What’s at the heart of the best cardiac hospitals?
One of HCIA’s top 100 tells all
When Baltimore-based HCIA-Sachs comes out with its list of 100 top hospitals — whether it’s in orthopedics, intensive care, or cardiology — there is always the lingering question of what makes one hospital part of the elite group and another one not.
According to Jean Chenoweth, senior vice president at HCIA-Sachs, in the case of the top cardiac facilities, there are as many differences as similarities. For example, mortality rates: There is a range of 22% among the top 100 this year. (See chart, p. 103.)
"And that’s better than the difference there was last year," she notes. "That’s how this can impact a hospital, by shining a light on an area that may not always be measured. We name the benchmarks and invigorate some hospitals to do better."
Chenoweth is sure the gap will narrow further when the next list of 100 top cardiac hospitals is released.
One of the top hospitals this year is Overlake Hospital in Bellevue, WA. Sheila Goldsmith, RN, MSN, director of critical care and cardiac services, says the excellence of the cardiac care program is a combination of hard work, concerted effort, and some serendipity.
"We have a very cohesive program that is seamless and connected," she explains. "We communicate and collaborate regularly, both formally and informally."
There are weekly program meetings with general discussions of how things are going, and specific conversations about individual patients and what the team members think is the best plan of care for them.
Part of the success comes from a willingness to collect and then use data, says Goldsmith. Along with internal data, there are statewide data available from the Clinical Outcomes Assessment Program (COAP) based in Seattle. COAP, a state-certified quality improvement program, collects data from every single heart program in the state that provides heart surgery and elective angioplasty. The data are delivered quickly, too. Already there are complete quarterly data for 1999, and at press time, the delivery of the annual report for the year was imminent, says Goldsmith. That’s a good return for a $2,000 annual investment.
National data come in handy. At Overlake, most of the national numbers come from the Society of Thoracic Surgeons, but Goldsmith says the information can be overly detailed, very voluminous, and usually runs about two years behind time.
The 100 top hospitals report is also useful, but in a more limited way, she adds.
More to data than meets the eye
Chenoweth agrees that there are gaps in the data that HCIA collects, all from public sources, to name its 100 top hospitals. "There are certainly limitations to the administrative data we use, but it is a reasonable place to begin."
But there is color commentary in the report on the winning organizations that includes information from other, nonpublic databases. For instance, the use of stents is shown to be more common among the top 100 hospitals, and that isn’t something that is available from the public information HCIA used to select the winners. Rather, that information came from further examination of data from the winning hospitals, she says.
"We do more research on the 100 top hospitals that is a different kettle of fish from the information we use to choose the hospitals," Chenoweth explains. "We collect detailed treatment data from them that allow us to look at protocols and treatment patterns that we won’t see in the public data."
Being named among the top cardiac hospitals in the country isn’t the end, however. Goldsmith says she can’t sit back on her laurels, nor can her staff. "We are a community hospital, which means we have to work harder all the time to compete."
Of course, that becomes easier when there are surgeons and cardiologists who are committed to being the best. It has been leadership from some of those physicians in the last 15 years that has improved emergent response in the community east of Seattle, allowing an emergency medical system to improve the time it takes to get patients to the hospital.
"Seattle often can’t provide primary angioplasty care because [caregivers] don’t get to the patients as quickly," explains Goldsmith. "In most cases, patients aren’t coming from close by, but from the suburbs, from outside the hospital neighborhood."
Time is muscle, she adds, so getting those patients in fast means a big difference in quality of life. "Providing good emergent response and primary angioplasty is a landmark of what we provide. Get them to the hospital and into the cath lab to open up those vessels and get the blood flowing."
Goldsmith also attributes Overlake’s success to its use of clinical nurse specialists to help with staff training and orientation. Those nurses are also available on a per-patient basis to assist in problem solving. The hospital also has a nurse practitioner who sees every patient before, during, and after surgical care.
"That makes a big difference to recovery times," she says. It also helps physicians who might be busy in surgery. The nurse practitioner can write prescriptions, discharge patients, and give discharge instructions to them. That expedites and facilitates good patient flow, she says.
Nursing, in general, is a big component of the hospital’s cardiac program and of the hospital itself, says Goldsmith. "We are a very nurse-centered hospital. We have an active nursing presence that physicians rely on and respect. We have ongoing education programs, and annual competency and skills testing. We also have a good retention rate among our nurses."
Lastly, Goldsmith thinks the size of the hospital works to Overlake’s advantage. "We can talk to people, reach them, and make changes quickly. It’s not like turning a battleship. And we are committed to working and improving what we do constantly."
Some might think that the data don’t have an impact, but Chenoweth isn’t one of them. "Because the industry is now competitive and because of the Internet, where information is easily available to consumers, hospitals react strongly if a competitor has better scores than they do or wins an award and they don’t. And I think the hospitals that get this award take it seriously. It isn’t something we publish in a consumer magazine, but something that goes into industry publications. We aren’t trying to sell anything. We are a data company trying to promote benchmarks that help hospitals improve performance."
[For more information, contact:
• Jean Chenoweth, Senior Vice President, HCIA-Sachs, Baltimore. Telephone: (410) 895-7498.
• Sheila Goldsmith, RN, MSN, Director of Critical Care and Cardiac Services, Overlake Hospital, Bellevue, WA. Telephone: (425) 688-5613.]
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content