Heart attack patients in the Medicare population experience high mortality rates and generate substantial healthcare costs. In light of the upcoming Centers for Medicare & Medicaid Services bundled payment mandates for heart attacks and coronary bypass surgeries, the inSight Advisory–Clinical Data Solutions team at HealthTrust is proving to be a strategic asset for hospitals wanting to improve patient outcomes while ensuring cost effectiveness.
The team provides consulting and analytics in the areas of bundled payments, physician engagement, care redesign, clinical data and benchmarking, medical device management, patient engagement, patient-reported outcomes and cost optimization. St. Francis Hospital, a 245-bed acute care hospital that is part of the Bon Secours St. Francis Health System in Greenville, South Carolina, began working with the inSight Advisory–Clinical Data Solutions team to improve heart attack outcomes. St. Francis Hospital now outperforms most hospitals in the country.
Ambitious Goals for Improvement
Just three years ago, St. Francis Hospital had rates of mortality and readmissions higher than national averages for acute myocardial infarction (AMI) episodes. Above-average rates of complications in heart attack patients who underwent percutaneous coronary intervention were in some cases associated with a reaction to the contrast agent used in the cath lab to help locate blockages. In severe cases, these patients could develop contrast-induced nephropathy (CIN), a condition carrying significantly higher risk of injury and death. Many providers who perform contrast procedures don’t have systems in place to assist with the prevention of CIN, like St. Francis does.
To improve AMI outcomes, St. Francis set ambitious goals. Opportunities were identified to initiate protocols aimed at rapidly identifying and risk-stratifying heart attack patients, and providing timely notification and utilization of interventional procedures.
Another priority was managing AMI patients with other significant comorbid conditions that can impact clinical outcomes. For example, AMI patients who are diabetic will often have significant kidney disease. Use of contrast material in diagnosing and treating AMI can introduce stress to the kidneys, and impaired renal function and CIN carry significantly higher risk of death.
Redesigning the Program
The quality team at St. Francis, led by Christopher Smith, M.D., medical director, in conjunction with Ron Spencer, RN, MSN, administrative director of cardiovascular and endoscopy service lines, worked to ensure rapid identification of AMI patients in the emergency department. The team also worked to inform the cardiology and nursing staff about risks associated with radiographic contrast materials and to put appropriate protocols and risk assessment tools in place to avoid as many adverse events as possible.
Meanwhile, HealthTrust’s Vice President of Clinical Consulting and Analytics April Simon, RN, MSN, assisted team efforts to instill best practices in affecting cardiac outcomes. The team initiated an evidence-based algorithm for rapid identification of AMI patients and monitoring of clinical outcomes to guide team efforts, resulting in the implementation of evidence-based toolkits for reducing CIN and door-to-balloon time.
“HealthTrust and our cardiovascular team worked together to understand and address the underlying drivers of our clinical outcomes,” Spencer says. “By identifying high-risk AMI patients and deploying evidence-based practices and toolkits, our program is now recognized for its best practices in quality and cost containment.”
Collaboratively, the team was able to improve heart attack outcomes and reduce patients’ risk for acute kidney injury from CIN. The community hospital is now in the upper 5th percentile among hospitals nationwide according to these outcomes:
- Door-to-balloon time reduced to 33 minutes
- Treatment of renal failure lowered in 2014 from $300,000 to less than $30,000
- Occurrence of acute renal failure fell to 2 percent, versus the national benchmark of 6 percent
- Readmissions dropped 3 percent, which is below the national benchmark
- Over a three-year period, 28 more saved lives than the average hospital
HealthTrust inSight Advisory–Clinical Data Solutions evaluates care delivery processes, identifies improvement opportunities and implements physician-approved clinical protocols—all of which can help maximize provider performance under bundled payment models. For more information, contact the inSight Advisory team at firstname.lastname@example.org.