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Getting to the Heart of Cardiology Alignment

Joe Cantlupe, for HealthLeaders Media, February 9, 2012

Success key No 3: Same-day discharge
As it began focusing more on cardiac care with development of a new heart institute, Spectrum Health, a 1,370-licensed-bed system, ensured physician and administration partnership to improve clinical outcomes, targeting same-day discharge for angioplasty patients in cardiology programs.

The program highlighted specific metrics that must be reviewed and benchmarks to be achieved as part of a coordinated effort between physicians and administration, says Richard McNamara, MD, interim comedical director of Spectrum Health Frederik Meijer Heart & Vascular Institute and chief of cardiology at Spectrum Health.

"We put this in front of physicians, that these are the metrics we are going to identify and focus our efforts on," says McNamara, referring to the angioplasty and other programs. "We are engaging physicians a lot more consciously about identifying goals. And we have incentive pay to meet those goals," McNamara says.

"We went across the board, looking at clinical problems that required a lot of cooperation with administration and physicians," he adds.

The program is part of the institute's executive leadership council, whose subcommittees examine research, education, business, and medical programs.

The hospital has focused on improving efficiencies in a same-day discharge program for percutaneous coronary intervention patients, McNamara says. The procedure used to carry out the PCI process is coronary artery stenting. Nationally, at least 1 million PCI procedures are performed annually among Medicare patients.

In a review of low-risk Medicare patients who underwent elective PCI, same-day discharge has been rarely used, with only 1.25% of 1,339 patients discharged on the day of their procedure, according to an independent study from the Duke Clinical Research Institute in Durham, NC.

PCI has not been associated with an increased risk of rehospitalization or death, the institute states. 

While Spectrum Health is still compiling data, its preliminary reports show that it averaged same-day discharge for 16 patients each month, representing about 30% of all scheduled elective PCIs, says Patrice Villemure, executive director of the Fred and Lena Meijer Heart Center.

Overall, the hospital database shows 281 PCI patients who had same-day discharge. "We have no major complications, which have been measured as bleeding, reinfarction, stroke," says Villemure. "Patients have been highly satisfied with the program," she adds.

"There were PCI patients stable enough to go home the same day of the procedure," says McNamara. "We felt they were responsible for a large number of beds used in the hospital. We were not getting the utilization that we wanted; there were unnecessary expenses, and that's what we wanted to change."

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