‘Continuity saves people’
Dr. Mark Nelson
WMHS cardiac program marks achievements in 2018
In the complicated and highly technical world of cardiovascular surgery, every detail is key – from the care the patient receives pre and post operation to the decision-making undergone in the operating room. Thanks to the effort and expertise they demonstrate at every turn in the process, Western Maryland Health System’s cardiac program hit another benchmark recently, as the team marked another year with zero mortalities 30 days post-operation in 2018.
“This is something we always strive for,” said Dr. Mark Nelson, cardiothoracic surgeon who performs the open-heart surgeries at WMHS. “Our patients are monitored very carefully. We micromanage everything and the outcomes are of the utmost importance. Many factors beyond mortality are looked at like stroke rate, renal failure, pneumonia and all sorts of other metrics. More important than anything is the care the patients get post-operation in the cardiovascular unit. There are a lot of variables and a lot of things have to go right for it to work.”
“The WMHS cardiac program is a clear reflection of our mission to provide patient-centered care and improve the health and well-being of our community,” said Christine Ruhl, Director of Critical Care Services. “Patients and families are able to receive superior cardiac care while staying within the community and close to their loved ones while the recover.”
Outcomes in cardiac surgery are measured in 30-day mortality. “That means, of course, that we follow our patients extremely closely during that time and beyond if need be,” Dr. Nelson said. “Low mortality is just part of it. Obviously, it’s the lower the better, and we are consistently at or below the national average, but there is a lot more to it.”
Even with a year of no mortalities, the team is always striving for improvement. They measure the amount of conditions like wound infections and strokes, as well as other metrics such as post-operative length of stay, time on the ventilator, and the type and amount of medication issued. “We review all of this quarterly and make sure we are within the parameters compared with the rest of our area and the country. We always do very well,” Dr. Nelson said. The program also marked zero cerebrovascular accidents (strokes) in 2018.
“Quality care and outcomes are key focus areas for the cardiac program and our close involvement with the Maryland Cardiac Surgery Quality Initiative along with benchmarking our data with the Society of Thoracic Surgery nationally ensures we maintain a strong quality focus and continually strive to improve,” Ruhl said.
“There’s a lot of scrutiny,” said Jamie Karstetter, Vice President and Chief Nursing Officer. “You obviously want zero mortality, but it’s not always achievable.”
The continuous attention each patient receives goes a long way in keeping the results as positive as possible. At WMHS, the patient recovers in the cardiovascular unit from start to finish as part of a one-stop approach that has been in place since WMHS started performing cardiac surgery. “This allows continuity,” Dr. Nelson said. “It’s a team-heavy approach, there’s no question about it.”
Patient care is provided by physician assistants and cardiovascular operating room staff, as well as CVU nurses who take care of the patient throughout surgery until they are discharged
“The nurses are experienced, if something happens to the patient on day two or three after surgery, they are able to identify a small issue before it becomes a larger problem”, Karstetter said. “They catch things quickly and get on the phone with Dr. Nelson immediately, which really plays into the great outcomes.”
Just before the mortality results were announced, the WMHS cardiac program was also recognized for the fifth consecutive year with the Cardiac Surgery Excellence Award by Healthgrades, which honors the health system for being the in the top 10 percent for cardiac surgery among hospitals in the nation.
Karstetter said the impact that the program has had over the last two decades is a point of pride for the entire community. “From a nursing care perspective, you see the patients come out of the operating room with many lines and tubes, watch them progress over several days and then discharge to home; it is very gratifying for everyone involved, especially the families.”
Dr. Nelson, who started the program in 2000, recognizes what the continued achievements mean. “It’s very gratifying and it’s nice to know that all of our hard work pays off,” he said. “We’d still like to make things better, as best as we can. It can never be perfect because it’s an imperfect environment. These patients are sometimes very sick and sometimes it’s just impossible to make everyone better.”
By doing their best to eliminate gaps in care and keeping the patients in the CVU the entire time, that imperfect environment is minimized. “Continuity saves people,” Dr. Nelson added. “Patients are taken care of continuously by the same people in the same team and that makes a difference.”