When the Cleveland Clinic decided to launch a cardiovascular services program in 2001 at its satellite hospital in South Florida, physicians, equipment and expertise made the move.
The idea was to transfer the clinics high standards in heart services to its facility in Weston, Fla. We took trips to Cleveland to learn how they did it up there, recalls Bernardo Fernandez, chief executive officer of the Cleveland Clinic Florida. We brought in the experts to give us advice on processeshow to take the patient from point A to point B.
Riverside Medical Center in Kankakee, Ill., south of Chicago, also sought to imitate the experts when it opened the Rush-Riverside Heart Center on the Kankakee campus in 1999. Although the Rush System for Health doesnt own Riverside, the hospital is affiliated with Rush and its flagship facility, Rush University Medical Center in Chicago.
Experts at the Chicago facility helped us in recruiting and securing top-notch cardiac surgeons, nurses and technologists. They have helped us with review of protocols and treatment approaches, says Margaret Frogge, senior vice president of corporate strategy at Riverside. We participate in research studies with them, educational programs, and advanced training of our nurses, technologists and physicians, she says.
The replication strategy has paid off as both Cleveland Clinic Florida and Riverside are listed for the first time on the 2007 edition of The 100 Top Hospitals: Cardiovascular Benchmarks for Success from Thomson Healthcare. Both the Cleveland Clinic in Ohio and Rush University Medical Center are veterans of the 100 Top list of heart hospitals. Thomson released the ninth annual study exclusively to Modern Healthcare. Thomson took over the reins of the cardiovascular services study when it purchased Evanston Ill.-based Solucient in 2006.
The Cleveland Clinic and Rush are just two of the organizations with more than one facility on the 2007 list. Others include: William Beaumont hospitals in Royal Oak, Mich., and Troy, Mich.; Henry Ford Hospital, Detroit, and Henry Ford Macomb Hospital in Clinton Township, Mich.; and Mercy Medical Center-North Iowa in Mason City and Mercy Medical Center-Des Moines. Memorial Hermann Healthcare System, Houston, has numerous hospitals on the list: Memorial Hermann-Texas Medical Center, the flagship, and four smaller hospitalsMemorial Hermann Southwest Hospital, Memorial Hermann Southeast Hospital, Memorial Hermann Northwest Hospital and Memorial HermannThe Woodlands Hospital, all of which are reported to Medicare under the name, Memorial Hermann Hospital System.
Two investor-owed cardiology hospitals owned by MedCath Corp., Charlotte, N.C.Heart Hospital of Austin (Texas) and Arizona Heart Hospital, Phoenixare on the list as is Tucson (Ariz.) Heart Hospital. MedCath owned a stake in Tucson Heart Hospital until 2006, when it sold its share to Carondelet Health Network, Tucson.
We clearly are seeing the transfer of know-how and possibly technology from flagship hospitals to smaller hospitals, says Jean Chenoweth, Thomsons senior vice president of performance improvement and 100 Top Hospitals programs.
In addition to Cleveland Clinic Florida and Riverside, 17 other hospitals are on the list for the first time. Two hospitalsMorton Plant Hospital in Clearwater, Fla., and Munroe Regional Medical Center in Ocala, Fla.have made the list all nine years; six others have been named to the list eight years.
To select the top 100 cardiovascular hospitalsor benchmark hospitalsThomson researchers evaluated 975 hospitals on eight measures of clinical quality and operating efficiency. The study comprised 165 teaching hospitals with cardiovascular residency programs, 286 teaching hospitals without residency programs and 524 community hospitals.
Thomson used medical claims information on 12 million Medicare patients from the Medicare Provider Analysis and Review (MedPAR) data for 2005 and 2006. It also used Medicare cost reports from 2005 and 2006.
The top hospitals scored better than their peer hospitals on all performance measures. For example, benchmark hospitals had:
How do the top cardiovascular hospitals do it? They key, Chenoweth says, is sustained attention to detail and a commitment to performance improvement. A truly high-performing hospital has to develop very efficient internal systems to ensure good results, she says.
Thats certainly the approach Riverside has taken. In the early days of the heart service, for example, the director of the cardiac catheterization laboratory at Rush Medical Center visited Riverside at least monthly to help hone processes in Kankakee. That close attention has led to continual improvements in the hospitals average door-to-balloon rateor the amount of time it takes for emergency-room AMI patients to receive an angioplasty. The rate is 79.2 minutes currently, compared with 88.4 minutes last year, both of which are better than the national standard of 90 minutes.
Riverside clinicians also have adopted processes to help prevent multiple hospital stays for patients with congestive heart failure. The hospital in 2002 set up a systematic program in which cardiac nurses keep tabs on patients through phone calls and office or home visits. Nurses respond to patient telephone calls round the clock, 365 days a year. The idea is to react to symptoms of relapsesuch as weight gain or shortness of breathbefore hospitalization is necessary.
It is really one of the populations that is difficult to handle because it requires a concerted team effort, Frogge says.
Since the program was implemented, the readmission rate for congestive heart failure patients has ranged from 9% to 11%a significant drop from the 30% rate before the program, according to the hospital.
Cleveland Clinic Florida also has taken steps to slash its door-to-balloon times. In 2001, for example, it purchased technologyLifenet Receiving Station from Medtronic, Redmond, Wash.that allows physicians in the clinics emergency room to receive electrocardiogram information directly from heart-monitoring devices in emergency vehicles. This process saves time because cardiologists dont have wait until patients are in the emergency room to collect and analyze ECG data. Fernandez says this is one reason why the clinics door-to-balloon average is 50 minutes.
In another effort aimed at improvement, Cleveland Clinic Florida has institutionalized what Fernandez calls innovation trips to Ohio. Says Fernandez, We encourage our managers and technologists to go to Cleveland Clinic in Ohio to see how things are done so we can have the same processes and the same standards of care.
Linda Wilson, a former Modern Healthcare reporter, is a freelance writer based in McHenry, Ill. Contact her at [email protected]