,” says CCHC Medical Director for Quality and Safety and CCH Chief Medical Officer Dr. James Butterick. Dr. Butterick and Colette Silverman, Director of Quality for CCHC, lead the Quality Measures Program.
In another executive change, Christopher J. O'Connor has been named Vice President of Development for the Cape Cod Healthcare Foundation. He succeeds Tom Mundell, who resigned in the fall. Steve Abbott, former president/CEO of Cape Cod Healthcare, had been filling in during the interim.
Mr. O’Connor had been a senior vice president specializing in capital campaigns for Ghiorsi & Sorrenti, a national development consulting firm. He received his BS in Management from Bentley University and is a Certified Fund Raising Executive.
The Centers for Medicare and Medicaid Services have determined evidence-based, best practices for so-called “Core Measures.” Core Measures evaluate treatment for surgeries, acute myocardial infarction, heart failure and pneumonia.
CMS rewards hospitals that implement the practices, and may penalize those that do not. With the high number of Medicare patients Cape Cod Hospital and Falmouth Hospital treat, the financial implication of not complying with the CMS expectations is obvious.
But Cape Cod Healthcare says it is going above and beyond the Core Measures with a Quality and Safety program that emphasizes other aspects of care that mean just as much or more to patients it cares for.
Quality and Safety leaders are looking at quality measures across the board by examining outcomes and safe practices, patient satisfaction and mortality/morbidity.
The spotlight on quality measures was turned up last year, after the arrival of the President and CEO, Dr. Richard Salluzzo. He and Chief Operating Officer Mike Lauf began an immediate campaign to enlist everyone’s help in making changes that will raise the level of safety and quality at the hospitals. Dr. Salluzzo told managers and directors he wanted a system-wide, comprehensive approach.
“This is the most extensive score card I’ve ever been a part of,” said CCHC Medical Director for Quality and Safety and CCH Chief Medical Officer James Butterick, M.D. Dr. Butterick and Colette Silverman, Director of Quality for CCHC, lead the Quality Measures Program.
The cornerstone of the Quality program is a simple idea: that quality and safety are inextricably linked. Attached to that is the idea that improvement in one area will result in improvement in the other.
And the notion will only catch on if the people on the front lines of health care are part of the process and agree with it, Silverman said.
“We have to engage employees at all levels to make the changes,” Mr. Silverman said.
That philosophy is an integral part of the Process Improvement (PI) initiative started earlier this year at both Cape Cod Hospital and Falmouth Hospital. When process is improved positive things happen, including a rise in quality throughout the system.
There are between 50 and 100 projects that CCHC should be paying attention to; things that “make or break the hospital experience for people,” Dr. Butterick said.
Priority focus areas for 2009 are: Falls, Hand washing, Organization-wide Awareness & Improvement of Patient Safety, DVT Prevention, and the Discharge System.
Other PI initiatives on the hospitals’ “dashboards” involve the Emergency Departments, Surgery, Cath Lab, Patient Access, Nursing, Pain, Pharmacy, Lab, Facilities, Core Measures, Healthcare-associated Infections, Mortality, Hospital-acquired Conditions, Patient Satisfaction.
“This is helping people to focus on what we do – take care of patients better,” Dr. Butterick said.
Silverman and Dr. Butterick are working closely with Cathy Bachert, Director of Performance Improvement at CCH; Pamela Kendrick, Director of Quality and Case Management at FH; Debbie Meguerdichian, Director of Quality and Compliance at VNA; and Christine Pereault, Performance Improvement Coordinator for JML Care Center.
Mr. Lauf is overseeing the PI initiatives in all departments, and meets often with the CCHC Quality Subcommittee. FH COO Sue Wing is helping to lead the PI program there. The quality leadership group usually meets twice each month with Dr. Salluzzo.
The Process Improvement projects are already demonstrating positive outcomes. Changes in the Emergency Department at CCH have had startling results which translated quickly to a rise in patient satisfaction, Dr. Butterick said. An initiative to move critically ill patients out of the ED and to the ICU faster effectively dropped the process from an average of 10 or 11 hours to an average of five hours, he said. That, in turn, increased ED capacity by 50 percent.
At Falmouth Hospital, Garth Meyerhoff, Director of Engineering, recently took on a different challenge. His goal was to make sure all meals were delivered to patients within 15 minutes of being prepared in the kitchen, to make sure that patients were receiving hot meals. The project is already seeing positive results, Dr. Butterick said.
“These (projects) are not necessarily expensive; it’s just about how to do it better,” he concluded