BryanLGH Heart Institute Annual Report

2010

annual report

40 years of excellence

|

innovation

|

experience

Patients First.

highlights

Our commitment  to quality outcomes In June 2010 we will mark the second anniversary of our enhanced relationship with BryanLGH Medical Center, one that established a specialty heart hospital within a hospital. Thank you for your support and the referrals you have made to BryanLGH Heart Institute.

The purpose of this report is to provide you with a concise update on the latest services and technologies available for your patients, as well as to share with you clinical outcomes that demonstrate our commitment to the highest quality heart care for Nebraska and the region.

Our goal is to provide you with an unparalleled level of service, and your patients an exceptional healthcare experience. Please let us know if there are ways BryanLGH Heart Institute can be of additional assistance in your practice.

Sincerely,

Clyde Meckel, MD Executive Medical Director

Edward Raines, MD, JD Surgical Director

(Front row, left to right): Clyde Meckel, MD; Ryan Whitney, MD; Dale Hansen, MD (Back row, left to right): Scott Coatsworth, MD; Robert Hibbard, MD; Andrew Merliss, MD; Steven Krueger, MD; Joseph Kummer, MD; Keith Miller, MD; Todd Tessendorf, MD; Timothy Gardner, MD; David Hughes, MD; Edward Raines, MD

more than

500

p at i e n t s t h o u g h t o f u s f i r s t f o r h e a r t s u r g e r y l a s t y e a r.

BryanLGH Heart Institute is the region’s most experienced heart care provider.

highlights

Dual Recipient BryanLGH is the only hospital in Nebraska to have received both awards and is one of only 74 dual award recipients in the United States for 2010.

The BryanLGH Heart Institute specializes in cardiology and cardiothoracic surgical care, offering world-class diagnosis and treatment of heart disease. BryanLGH Medical Center and the BryanLGH Heart Institute, the specialty cardiac hospital within BryanLGH Medical Center, are proud to have received both the 2010 Distinguished Hospital Award for Clinical Excellence™ and the Patient Safety Excellence Award™ by HealthGrades®.

BryanLGH is the only hospital in Nebraska to have received both awards and is one of only 74 dual award recipients in the United States for 2010.

Volume Highlights, Fiscal Year 2009 •

eart Surgeries — More than 500 cases, H increase of 12%

•

iagnostic Heart Caths — More than D 3,200 cases, increase of 10%

•

Echocardiograms — More than 14,900

•

Electrocardiograms — More than 26,900

•

Holter Monitors — More than 2,000

•

PCI/Stents — More than 900 cases, increase of 28%

•

ardiac Patient Days — More than 3,570 C critical care, more than 10,000 cardiac care

•

EP, Pacers and ICD — More than 950 cases

•

Chest Pain Clinic Patients — More than 700

•

ardiac and Nuclear Stress Testing — C More than 10,000 cases

•

Clinical Research — More than 40 trials

www.bryanlgh.org

This past year, three new technologies have become part of the advanced cardiac care at BHI, including: aquapheresis, advanced technology for fluid removal for patients with CHF; the Impella Device, a temporary left ventricular assist device for complex cardiac intervention and cardiogenic shock patients; and

te

c

3

hn

ie

anoxic brain injury.

s

hypothermia core body cooling  to prevent or reduce

olog

BHI has a consistent history of being first in heart and vascular care delivery.

highlights

more than

30

C o m m u n i t i e s a c r o s s f o u r s tat e s a r e p r o v i d e d a d va n c e d s e r v i c e s f r o m B HI .

As the leading provider of cardiac and vascular services in Nebraska and the surrounding region, BHI has a consistent history of being first in heart and vascular care delivery.

Back in the 1960s, Bryan Memorial Hospital

The year 2009 continues that legacy of advanced

was first in the region to perform cardiac

cardiac care for Nebraska and the surrounding

angiography and open heart surgery. In

region. Echocardiography and vascular services,

the 1970s, the hospital performed the first

including mobile services, were reaccredited

CABG surgery and pacemaker implants.

by the national accreditation bodies ICAEL and

In the 1980s, Bryan Memorial was the

ICAVL. 3D imaging for echocardiography and

first to perform angioplasty, and in the

valve imaging is used daily. HeartAware, the

same decade, introduced mobile cardiac

computer online risk assessment tool, is now

and vascular services.

available for public access. And our mobile screening services, including a semi trailer

The 1990s brought coronary stenting,

fully equipped for public screening, has

advanced electrophysiology studies, ICD

traveled throughout the region.

implants and LVADs. In the 2000s came cardiac robotic surgery, minimally invasive

Second generation upgrades have been made to

valve repair surgery, and cardiac CT.

the robotic surgery system. And we’ve adopted new innovations and improved techniques for minimally invasive valve surgery. The cardiac Maze procedure, for atrial fibrillation, is now performed by our highly acclaimed and recognized cardiac surgery program.

All of these advances, along with the experience and dedication of the most skilled and qualified clinicians, makes BryanLGH Heart Institute the First Name in Heart Care.

www.bryanlgh.org

Surgery Advances • Robotic Surgery Upgrade: daVinci Robot upgraded to facilitate enhanced cardiac procedures.

• Minimally Invasive Valve Surgery training site for other cardiac surgeons.

• Maze Procedure: Enhanced Atrial Fibrillation surgical treatment.

Surgical Cardiac Procedures More than 500 cases (12% increase) CABG-Only Surgeries:

More than 300 cases

The BryanLGH Heart Valve Center of Excellence brings together a team of experienced experts from multiple disciplines to offer the most complete and fully integrated care in the region for patients with valvular heart disease.

Heart Valve Center of Excellence Team

Edward Raines, MD Surgical Director

Keith Miller, MD, PhD, FACC Cardiology Director

Terry Bejot, MD H G E A LT H

•

ew patient evaluations by cardiologists, cardiac surgeon N and other specialists as needed, complete in one stop

•

on-invasive evaluation including cutting edge quantitative N and 3-dimensional echocardiography techniques

•

Minimally invasive surgical options to reduce patient morbidity

•

ull perioperative support services from on-site F pulmonary/intensive care specialists

•

ost experienced cardiac anesthesiology M and perfusionist teams in the area

•

I mmediate availability of all subspecialty and ancillary services for complex patients

•

omplete postoperative care and follow-up, including C rehabilitation and long-term outcomes tracking

R A D E S®

G U I D I N G A M E R I C A T O B E T T E R H E A LT H C A R E ®

Anesthesia Director

Rhonda Olmsted, APRN Valve Center Coordinator

H E A L T H G R A D E S® G U I D I N G A M E R I C A T O B E T T E R H E A LT H C A R E ®

H E A L T H G R A D E S® G U I D I N G A M E R I C A T O B E T T E R H E A LT H C A R E ®

Five Star rated for Valve Replacement Surgery 20092010

i n N e b r a s k a f o r C a r d i a c S u r g e r y ( HealthGrades 2010 )

Mitral Repair

80%

Mitral Replacement

Minimally Invasive

CY

Open

CY

– 2009 –

54%

distribution of

Mitral valve

– 2009 – mitral valve procedures

procedures

46%

20%

Valve Replacement Mortality Rates

BryanLGH vs. National Predicted Rates 6.0%

6.2% 5.3%

4.0% 2.7%

3.5%

2.0%

Valve Replacement

30 Days Post Discharge

BHI Actual National Predicted

Valve Procedure Mortality Rates

BryanLGH vs. Society of Thoracic Surgeons CABG

(RISK-ADJUSTED)

2.0 %

(2004-2009)

0.0 %

2.0 % (2009)

1.2 %

MITRAL VALVE REPAIR

(2008-2009)

MITRAL VALVE REPAIR/CABG

(2008-2009)

(2008-2009)

BryanLGH Heart Institute

Society of Thoracic Surgeons

0.0 %

(2008-2009)

5.3 %

cardiac surgery

1

#

ranked

BHI is the most experienced minimally invasive cardiac surgery program in the region

875

angioplasty/stent procedures in 2009

3,110

Heart Caths Performed

875

Angioplasty/Stent Procedures in

2009

interventional cardiology

CMS ORYX Time Compliance Door-to-Balloon Time Measured (Less than 90 Minutes)

BryanLGH Heart Institute National Average

Key 92%

BHI National

78.9% 25%

50%

75%

100%

Average Length of Stay for Angioplasty/Stent Procedure

for Angioplasty/Stent Procedure

1.5% 1.0%

2.25

BHI National

Risk-Adjusted Mortality Rate

1.3% 0.77%

.5% 3.0

1 day

2 days

3 days

BHI

National

www.bryanlgh.org

Program advances include: • Thoracic stent grafting for trauma and dissection • Treatment of renovascular disease • Abdominal stent grafting variations made possible

with the latest generation of grafts • Reconstructing aortic disease • Infrapopliteal intervention for peripheral vascular leg disease

1

number

enroller in sapphire worldwide carotid stent trials

SAPPHIRE Overall Top Enrollers (352 centers worldwide)

interventional cardiology

Robert Hibbard, MD, FACC, has performed more than 600 percutaneous carotid procedures in patients at high risk for carotid endarterectomy (with MACE of less than two percent).

Number of Patients

BryanLGH Heart Institute, (Robert Hibbard, sole enroller)

Lincoln, NE

151

Cardiovascular Associates

Kingsport, TN

143

Wake Heart & Vascular Associates

Raleigh, NC

140

Vascular and Transplant Specialists

Norfolk, VA

132

First Coast Cardiovascular Institute

Jacksonville, FL

119

University of Texas Houston/Memorial Hermann Heart and Vascular Institute

Houston, TX

113

THREE-year trends BryanLGH Medical Center Diagnostic Peripheral Angiograms

Endovascular Peripheral Procedures

Aortic Stent Graft Procedures

Number of cases by year

Number of cases by year

Number of cases by year

2007 2008 2009

731

2007 785

2008 853

2009

498

2007 526

2008 617

2009

22 39 66

www.bryanlgh.org

more than

400

Pacemaker devices impl anted

The Electrophysiology department utilizes state-of-the-art Stereotaxis速 magnetic navigation and 3D mapping.

150 ablation procedures from December 2008-2009 •

Ablations of the following tachycardia:

First in the region to utilize state-of-the-art Stereotaxis® magnetic navigation and 3D mapping technology

– AV node re-entrant tachycardia

•

400 pacemaker devices were implanted

– Atrial fibrillation

•

250 ICD procedures

– Pulmonary vein isolation

– 53% are biventricular implants

– AV nodal ablation •

Accessory pathway tachycardia

•

Atrial flutter

•

Atrial tachycardia

•

Ventricular tachycardia

www.bryanlgh.org

Electrophysiology (EP)

The electrophysiology department utilizes state-of-the-art Stereotaxis® magnetic navigation and 3D mapping technology to assist in cardiac ablation procedures. Use of this technology helps to ensure the best possible outcomes for patients.

BryanLGH was the first in our area to embrace this technology.

Wyoming Iowa Nebraska Illinois

Kansas

The BryanLGH Heart Improvement Program serves patients across a seven-state region.

Missouri

Arkansas

n e a r ly

700,000

People are diagnosed with he art failure e ach ye ar.

The BryanLGH Heart Improvement Program is a comprehensive heart failure treatment program featuring advanced medical and surgical therapy, as well as experimental treatments.

The backbone of the program is standard treatments. However, these are supplemented

Number of Patients

BryanLGH Heart Improvement Program

with advanced surgical therapies that distinguish BryanLGH from other heart

2002

failure treatment programs.

2005

Director Steven K. Krueger, MD, FACC,

375 550

2009

700

Coordinator Pat VerMaas, APRN, and 10 nurses and assistants have performed more than 70 experimental studies. Many of them have led

H E A L T H G R A D E S®

to what is now our standard and current

G U I D I N G A M E R I C A T O B E T T E R H E A LT H C A R E ®

medical treatment. Among these are: and resynchronization therapy. On average we H are E A Linvolved T H G R Ain D E18 S® active ongoing protocols

BryanLGH vs. National Comparison 100%

95%

90%

including new uses of standard medications

80%

and gene therapy.

70%

G U I D I N G A M E R I C A T O B E T T E R H E A LT H C A R E ®

heart failure

angiotensin receptor blockers, carvedilol,

Appropriate Care Measures

85%

60%

H E A L T H G R A D E S®

BHI

National

G U I D I N G A M E R I C A T O B E T T E R H E A LT H C A R E ®

BryanLGH is Five Star rated for Congestive Heart Failure 2007-2010

www.bryanlgh.org

Years of nursing experience on our intensive care and cardiac units

942

In emergency situations when time is critical and expert care can save a patient’s life, our StarCare helicopter team, on call 24 hours a day, includes a critical care flight nurse and respiratory therapist.

40 years of excellence, innovation and experience assures our patients the best possible care.

•

ighly trained cardiac nurses available H in cath lab, ICU and cardiac unit

•

otal years of experience for ICU T and cardiac unit: 942

•

hest Pain Center established to C rapidly evaluate symptoms of chest pain in a safe setting

•

L atest technology, including:

– Ultrafast Cardiac CT Imaging – Impella (Ventricular Assist Device) – I nner Cool for hypothermia used post arrest –E CMO

(Extracorporeal Membrane Oxygenation)

– CRRT

(Continuous Renal Replacement Therapy)

–C ritical Care Intensivist Coverage •

enefits of heart hospital with skills and B technology, plus the benefits of a full-service hospital for specialists and services

•

Newer enhancements:

– 3D Echocardiography – Definity Contrast Imaging

www.bryanlgh.org

Cardiac Medicine

– Aquapheresis

The Physicians of BryanLGH Heart Institute Scott Coatsworth, MD, FACC / drcoatsworth@bhi-1.com A native of Lincoln, Nebraska, Dr. Coatsworth attended the University of Nebraska–Lincoln and went on to the University of Nebraska College of Medicine, where he received his medical degree with high distinction. He then attended the University of Iowa for both his residency in internal medicine and a fellowship in cardiology, where he served as Chief Fellow in Cardiology.

Dr. Coatsworth is certified by the American Board of Internal Medicine and the American Board of Internal Medicine Subspecialty Board of Cardiovascular Diseases. He has achieved fellowship status with the American College of Cardiology, Society for Cardiac Angiography and Interventions, and the American Heart Association Clinical Council.

Timothy Gardner, MD, FACC / drgardner@bhi-1.com Dr. Gardner pursued his undergraduate education at Portland State University. He attended Baylor College of Medicine in Houston, Texas and graduated with honors. Dr. Gardner completed internal medicine residency and a cardiovascular fellowship including interventional cardiology at the Johns Hopkins Hospital in Baltimore, Maryland in 1996.

Dr. Gardner is board certified in Cardiovascular Diseases and Interventional Cardiology. He is a fellow in the American College of Cardiology and has been recognized several times as one of America’s Best Cardiologists by the Consumer’s Research Council of America. His special interests are in coronary and peripheral interventions and pacemaker implantations.

Dale A. Hansen, MD, FACC / drhansen@bhi-1.com A native of Hartington, Nebraska, Dr. Hansen attended the University of Nebraska–Lincoln, where he graduated with distinction and was a member of Phi Beta Kappa. He went on to the University of Nebraska College of Medicine in Omaha, where he received his medical degree and was a member of ACA. Dr. Hansen served his residency in internal medicine and a fellowship in cardiology at the University of Nebraska Medical Center. He also completed a fellowship in cardiology at Creighton University Affiliated Hospital in Omaha.

Dr. Hansen is certified by the American Board of Internal Medicine and the American Board of Internal Medicine Subspecialty Board of Cardiovascular Diseases. He has achieved fellowship status in the American College of Cardiology and the American College of Chest Pain.

Robert N. Hibbard, MD, FACC / drhibbard@bhi-1.com Dr. Hibbard completed his undergraduate studies at the University of Wyoming and then attended the Creighton University School of Medicine in Omaha, Nebraska. He completed his internship, residency in internal medicine and fellowship in cardiology at the Creighton University School of Medicine.

Dr. Hibbard is certified by the American Board of Internal Medicine and the American Board of Internal Medicine Subspecialty Boards of Cardiovascular Diseases and Interventional Cardiology. He is a fellow of the American College of Medicine, American College of Cardiology, American College of Chest Physicians and the American Society of Angiography/Intervention.

David Hughes, MD / david.hughes@bryanlgh.org Dr. Hughes attended the Baylor College of Medicine and was a general surgery resident and later a thoracic surgery resident at the University of Michigan Hospitals in Ann Arbor. He completed a fellowship in cardiovascular surgical research at the Texas Heart Institute in Houston where he helped investigate the potential for nuclear-powered artificial hearts.

Since finishing residency, Dr. Hughes has served as Chief of the Cardiac and Thoracic Surgery Division at Creighton University School of Medicine, as assistant clinical professor of surgery at the University of Nebraska College of Medicine and as Chief of Cardiothoracic Surgery at Clarkson Hospital in Omaha. Dr. Hughes specializes in valve surgery, coronary artery bypass graft surgery, aortic root surgery, and surgical treatment of lung cancer. He is board certified by the American Board of Surgery and the American Board of Thoracic Surgery.

Steven Krueger, MD, FACC / drkrueger@bhi-1.com A native of Kearney, Nebraska, Dr. Krueger attended Nebraska Wesleyan University in Lincoln where he earned his B.S. in Biology. He received his medical degree from the University of Nebraska College of Medicine in Omaha. He completed his internship and residency at Stanford University Medical Center in Palo Alto, California. Dr. Krueger served fellowships at the University of Utah in Salt Lake City in cardiology, electrophysiology and congestive heart failure.

Dr. Krueger manages the care of over 800 patients in the Heart Improvement Program and has served as principle investigator on over 75 clinical research trials. He is certified by the American Board of Internal Medicine and the American Board of Internal Medicine Subspecialty Board of Cardiovascular Diseases. He also has achieved fellowship status in the American College of Physicians and the American College of Cardiology.

Joseph L. Kummer, MD, FACC / drkummer@bhi-1.com A native of Omaha, Nebraska, Dr. Kummer attended Saint Louis University, where he received two undergraduate degrees and completed pre-medical studies in 1996. He then attended the University of Nebraska College of Medicine in Omaha where he earned his medical degree in 2000. He completed his internship and residency in Internal Medicine at Northwestern University in Chicago.

He went on to complete his fellowship in cardiology and cardiovascular disease at Henry Ford Hospital in Detroit, Michigan.

Clyde Meckel, MD, FACC / drmeckel@bhi-1.com A native of Burwell, Nebraska, Dr. Meckel attended the University of Nebraska–Lincoln, where he graduated with high distinction. He then went on to the University of Nebraska College of Medicine where he received his medical degree and graduated with high distinction. He served his internship at Brigham and Women’s Hospital and Harvard Medical School in Boston, Massachusetts. He also completed his residency in internal medicine and his fellowship in cardiology at Brigham and Women’s Hospital.

Dr. Meckel is board certified by the American Board of Internal Medicine and the American Board of Internal Medicine Subspecialty Board of Cardiovascular Disease and Interventional Cardiology. He is a fellow of the American College of Cardiology, a member of The Society for Cardiac Angiography and Interventions and a member of the American Society of Nuclear Cardiology.

Andrew Merliss, MD, FACC / drmerliss@bhi-1.com Dr. Merliss attended Colgate University for his undergraduate studies. He then attended the George Washington University School of Medicine, where he also completed his internship. From there, he completed his residency at Harvard Medical School and went on to serve his cardiology fellowship at Boston University Hospital. He completed his fellowship in cardiac electrophysiology at Harvard Medical School, where he taught for five years.

Dr. Merliss is certified by the American Board of Internal Medicine and the American Board of Internal Medicine Subspecialty Board of Cardiovascular Diseases, as well as the Subspecialty Board of Cardiac Electrophysiology. He is a fellow of the American College of Cardiology and is a member of the North American Society for Pacing and Electrophysiology and Project Pacemaker International.

Keith Miller, MD, PhD, FACC / drmiller@bhi-1.com A native of Omaha, Nebraska, Dr. Miller attended Cornell University in Ithaca, New York where he completed his undergraduate studies.

He went on to earn his medical degree and his PhD in molecular biology from the University of Nebraska College of Medicine in Omaha.

He completed his residency in internal medicine at the University of Iowa Hospitals and Clinics in Iowa City and his cardiology fellowship at the University of Chicago Hospitals.

Dr. Miller is certified by the American Board of Internal Medicine, the National Board of Echocardiography and the Certification Board of Nuclear Cardiology.

Edward Raines, MD, FACS, JD / edward.raines@bryanlgh.org Dr. Raines attended the University of Nebraska College of Law and received his medical degree from the University of Nebraska College of Medicine.

He then attended the University of Utah Affiliated Hospitals in Salt Lake City for his general surgery residency, serving as Chief Resident, as well as completing his fellowship in cardiothoracic surgery.

Dr. Raines specializes in minimally invasive cardiac surgery, robotic thoracic surgery, and mitral valve repair. He is among fewer than 10 surgeons in the country successfully performing the Ross heart valve replacement surgery. Additionally, Dr. Raines has been the principle investigator of several national research studies in cardiac surgery and artificial hearts. Dr. Raines is board certified by the American Board of Surgeons and American Board of Thoracic Surgery; he is also a member of the Cardiothoracic Surgery Network, the International Society for Minimally Invasive Cardiothoracic Surgery and the Society of Thoracic Surgeons.

Todd Tessendorf, MD, FACC / drtessendorf@bhi-1.com A native of Columbus, Nebraska, Dr. Tessendorf received his undergraduate degree from Nebraska Wesleyan and his medical degree from the University of Nebraska College of Medicine. He completed his internship and residency at University of Nebraska Medical Center and a cardiology fellowship at the University of Missouri-Kansas City. Dr. Tessendorf has a focus in coronary catheterization, nuclear cardiology, and echocardiography.

Dr. Tessendorf is certified by the American Board of Internal Medicine Subspecialty Board of Cardiovascular Diseases.

Ryan Whitney, MD, FACC / drwhitney@bhi-1.com A native of Omaha, Nebraska, Dr. Whitney attended the University of Nebraska–Lincoln for his undergraduate studies and went on to the University of Nebraska College of Medicine in Omaha where he received his medical degree. He completed his residency in internal medicine at the University of Iowa Hospitals and Clinics in Iowa City. He returned to Omaha to serve his fellowships in cardiology and interventional cardiology at the University of Nebraska Medical Center.

Dr. Whitney is certified by the American Board of Internal Medicine Subspecialty Boards of Cardiovascular Diseases and Interventional Cardiology.

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