2014 Annual Report

Heart, Vascular & Neurovascular Collaborative Care Program

Annual Report

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Welcome to the 2014 Memorial Hospital Heart, Vascular and Neurovascular Collaborative Care Program Report. We are

The goal of this program is to bring to our community an option in care delivery that far exceeds expectations with top 10 outcome performance and an eye towards cost containment.

As you’ll come to see, there is reason to be encouraged about 2015 and beyond. We thank you for learning more about us and our efforts in improving the quality of heart, vascular and neurovascular care in our communities.

excited to share with you a summary of the outstanding developments, programs and highlights from a year marked by considerable growth.

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Kreg Gruber

Memorial Hospital President

Gerard Duprat, M.D.

Beacon Medical Group Interventional Radiology

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To provide the best care, we are continually investing in the expansion of cuttingedge technology and programming. 2014 was no different, as we sought to focus on a variety of areas that will significantly advance the level of patient care.

New Programs/Procedures Structural heart (LARIAT) LARIAT™ procedure is an innovative way to treat atrial fibrillation in patients who are unable to take blood-thinning medications.

Hybrid ablation (nContact) This is a new hybrid procedure that treats atrial fibrillation by combining the use of surgical and minimally invasive therapies.

Fenestrated stent graft Fenestrated grafts are patient specific designed stents for those with abnormal anatomy.

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Stroke certification application (obtained 3/2015) Memorial Hospital is aiming to become a primary stroke center by obtaining compliance with strokerelated standards and requirements, including program management, delivery of clinical care and performance improvement.

Lipid/Statin therapy protocol Lipid/Statin therapy protocol was developed by cardiology, interventional radiology, primary care and the hospitalist program that uses a best practice among physicians when ordering medications for lipid or statin therapy.

Echo certification application (obtained 2/2015) Memorial Hospital is seeking to become an accredited echocardiography facility for its commitment to addressing lifethreatening heart disorders.

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Looking back on 2014, there are many inspiring examples of amazing patient care.

Below are two such stories that capture the medical expertise and compassionate care that are at the heart of the program.

“Unbelievable Care” John Balzano was working out in his basement in January 2014 just like any other day—when suddenly he felt dizzy and the room spinning. John, a father of two, had suffered a ruptured aneurysm. He was taken to Memorial Hospital where he underwent a neurocoiling procedure to stop the bleeding in his brain. Beacon Medical Group’s neurointerventional radiologist Michael Hall, M.D., performed the minimally invasive procedure.

As is the case with someone who suffers a ruptured aneurysm, they have to relearn how to walk, motor skills and other functions. After he was released from Memorial, John spent almost three months in outpatient therapy at Elkhart General Hospital. He progressed from a wheelchair to a walker.

John returned to work six months after the ruptured aneurysm, but following physician orders, he is taking things slow.

He hopes to return to playing pick-up basketball games and lifting weights John credits Memorial’s clinical staff for everything they did to save his life and help spearhead his recovery.

Says John: “The care was unbelievable. The staff was there for me day and night.”

Second Chances

Barbara Vernon is back to doing what she loves the most—watching her teenage son play high school baseball—after suffering a ruptured brain aneurysm that nearly took her life.

Barbara, Vice President of Programs at Child and Parent Services in Elkhart, felt what she described as a “cherry bomb going off in my head” on the evening of March 18, 2014.

Paramedics arrived to find Barbara, conscious but racked with pain, on the floor in her bedroom.

After undergoing tests at Elkhart General, Barbara was taken to Memorial Hospital where she was prepped for a neurocoiling procedure by neurointerventional radiologist Michael Hall, M.D., of Beacon Medical Group Vascular Interventional Radiology. Following the minimally invasive procedure, Barbara remained in the ICU for 13 days.

She was transferred to Memorial’s rehabilitation floor where physical, speech and occupational therapists worked with Barbara on walking, writing and fine motor skills. Released from Memorial four days later, Barbara still had a long way to a full recovery.

Amazingly, nine weeks after the ruptured brain aneurysm, Barbara was back at work, a couple hours a day at the start.

But during her six-month check-up in October, an arteriogram revealed the coil had shifted, raising the possibility the aneurysm could rupture again, so the same procedure was

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repeated. She returned to work just one week later.

Things are returning to normal for Barbara. She’s not quite back to herself, but “99 percent of the time, I feel good.”

Barbara is back to watching her son Jake in his Concord Minutemen baseball games. A new perspective on life has led Barbara to hold tighter to relationships and commitments.

“I don’t want to miss anything,” she says. “I say, ‘I love you’ a lot more.”

She credits Dr. Hall and the staff at Memorial for giving her a second chance at life.

“They saved my life – what else can I say. When things seemed so out of control, they showed calm and focus. They made it possible for me to be healthy again.”

Barbara was just as enthused with how Dr. Hall and the nurses treated her family.

“When things seemed out of control, they were focused and calm. They always took time to speak with my family and to reassure them of what was going on with me. That made such a difference.”

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On the Rise: Endovascular & Surgical Growth 2013

2014

Pacemakers

149

169

Open Heart Surgeries

178

186

Cerebral Angiogram

296

459

37

46

114

152

Hemorrhagic Stroke

64

80

Cerebral Vascular Coiling

12

20

850

1,112

Endovascular Aortic Aneurysm Repair Carotid Endarterectomy

TOTAL

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The Heart & Vascular Center ramped up its efforts from 2013 to 2014 in performing certain processes and practices that yield better patient outcomes.

It’s All in the Numbers National Average

2013 H&VC Results

2014 H&VC Results

Coronary Interventions given appropriate medical therapy (Aspirin, beta blocker, statin & P2Y12) at discharge

94%

91%

97.1%

CHF patients given left ventricular function evaluation

99%

100%

100.0%

CHF patients given ACE/ARB (blood pressure meds) at discharge

97%

100%

100.0%

Collaborative surgical evaluation prior to peripheral vascular intervention

90%

not measured

95.1%

60.4%

not measured

79%

90%

not measured

90.4%

Vascular surgery with septic shock

*0.8%

0%

0.5%

Vascular surgery with post-op pneumonia

*1.6%

1.1%

0%

Ischemic stroke given statins at discharge

94%

93.9%

98.5%

Stroke patients assessed for rehab

97%

99.6%

99.6%

Stroke education provided

88%

91.6%

97.6%

Peripheral vascular interventions given appropriate medical therapy (statin) at discharge Smoking cessation addressed across all vascular interventions/ procedures

* Based on a lower scale

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Physician Strong Below is a list of all physicians who practice in the Heart & Vascular Center.

Ahmed Abdel-Latief, M.D. M. Shakil Aslam, M.D. Jeffery Borders, M.D. Alfredo Cassetti, M.D. Vinod Chauhan, M.D. Gregory Credi, M.D. Gerard Duprat, M.D. Andrew Fiedler, M.D. Thomas Fischbach, M.D. Michael Hall, M.D. John Katsropoulos, M.D. John Kobayashi, M.D. Daniel Meng, M.D.

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Raman Mitra, M.D. Naseer Nasser, M.D. Ronald Nelson, M.D. Timothy Noveroske, M.D. Breno Pessanha, M.D. Charles Peterson, M.D. Thomas Poulin, M.D. Kevin Small, M.D. Michael Steinberg, M.D. Szabolcs Szabo, M.D. Scott Thomas, M.D. Mark Thompson, M.D. Robert Yount, M.D.

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Heart, Vascular & Neurovascular Collaborative Care Program QualityOfLife.org/heart

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