This article appears in the June 2012 issue of HealthLeaders magazine.
The interventional cardiology program at The Mount Sinai Hospital consistently ranks as a top—if not the top—program in New York City in terms of volume and lowest complications. Samin K. Sharma, MD, director of clinical cardiology and president of The Mount Sinai Heart Network, says the reasons are quite simple.
Register Today: Excellence in Cardiac Care—
Elements of Success from The Mount Sinai Medical Center
Live Simulcast from The Mount Sinai Medical Center: How do you balance the latest in advanced cardiovascular treatment with market growth? Join HealthLeaders Media and the cardiovascular team on July 18 at The Mount Sinai Medical Center to learn how Sinai has reinvented one of the top cardiovascular enterprises in the country.
Leadership and teaching, adherence to a strict set of protocols, and communication all form the basis of the program's success in the city's fiercely competitive heart market. Even something as seemingly small as making sure there is a senior interventionalist on the floor can pay big dividends in quality. In 2008, the program at Mount Sinai performed 4,577 percutaneous cardiac interventions, with a risk-adjusted 30-day mortality rate of 0.62 for all cases.
"There are five of us interventionalists who are the backbone of this program at Mount Sinai," Sharma says. "One of us always stays until the lab is done. It could be midnight, could be 2:00 a.m., but we stay all night to help these other interventionalists to get a good outcome."
But having senior physicians around to mentor and guide is only a supplement to a program based on evidence-based protocols.
"We have a set protocol for all the routine and complex procedures," Sharma says. "If a complication should occur, we have protocols for how the procedure should be done from a technical point of view. Everything is standardized despite having up to 19 interventionalists who come and do the cases." Sharma says the protocols are followed by all physicians, even the voluntary physicians, who perform procedures at Mount Sinai. The key to adherence is constant teaching, he says. Sharma recalls a visit by the health commissioner of New York state who came to tour the lab to see how it worked.
"I mentioned about the protocol and we showed the book to the health commissioner at that time. He said, 'You're telling me that your interventional fellows know about the book?' I said, 'No problem. We can go back to the cath lab and you can ask my intervention fellows anything from this 150-page book.' They opened it, asked questions, and the answers were perfect. That is why we emphasize so much teaching for our interventional fellows who are the backbone of the success of the program."
The protocol adherence extends beyond the physicians to the entire cardiac intervention team.
"Protocol is for everyone. We have a separate protocol for the nurses and 17 staff nurse practitioners. Many of those protocols are part of the same protocol book because that's the part that always stays—what medicine to give once a patient gets into trouble and so forth." Nurses also have protocols for everything from handoffs to how they should sign out, he says. As rigid as the protocol is for the team, it is nonetheless a living document that is updated regularly when evidence is reviewed, Sharma says. And as much as a set of protocols works well for Mount Sinai, that same book might not be a fit somewhere else.
"I'm not saying that people should duplicate what we have, but clearly there should be a set protocol. In this field, there is more than one right way to do things. At the same time, by and large, the concept has to be that when the variation occurs, that's where the trouble occurs." Other programs may modify protocols based on their needs, as long as the principles are mandatory. It's also important that all team members feel a sense of ownership of the protocol, and that their suggestions are heard, he says.
"Many times one of the voluntary physicians makes some good suggestions, so we will change our protocol based on incorporating their opinion," Sharma says.
That sense of full teamwork extends to any communication following complications, Sharma says. "If an issue occurs, we discuss it openly. That is a key, that open communication. If you have a closed-door discussion with one or two people, then other people on the team don't know. On any major complications, we speak the next morning. Then monthly we have a one-hour discussion to review."
This article appears in the June 2012 issue of HealthLeaders magazine.
Reprint HLR0612-11
Jim Molpus is the director of the HealthLeaders Exchange.