• March 2020

    Top 5 standard practices to build high-quality surgical programs

For the 11th  time, Baylor Scott & White The Heart Hospital – Plano has earned a 3-star ratings from The Society of Thoracic Surgeons (STS). The hospital is among the top 3% of all hospitals nationwide for isolated aortic valve replacement surgery (AVR), isolated coronary bypass surgery (CABG), AVR plus CABG surgery.

Dr. Kelley Hutcheson, Medical Director, Coronary Revascularization and Dr. William Ryan, Chief Quality Officer, Chairman of Cardiovascular Surgery provided their insights on the measures they have taken to consistently review and employ collaborative practices and improve quality of care. Here are the top five operational strategies implemented.

High-Risk Surgical Case Conference

Recognizing that high-risk cases would benefit from multiple physicians reviewing case details and diagnostic data, Baylor Scott & White The Heart Hospital – Plano, under the leadership of Dr. Hutcheson and Dr. Ryan, initiated the High-Risk  Surgical Case Conference in 2014, which employs a multidisciplinary heart team approach to clinical decision-making. “Cardiac physicians from multiple subspecialties meet, and there’s crosstalk between specialties before any decisions are made about interventions. This way, potential complications can be anticipated and often avoided by all specialties involved. Critical to this process is buy-in from all specialties to both bring their cases for presentation and to provide input to cases presented on a regular basis. The High-Risk Surgical Case Conference has been a standard operating procedure at the hospital since its inception,” explains Dr. Hutcheson.

STS Database Informs Patient Care

Baylor Scott & White The Heart Hospital – Plano has participated in the STS Database since its inception. The STS Database collects outcomes data nationally about cardiac surgery patients. Every six months, surgeons receive an individualized report summarizing their outcomes including absence of mortality, stroke rates, prolonged ventilation rate, use of internal mammary artery, bleeding rate, etc. These data then inform any changes in procedures or policy that are needed. Overall, it allows physicians and administrative staff to measure themselves against previous results, colleagues and other hospitals in real time. “The data is audited in-house, so we can act on it quickly to improve patient outcomes,” says Dr. Ryan.

Phase of Mortality Assessment

When there is a mortality, it is thoroughly analyzed. The team asks: In which phase of care did the death occur – pre-operative, intra-operative, post-operative? Was it an unavoidable catastrophe, or something that might have been prevented? “In 2013-2014, we began to carefully review all phases of care, i.e., pre-operative, intra-operative, post-operative phases and analyze which phase had the highest rate of mortality,” explains Dr. Ryan.

These data advise decision-making, and during high-risk case conferences, allow for discussion among physicians in different subspecialties to prevent potential problems in any specialty area. Dr. Ryan says, “Since the conferences were instituted, and we began utilizing these data, our mortality rate for certain phases of care is virtually zero.”

 Optimizing Nursing

The nursing staff at Baylor Scott & White The Heart Hospital – Plano plays a central role in patient outcomes and in how this hospital achieves some of the best ratings in the country. Nurses and physicians take the initiative to work closely as a team and where possible to standardize care that supports patients through their entire time at the hospital. Dr. Hutcheson explains, “The nursing staff is an integral part of every patient’s experience and outcome. Attentive nursing staff mitigate and communicate possible areas of risks from the pre-operative stage all the way to full recovery – that means from the pre-operative clinic assessment through the recovery room in the hospital to after they’ve gone home.”

Social Work and Rehabilitation Involvement

In this system of risk mitigation and patient satisfaction, social workers and rehabilitation specialists are also integrally involved in the process. Dr. Ryan says, “Now, we have these specialists with us when we’re rounding, doing placements and teaching.” All aspects of patient care are discussed and planned before any action is taken to treat a patient.

“The goal is to get a plan for the patient early that keeps the patient on track for success,” adds Dr. Hutcheson.

Implementing these strategies has not only led to a 3-star rating for Baylor Scott & White The Heart Hospital – Plano but has also reduced the overall cost of care and improved financial performance. According to Dr. Ryan, “Because we have no undue re-admissions and few post-discharge mortalities, we’ve done very well with the CMS bundled payments.”

Consequently, the combination of the High-Risk Surgical Case Conference, STS database reporting, phase-of-care mortality assessment, and optimized care through nursing, social work, and rehabilitation has led to Baylor Scott & White The Heart Hospital – Plano providing quality patient outcomes and care. The quality, mission-focused faculty and staff care for patients every day with the care strategy individualized for their needs.

Dr. Hutcheson is a cardiothoracic surgeon who serves as the Director of the multidisciplinary Surgical Case Conference as well as the Medical Director of Coronary Revascularization for Baylor Scott & White The Heart Hospital – Plano. She has a professional interest in minimally invasive cardiac surgery, mitral valve surgery, coronary revascularization, atrial fibrillation surgery, and medical missions. She is active in national cardiac surgery research trials including serving as lead investigator and makes national presentations on cardiac surgery topics. She has published numerous articles in peer-reviewed journals.

Dr. William Ryan is Chief Quality Officer and Chief of Cardiovascular Surgery at Baylor Scott & White The Heart Hospital – Plano. He has been a practicing Cardiovascular surgeon for 36 years and was an early pioneer in the adoption of small incision mitral surgery as well as use of the Ross Procedure in the young adult population. He has contributed to the peer-reviewed literature on these and other topics throughout his career.