A little teamwork paid off in a big way for employees at Yale-New Haven (Conn.) Hospital. By working together, they found a way to improve care for the facility's cardiac patients.
Yale-New Haven's departments that deal with cardiac care teamed up to form the Cardiology Clinical Practice Council, which acts as a multidepartmental communication clearinghouse. In just over two years, the council has managed to cut through bureaucracy to streamline and improve delivery of care.
As a result of the changes the council implemented, cardiac patients have shorter hospital stays and lower readmission rates. Among uncomplicated angioplasty patients, length of stay decreased to 1.2 days from 3.1 days; cardiac-care unit utilization decreased to 16% from 70%. In addition, patient satisfaction scores for cardiac care were the highest in the hospital.
For its efforts, Yale-New Haven won this year's Marriott Service Excellence Award for Internal Service.
Before the council was launched in September 1995, parallel committees existed within departments.
"It was difficult to make changes because there was no way of getting information out to the general community," says Henry Cabin, M.D., university cardiologist and project co-chair. "Now everything's passed through the council. We're a clearinghouse for groups who might want to change things and have a centralized collection of information for the implementation of changes and the promulgation of information."
Most important, the program put patients first, says Diane Vorio, nurse manager and project co-chair. "Everybody left their own agendas behind and came to the table to improve cardiac patient care," Vorio says. "We placed a lot more focus on the cardiac patient, not what's best for each department."
For example, patients with congestive heart failure became involved in their own treatment when they were taught methods of intervention and disease management such as monitoring daily weight. Documentation of weight management training increased to 87% from 27%, and the percentage of patients monitoring weight rose to 78% from 21%.
Meanwhile, time spent in the cardiac catheterization laboratory decreased to 19 minutes from 33 minutes. Time from catheterization to coronary artery bypass graft was reduced from seven days to one or two days.
The council was able to accomplish these successes by improving teamwork between departments. It surveyed cardiologists to identify negative as well as positive aspects of cardiac care. Based on the survey results, the council concentrated on specific areas for improvement in the emergency room, cardiac-care units, the cardiac catheterization lab and computer facilities.
The cardiologist survey, which had never been administered at Yale-New Haven before, gave cardiologists a voice in the outcome of the cardiac patients' overall care.
Before the council, "physicians felt a lack of input," Vorio says. "The survey made them feel someone would make the changes and their concerns would be met."
She acknowledges, however, that creating such a multidisciplinary group can be difficult.
"In an academic health center, (the council) is a challenging thing to do," she says. "It's difficult to get departments (to buy) into the idea, but we've been able to get everybody committed. If you focus on the patient, you can have extraordinary results."