A clinical director with HealthTrust’s Clinical Data Solutions team shares her takeaways from the Society of Thoracic Surgeons (STS) 2018 meeting, which includes efforts to build a national system of valve centers, an arrhythmia center of excellence and biomarkers of kidney injury—as well as better position physicians for value-based care and shared decision-making with patients.
The transition from surgical to percutaneous treatment approaches, and how to optimize outcomes of patients needing valve repair or replacement, were among the dominant themes of this year’s Society of Thoracic Surgeons (STS) annual meeting, held Jan. 27 – 31 in Fort Lauderdale, Florida. I was joined at the meeting by colleagues Robin Cunningham, R.N., MSN, Mark Dumond, BSBA, RT(R), and Denise Dunco, R.N., MSN, on the clinical evidence review team at HealthTrust. Among my key takeaways:
Physicians taking the lead on quality improvement. In his presidential address, Richard Prager, M.D. (University of Michigan Health System, Ann Arbor) made an appeal for physicians to be leaders of accountability and transparency, and actively review their own performance data against that of their regional peers as a means to quality improvement. This has long been the mantra of HealthTrust’s Clinical Data Solutions (CDS) team; we use outcomes data to evaluate processes in a non-judgmental manner and pinpoint ways to enhance patient care. We encourage physicians to stop thinking of performance evaluation as a punitive exercise and lead multidisciplinary quality improvement teams at the institutions where they work.
Biomarkers of kidney injury. In a presentation on how even mild acute kidney injury (AKI) adversely affects early survival after thoracoabdominal aortic aneurysm repair, Subhasis Chatterjee, M.D. (Baylor – Texas Heart Institute) reported on the development of kidney biomarkers that can indicate a risk of kidney injury earlier than the standard measure of serum creatinine level, so doctors can intervene quicker. I spoke with one company that manufactures noninvasive tests to learn they are already being utilized in some HealthTrust member facilities. These tests include checking for biomarkers such as Insulin-like Growth Factor Binding Protein 7 (IGFBP-7) and Tissue Inhibitor of Metalloproteinase 2 (TIMP-2). Presence of both these biomarkers corresponds to an increased risk of AKI. As a nurse, I see huge utility for kidney biomarkers because kidney injury can be a significant complication for the cardiovascular population, including heart surgery and heart failure patients and patients undergoing percutaneous coronary intervention. One of the toolkits CDS has compiled for facilities and physicians is focused on best practices and interventions they can deploy to avoid kidney injury—a perennial problem in cardiac surgery as well as orthopedics and spine.
Two-tier system for valvular heart care. The comment period is open for an STS consensus document calling for a national system of valve centers, as shared in a presentation by Michael J. Mack, M.D., FACC, medical director of cardiovascular surgery at Baylor Health Care System, and chairman of The Heart Hospital Baylor Plano Research Center in Plano, Texas. The proposed system for valvular heart care would resemble the current two-tier system for trauma care. Level 1 centers would have criteria that includes having a heart valve clinic, multimodal imaging, a multidisciplinary heart valve team, established best practices, sufficient patient volume, and participation in the STS registry. All remaining primary valve centers would be limited in procedural scope. Approval of the plan will create regional hubs of specialization.
Physician vs. patient definition of surgical success. Another session led by Dr. Mack, “Long-Term Fate After Discharge Following Cardiac Surgery,” looked at predictors of discharge disposition and how the success of surgery is differentially defined by physicians and patients. Surgeons, he said, need to consider patients’ expectations of success during the informed consent process—that is, practice “shared decision-making”—and be honest about the likelihood that their postoperative course will include spending time some place other than home, and how long that will likely be.
Arrhythmia center of excellence. Aaron Robinson, CEO of Florida’s Health First Community Hospitals, presented on the development of an arrhythmia center of excellence in Cocoa Beach to capture a bigger share of the exploding atrial fibrillation (AF) population, and to reduce regional variations in care with the adoption of evidence-based care practices. Some of the “strategic pillars” include subspecialty depth (making sure subspecialty physicians are aligned and willing to participate), integrated IT systems (since the majority of care is provided on an outpatient basis), participation in an AF database and standardized arrhythmia pathways. Collaboration happens across specialties to improve patient access. A multidisciplinary team approach is utilized, with the team comprised of an electrophysiologist (EP), cardiac surgeon, cardiologist, anesthesiologist and AF coordinator (usually a nurse), with the EP physician serving as the program’s medical director.