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SUMMA CARDIOVASCULAR INSTITUTE

10th Annual Report: 2013 OutcomesS C di l I iSumma Cardiovascular Institute

Tuesday, April 8, 2014

2013 Annual Clinical Outcomes Report - Presented April 8, 2014

2013 Cardiovascular Clinical OutcomesPresentation Agenda

Outcomes Topic Presenter(s)Introduction Kenneth Berkovitz, MD

Overview of Quality Improvement Roger Chaffee, MDNoninvasive Cardiology Otfried Niedermaier, MDCardiovascular Rehabilitation Joseph Redle MDCardiovascular Rehabilitation Joseph Redle, MDInvasive & Interventional Cardiology William Bauman, MDCardiovascular Research and Education Otto Costantini, MDOpen Heart Surgery Robert Debski, MDVascular Surgery Joseph McShannic, MDHeart Rhythm Services Michael Pelini, MD

Tyler Taigen, MDWrap Up Kenneth Berkovitz, MD

Summa Card iova s cu la r Ins t i tu te 2



Introduction

Kenneth Berkovitz, MDMedical Director, Cardiovascular Service Line

Summa Health System

Chair, Department of Cardiovascular MedicineSumma Akron City & St. Thomas Hospitals


2013 is the 10th Annual Presentation of Cardiovascular Clinical Outcomes

2012

2013 Cardiovascular Clinical OutcomesPresentation Agenda

Outcomes Topic Presenter(s)Introduction Kenneth Berkovitz, MD,

Overview of Quality Improvement Roger Chaffee, MDNoninvasive Cardiology Otfried Niedermaier, MDCardiovascular Rehabilitation Joseph Redle, MDInvasive & Interventional Cardiology William Bauman, MDCardiovascular Research and Education Otto Costantini, MDO H t S R b t D b ki MDOpen Heart Surgery Robert Debski, MDVascular Surgery Joseph McShannic, MDHeart Rhythm Services Michael Pelini, MD

Tyler Taigen, MDWrap Up Kenneth Berkovitz, MD


Summ a Card iovascu la r Ins t i tu te 2



2014 Quality Improvement Initiatives

Roger Chaffee, MDMedical Director, Quality Assurance & Peer Review

Summa Health SystemSu a ea t Syste


Quality ImprovementCare Redesign

• LOS• Readmission• Cost

• LOS• Readmission• Cost

PercutaneousCatherization

Cardiac SurgeryCatherization Surgery

Acute Myocardial Infarction

Heart Failure

• LOS• Readmission• STEMI Care

• LOS• Readmission• Inpatient Care


• Follow-Up Care


Quality ImprovementCharacteristics of a Quality Heart Failure Program

Early physician follow-up

Education at patient discharge

Multidisciplinary disease management Multidisciplinary disease management

Early communication with physician responsible for follow-up care

Address non-cardiac needs as well as cardiac related

Educate physicians who misinterpret attempts to provide uniform care as ‘patient stealing’

Summa Card iova s cu la r Ins t i tu te

Cardiosource World News, March 2014

7


Quality ImprovementCohorting of Heart Failure Patients

100.0%

70.0%

80.0%

90.0% Striving to reach 100% cohorting to 5W, CCU, or ICU

40.0%

50.0%

60.0%

% C

ohor

ted

Implementation of weekly monitoring and reporting strategy

10.0%

20.0%

30.0% 60.3% 71.1%

0.0%

2013 1st Qtr2014 1st Qtr



Quality ImprovementHeart Failure Core Measures

9591

99 10098 98 98100 100 100 10090

100

77

60

70

80

nce

Striving to reach 100% compliance in 2014

30

40

50

% C

ompl

ian Implementation of real-time monitoring and intervention

10

20

30

0Discharge

InstructionsACE/ARB for

LVSDLVS Assessed Smoking

Cessation

Summa Akron City Premier Top Performers Premier Top Decile


y p p

9

*Premier Data Report 11/2012 through 10/2013


Quality ImprovementData-Driven Decision Making

Decreased Decreased Patient Risk

Increased Increased

Data-Driven

Decision

ProductivityTransparency

Decision Making

Decreased Cost

More Informed Decision M ki

Increased Process

Improvement

Making




Noninvasive Cardiology

Otfried Niedermaier, MDMedical Director, Noninvasive Cardiology

Summa Akron City & St. Thomas HospitalsSu a o C ty & St o as osp ta s


Noninvasive CardiologyTotal Procedure Volume - Echocardiograms

1 876 1,817 1 860

25,00020,314 21,021 21,666 22,792 21,973

2,695 2,721 3,139 4,810 3,3871,221 1,417 1,560 1,5531,131 1,457 1,876 1,860

15,000

20,000

roce

dure

s

16,488 15,622 15,234 14,605 15,17310,000

umbe

r of

Pr

,

0

5,000Nu

2009 2010 2011 2012 2013Summa Akron City Summa BarbertonSumma Wadsworth-Rittman Summa Western Reserve


**Summa Wadsworth-Rittman did not report in 2009.


Noninvasive Cardiology Total Procedure Volume – Stress Echos

5795 000

6,0004,666 4,862 5,055 5,099 5,346

885 948 941 1,092855124 153 159 179222247 433 515 624 579

4,000

5,000

roce

dure

s

3,410 3 328 3,440 3 204 3,6902,000

3,000

umbe

r of

Pr

3,410 3,328 3,440 3,204

0

1,000

Nu




Noninvasive Cardiology Total Procedure Volume – Stress Nuclear

866363

6,000

7,0006,553 4,988 4,693 4,486 4,818

788

866

578575 593

505419 457 436 490

4,000

5,000

6,000

roce

dure

s

4,536

888 794 832775

575 593

2,000

3,000

4,000

umbe

r of

Pr

3,103 2,867 2,625 3,048

0

1,000

,000

Nu




Echocardiography ServicesContinuing Quality Improvement Program

Test2013Q1

2013 Q2

2013 Q3

2013 Q4

SonographerPeer review of performance and completeness of all required anatomical

TTE 97% 97% 97% 99%

SE 98% 97% 97% 98%co p ete ess o a equ ed a ato caand physiological information on each patient needed for an accurate interpretation.

DSE 96% 98% 97% 98%

PhysicianPeer review of interpretative accuracy, consistency, and completeness.

TEE 95% 98% 99% 98%

SE 100% 89% 99% 98%

DSE 99% 89% 98% 100%

TTE 99% 96% 100% 98%



Echocardiography Services2014 Vision and Goals

1. Further develop our CQI program to improve all facets of the echocardiography process

2. Complete National Board of Echocardiography credentialing for all physicians by 2015

3. Replace and standardize all echo equipment for improved performance with regular equipment replacement every 3-4 years

4 Establish similar policies cross campuses4. Establish similar policies cross-campuses

5. Integrate CVIS

6. Optimize and maintain echocardiography accreditation

7. Develop a 5-year strategic plan




Cardiovascular Rehabilitation

Joseph Redle, MDMedical Director, Cardiovascular Rehabilitation



Cardiovascular and Pulmonary RehabilitationSessions Completed 2008-2013

3,487 4 38825 000

30,00027,825 25,619 25,646 25,815 24,814 24,427

3,4873,524

4,3884,557 4,223 4,507

20,000

25,000

ssio

ns

24,388 22,095 23,535 21,258 20,591 19 92010 000

15,000

mbe

r of S

es

, 20,591 19,920

5,000

10,000

Nu

02008 2009 2010 2011 2012 2013

Summa Akron City Summa Barberton


y


Cardiovascular RehabilitationBefore and After

After Cardiac RehabAfter Cardiac RehabAfter Cardiac RehabAfter Cardiac Rehab

Before Cardiac RehabBefore Cardiac Rehab



2013 Aggregate Results: Quality of Life% Change in SF-36

SF-36 Sub-ScaleScore

Pre-RehabScore

Post-Rehab%

ImprovementPhysical functioning 65 3 76 1 16 5%Physical functioning 65.3 76.1 16.5%

Role-physical 30.2 71.7 137.6%

Bodily pain 58.1 69.4 19.5%

General health 62.3 69.2 11.0%

Vitality 49.0 63.7 30.0%

Social functioning 68.5 88.9 29.8%

Role-emotional 63.4 89.1 40.6%

Mental health 73.8 83.2 12.7%


Table represents results for the SF-36 QoL Health Survey. Positive change represents improvement in each area.


2013 Aggregate Results: Exercise CapacityGraded Exercise Stress Test Pre-/Post-Rehab

80.9% Increase in Exercise Capacity

78

7.6

T)

567

of T

ask (

MET

234 4.2

n Eq

uiva

lent

012

Baseline Post Rehab

Mean


Baseline Post-Rehab


2013 Aggregate Results: Health KnowledgeKnowledge Test Pre-/Post-Rehab

35.0% Increase in Cardiac Health Knowledge

80.090.0

81.0T)

50 060.070.0

60.0

of T

ask (

MET

20 030.040.050.0

n Eq

uiva

lent

0.010.020.0

Baseline Post Rehab

Mean


Baseline Post-Rehab


Cardiovascular RehabilitationOutlook and Vision for 2014

Clete Weigel has been named Acting Manager of Cardiac Rehab

Strategic plan for 2014

-Increase patient access to cardiovascular rehabilitationIncrease patient access to cardiovascular rehabilitation

-Work with insurers to reduce cost of co-pays

-Accommodate an estimated 45%-55% growth due to CMS reimbursement of rehab for heart failure patients




Invasive & Interventional Cardiology

William Bauman, MDMedical Director, Cardiac Cath Lab



Coronary Diagnostic CathTotal Procedure Volume Trend

492 50033

3,000

3,5003,147 2,778 2,978 2,945 3,226 2,763 2,716 2,457

366399

462 497 685568 723

492400

397 411500

303 273273

38 149

2,000

2,500

3,000

2,289 1,979 2,119 2,037 2,008 1 854 1 706

672

1,000

1,500

2,000

1,979 , 2,008 1,854 1,706 1,503

0

500

,000

2006 2007 2008 2009 2010 2011 2012 2013Summa Akron City Summa Barberton HospitalRobinson Memorial Hospital Summa Western Reserve


p


Percutaneous Coronary Intervention (PCI)Total Procedure Volume Trend

178 1851,600

1,8001,382 1,400 1,571 1,497 1,647 1,593 1,563 1,506

157 154178 185 217 178

1,200

1,400

1,382 1,400 1,414 1,343 1,469 1,408 1,346 1,328600

800

1,000

200

400

600

02006 2007 2008 2009 2010 2011 2012 2013

Summa Akron City Summa Barberton Hospital



Percutaneous Coronary Intervention (PCI)Risk-Adjusted Mortality

2

2.5

3 326

15

32

2028

23

1.5

2

ality

1

16 28

15

0.5

1

% M

orta

2006 2007 2008 2009 2010 2011 2012 2013Summa Barberton 0 0 0 0 1 8 0 5 1 7

0 0 0 0 01

0

Summa Barberton 0 0 0 0 1.8 0.5 1.7Summa Akron City 0.9 1.5 1.0 1.3 2.0 1.4 1.6 2.0ACC-NCDR 1.0 1.2 1.2 1.3 1.5 1.3 1.7 1.7

Barberton did not participate prior to 2011.


Barberton did not participate prior to 2011.ACC-NCDR Report 2013 – 3rd quarter rolling 4 quarter results.Data labels represent number of deaths.


Percutaneous Coronary Intervention (PCI)2013 Admission Status – Summa Akron City

Salvage0 2%

Elective27.9%

Emergent24.5%

0.2%

Urgent


Urgent 47.4%

28


Percutaneous Coronary Intervention (PCI)Adverse Event: Cardiogenic Shock

5 342.5

3.0k

3

5

25

34

221.5

2.0

enic

Shoc

k

0 5

1.0

% C

ardi

og

2011 2012 2013Summa Barberton 1 7 2 5 0

00.0

0.5

Not collected in 2013Summa Barberton 1.7 2.5 0Summa Akron City 1.8 2.6 1.7ACC-NCDR 1.0 1.1 1.1

Not collected in 2013

Barberton not submitted for 2013.


Patients requiring CABG were excluded.Data labels represent number of cardiogenic shock patients.Definition: Hemodynamic compromise ≥30 min. requiring support measures


Percutaneous Coronary Intervention (PCI)Adverse Event: CABG

1.2

1.4

0.8

1.0

ABG

15 5

0 2

0.4

0.6

% C

A

2011 2012 2013Summa Barberton 0 0 0 5 0

0 30.0

0.2



Barberton not submitted for 2013


Barberton not submitted for 2013.Data labels represent number of post-PCI CABGs.


Percutaneous Coronary Intervention (PCI)Risk-Adjusted Bleeding Event w/in 72 Hours

954

7.08.0

54

344.05.06.0

ding

Eve

nt

2

28

1 02.03.0

% B

leed

2011 2012 2013Summa Barberton 7 4 2 3 0

00.01.0



Barberton not submitted for 2013.


Patients requiring CABG were excluded.Data labels represent number of bleeding events.Definition: Hgb drop ≥ 3g/dL, RBC transfusion, or procedure to stop bleeding


Percutaneous Coronary Intervention (PCI)Adverse Event: Access Site Injury

84 04.55.0

8

2.53.03.54.0

Site

Inju

ry

30 26 26

1.01.52.0

% A

cces

s S

2011 2012 2013Summa Barberton 4 4 0 5 0

1 00.00.5





Barberton not submitted for 2013.Patients requiring CABG were excluded.Data labels represent number of access site injuries.


Percutaneous Coronary Intervention (PCI)Adverse Event: Whole Blood/RBC Transfusion

52.5

3.0

23 221.5

2.0

rans

fuse

d

18

0 5

1.0

% Tr

2011 2012 2013Summa Barberton 2 8 0 5 0

1 00.0

0.5





Barberton not submitted for 2013.Patients requiring CABG were excluded.Data labels represent number of patients transfused.


Percutaneous Coronary Intervention (PCI)Radial Usage 2012 thru Present

74 1%70 0%

80.0%Increases patient comfort and ambulation 74.1%

50 0%

60.0%

70.0% ambulation

Decreases morbidity due to bleeding and infections

48.7% 47.7%

30 0%

40.0%

50.0%Decreases 30-day readmissions

Cost savings

26.5%20.0%

30.0%

4.9%0.0%

10.0%

2012 2013 Jan-14 Feb-14 Mar-14


2012 2013 Jan 14 Feb 14 Mar 14

34

* Radial use for Summa Akron City.


Acute Myocardial InfarctionDoor to Balloon Time (D2B)

90100

ACC Guideline: 90 MinutesBetween July 2010 and December 2013, the percentage of patients with D2B ≤ 90 minutes was 98.6%.

70 6977 7370

808 out of 591 patients had a D2B ≥ 90 minutes.

6964 6163

5649 50

45 48405060

Minu

tes

102030

010

2008 2009 2010 2011 2012 2013


Summa Barberton Summa Akron City ACC Hospitals Top Decile

35


Acute Myocardial InfarctionFirst Emergency Contact to Balloon Time (E2B)

100

120ACC Guideline: 120 Minutes

10195 93 89 8480

100

s

40

60

Minu

tes

20

40

02009 2010 2011 2012 2013

Summa Akron City ACC Hospitals Top Decile


Summa Akron City ACC Hospitals Top Decile**Barberton not currently reporting.


Invasive and Interventional Cardiology 2014 Goals and Vision

Transcatheter Aortic Valve Replacement (TAVR) Clinic-On-line September 2014On line September 2014-Expect approximately 20 procedures per year

C ti t t di l PCI ith d t bl Continue to support radial access PCI with demonstrableoutcome metrics

Commit to care redesign efforts-Improve cath lab operation efficiency-Standardize patient careStandardize patient care -Reduce bleeding complications




Cardiovascular Research & Education

Otto Costantini, MDDirector, Clinical Research for the Summa Cardiovascular Institute



Translational Research

• NEOMED Basic Science Laboratory lead by Dr. Marc Penn

• Cath Lab (Dr. Silver) EP Lab (Dr. Taigen) OR (Dr. Espinal and Firstenberg; Dr. McShannic and Moawad)

• Only hospital system in NE Ohio offering patients • Only hospital system in NE Ohio offering patients clinical trials looking to regenerate cardiac muscle, improve sternotomy scar and improve PVD via stem cells or products that attract stem cells to the specific tissue



Sternal Wound and Claudication Trials

Site Cohort 1 Cohort 2 Cohort 3 Site TotalMontefiore-Einstein 2 2 3 7Summa 4 2 6Sentara n/a 2 4 6Utah 3 1 4Northwestern n/a 2 1 3Northwestern n/a 2 1 3Subject Total 9 9 8 26

Cardiology Minneapolis Northwestern Summa Medanta Sir Ganga Ram Montefiore TotalsPC Heart Institute

# Consented 2 0 3 2 3 7 1 18# Screen Fails 2 0 1 5 0 1 1 6# Dosed in Cohort 4 0 0 2 1 3 6 0 12

Total # Dosed in Study 7 5 7 2 9 18 0 48



Retro- HF



Translational Research

• STOP HF - Finished Enrolling

• Sternal Wound Healing Trial - Finished Enrolling

• STOPCLI- Finished Enrolling

• RETRO HF- Currently Enrolling

ALLSTAR T i l I ti • ALLSTAR Trial- In preparation • Cedar Sinai in Los Angeles lead center



Center for Cardiovascular Research

• Utilizes a robust cardiac rehab database to collaborate with faculty and trainees from Univ. of Akron and yKent State to investigate the effect of heart failure on neurologic and cognitive function

• 27 peer reviewed publications in 2013• NIH Grants- Dr Joel HughesNIH Grants- Dr. Joel Hughes• Non NIH Grants- Ohio Third Frontier



Sponsored Clinical Trials

• The SCVI is a participating site for NIH sponsored and Industry sponsored Clinical sponsored and Industry sponsored Clinical Trials

• NIH • PROMISE (Dr Iler): Stress testing vs CTA for

Chest Pain Evaluation

• Pre Determine: Genetics as a predictor for sudden • Pre-Determine: Genetics as a predictor for sudden Cardiac Death.



Sponsored Clinical Trials

• Participating site for NIH sponsored and Industry sponsored Clinical Trials

Industry Sponsored: • Odyssey: Evaluating new cholesterol lowering agent (Dr y y g g g (

Silver)• Laptop: Evaluating a left atrial pressure device to

monitor heart failure (Dr Pelini/Niedermeier)( )• Genetic AF Trial: Tailoring medical therapy for Afib

based on genetic make up of the patient (Dr Costantini)• SQ ICD: A national registry of the newly developed SQ ICD: A national registry of the newly developed

subcutaneous ICD (Dr Pelini)



Goals

• Increase funded clinical research by leading single center and multicenter trialsingle center and multicenter trial

• Outcomes and Quality ResearchQ y• Leverage the SummaCare Product and its Databases• Engage our residents, fellows and faculty

• Attract New Technology• CardioSolv: A new technology using MRI to identify

ablation sites for ischemic VTablation sites for ischemic VT• Collaborate with our partners in the area

• NEOMED, Univ. of Akron, Kent State, ABIA



Goals

• Increase our participation in clinical trials• Recruit Staff we will have a total of 4:• Recruit Staff- we will have a total of 4:

• RN Manager of Clinical Research • 2 RN Coordinators and a Research Assistant

• Streamline our processes in order to be competitive• Contracts and Budgets• IRB submissions• Grant Writing- NIH/Local Agencies/Foundations• PR- Let the community know what we are doing!



EducationIn-Training Exam Trends Summa PGY’s

6170

43

51 6350

60

ank

19

273330

40

erce

ntile

Ra

19

1622 21

10

20Pe

02009 2010 2011 2012 2013

Cardiology Scores Total Scores



Education: CV Fellowship

Diego Franco MD: University of Kentucky

Deepak Swaminath MD: Texas Tech UniversityDeepak Swaminath MD: Texas Tech University

Tim Byrnes MD: NEOMED/Summa Akron City Hosp



Education

• Cardiovascular Fellowship

• Starting July 2014 (received >350 applications)

• 3 Fellows 3 Fellows

• 9 Fellows when the program is fully staffed in July 2016

• Challenges of creating a curriculum and schedules conducive to a teaching environment

• Opportunities for clinical research




Cardiothoracic Surgery

Robert Debski, MDInterim Section Head, Cardiothoracic Surgery

Summa Health SystemSu a ea t Syste


Cardiothoracic SurgerySystem Procedure Volume

700514 597 475 435 390 394 356 362 317 292 352

10

43500

600

514587

4232 26

41 6254 51

62300

400

514432 393 358 368 315 300 263 241 290

100

200

02003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Summa Akron City Hospital Summa Barberton Hospital


Summa Akron City Hospital Summa Barberton Hospital*Barberton OHS program started October 2004.


Cardiothoracic SurgerySystem Valve Procedure Volume by Type

224 221250

179 187175 182

159 163139 140150

200

50

100

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013CABG + Valve 54 49 37 49 45 43 40 47 34 46

0

50

CABG + Valve 54 49 37 49 45 43 40 47 34 46Tricuspid 18 13 11 9 9 6 6 3 3 7Mitral 72 66 52 54 53 52 44 29 36 33Aortic 80 93 79 75 68 81 69 84 66 54Total 224 221 179 187 175 182 159 163 139 140


Total 224 221 179 187 175 182 159 163 139 140


Risk-Adjusted Operative MortalityAll Open Heart Surgery Procedures

6

114

5

lity

19

7

41 1 2

2

3

% M

orta

8 6 55

411

0

1

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013Summa Akron City 1.6 3.2 2.4 1.8 1.9 1.6 1.2 3.0 4.8 1.6Summa Barberton 0 0 0 0 0 0 2.9 0.0 3.1 3.1

0


STS 2.6 2.6 2.6 2.6 2.6 2.4 2.4 2.4 2.4 2.4*Barberton did not report measure prior to 2010.*Data labels represent number of deaths.


Risk-Adjusted Operative MortalityCoronary Bypass Graft Surgery (CABG)

4

4.5

511 1

3

3.5

4

lity

431.5

2

2.5

% M

orta

63

2

0

21

2 1

00.5

1

5

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013Summa Akron City 1.4 1.9 1.6 1.1 0.0 1.3 0.9 1.3 3.7 1.2Summa Barberton 0 0 0 0 0 0 3.7 0.0 3.9 3.9

0


STS 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 1.9*Barberton did not report measure prior to 2010.*Data labels represent number of deaths.


Deep Sternal Wound InfectionsAll Open Heart Surgery Procedures

61.82

4

46

1 21.41.61.8

tion

44

0 60.8

11.2

% In

fect

21

10

0.20.40.6

2007 2008 2009 2010 2011 2012 2013Summa Akron City 0.6 1.1 1.3 1.7 1.9 0.4 0.3Summa Barberton 0 0 0 0.0 0.0 0.0 0.0STS 0 4 0 4 0 4 0 4 0 4 0 3 0 3

0


STS 0.4 0.4 0.4 0.4 0.4 0.3 0.3*Barberton did not report measure prior to 2010.*Data labels represent number of DSWIs.


PostOp Length of StayAll Open Heart Surgery Procedures

12

8

10

4

6

Days

0

2


0


STS 8.1 8.1 7.9 7.9 7.7 7.7 7.7*Barberton did not report measure prior to 2010.


PostOp Length of Stay Summa Akron CityUniversal Bed Model Implementation

MS-DRG2012

Baseline2013

Apr.-Dec.∆ Days from

Baseline%

Improvementp pOverall CABG (MS-DRG 232-236) 9.3 7.8 1.5 +16.1%

Overall Valve (MS-DRG 216-219) 11.5 9.5 2.0 +17.4%

All Cardiovascular 10 0 8 6 1 4 +14 0%All Cardiovascular 10.0 8.6 1.4 +14.0%

Th U i l B d M d l i iti t d t S Ak Cit The Universal Bed Model was initiated at Summa Akron City during the month of March 2013

A significant drop in length of stay has been realized due to the g p g yimplementation.



Readmission within 30-Days of OperationAll Open Heart Surgery Procedures

25.0

14

815 0

20.0

38

5038

32 30 29 35

9 89

10.0

15.0

eadm

itted

0 0

5.0% R


0.0


STS 10.3 10.2 10.2 10.2 10.1 10.1 10.1*Barberton did not report measure prior to 2010.*Data labels represent number of readmissions.


Cardiothoracic Surgery2014 Goals

Focus on open heart surgery care redesign -Lower readmissions through standardization of post-g pop and follow-up care protocols-Increase operations efficiency / lower cost-Reduce post-operative blood product usage-Reduce post-operative blood product usage

Continue efforts to minimize incidence of deept l d i f tisternal wound infections




Vascular Services

Joseph McShannic, MD, FACSDivision Head of Vascular Surgery



Noninvasive Vascular ServicesSystem Procedure Volume

2,20525,000

23,719 21,227 21,406 18,457

4,1094,305 4,481 4,390

1,2191,137 1,054 1,203

2,2051,506 2,802

15,000

20,000

erfo

rmed

16,168 14 279

, 4,390

10,000

15,000

cedu

res P

e

14,279 13,069 12,864

0

5,000Pro

02010 2011 2012 2013

Summa Akron City Hospital Summa Barberton HospitalSumma Wadsworth-Rittman Summa Western Reserve


Summa Wadsworth Rittman Summa Western Reserve

** Summa Western Reserve not reported for 2013.


Noninvasive Vascular ServicesIAC Accreditation for Vascular Testing

Accreditation demonstrates our Accreditation demonstrates our commitment to quality care

Accredited for extracranial, venous, arterial, and visceral testing

3- year accreditation cycle

Accreditation includes Summa Akron City & St. Thomas Hospitals as well as the following outlying f iliti H d G G EDfacilities: Hudson, Green , Green ED, Medina, Canton, and White Pond; and Summa Barberton Hospital



Vascular SurgeryTotal Procedure Volume

840800

900

716600

700

cedu

res

324300

400

500

mbe

r of P

roc

324

222281

0100

200

300

Num

00

Summa Akron City Summa Barberton Summa Western Reserve2012 2013


**Summa Western Reserve not reported in 2013.


Vascular Surgery Procedure VolumeSumma Akron City

120

140

93

126114

93

125

9080

100

120

dure

s

69

9080 75

40

60

80

er o

f Pro

ced

2011 2012 2013

6 7 100

20

Num

be

Carotid 93 126 114Lower Extremity 93 69 125Endovascular (AAA) 90 80 75


Open AAA 6 7 10


Vascular Surgery MortalitySumma Akron City

273 5

4.0

23

27

2.5

3.0

3.5

13

17 20

1.5

2.0

2.5

Morta

lity

100.5

1.0% M

2011 2012 2013In-Hospital 1.8 3.2 1.230-Day 2.4 3.8 2.4

0.0


30 Day 2.4 3.8 2.4**Data labels represent number of mortalities.


Vascular Surgery Summa Akron CityCarotid Surgery Adverse Events

1512 0

14.015

8 0

10.0

12.0

ce

6

88

4.0

6.0

8.0

% In

ciden

c

M t lit St k I f ti MI Bleeding P l Urinary 0 1

20

2 2 23 31

320 0 1 2

3

0.0

2.0

Mortality Stroke Infection MI Bleeding Event Pulmonary Urinary

Retention2011 0.0 1.1 2.2 0.0 2.2 2.2 2.22012 2.4 2.4 0.8 2.4 4.8 1.6 6.3


2013 0.0 0.0 0.9 1.8 2.6 7.0 13.2**Data labels represent number of adverse events.


Vascular Surgery Summa Akron CityLower Extremity Adverse Events

9.010.0

7

86

86.07.08.09.0

ce

5

3

3

2

4

24 43.04.05.0

% In

ciden

c

M t lit Graft I f ti Wound Bleeding P l Renal

2

1 1

2

1

2

00

32

10.01.02.0

Mortality Graft Failure Infection Wound

DihiscenceBleeding

Event Pulmonary Renal Failure

2011 2.2 7.5 5.4 8.6 1.1 3.2 1.12012 4.3 8.7 2.9 5.8 1.4 2.9 0.0


2013 0.0 2.4 1.6 3.2 3.2 6.4 0.8**Data labels represent number of adverse events.


Vascular Surgery Summa Akron CityEndovascular (AAA) Adverse Events

6.0

4

34.0

5.0

ce

3

2 22.0

3.0

% In

ciden

c

M t lit G ft F il I f ti Bleeding P l Renal 0 0 0.0

100 0

1

0 00 0

1

0.0

1.0

Mortality Graft Failure Infection Bleeding Event Pulmonary Renal

Failure2011 0.0 0.0 0.0 3.3 1.1 0.02012 0.0 0.0 1.3 5.0 0.0 0.0


2013 0.0 2.7 2.7 4.0 0.0 1.3**Data labels represent number of adverse events.


Vascular SurgeryGoals for 2014

Increase access to quality vascular careImprove patient office experienceImprove patient office experienceIncrease patient satisfaction with care

Focus on reducing urinary retention in patients undergoing carotid procedures

Expand the use of the vascular database throughout the Summa Health SystemSumma Health System




Heart Rhythm Services

Michael M. Pelini, MDMedical Director Heart Rhythm Services

Tyler Taigen, MDMedical Director Atrial Fibrillation Program


Permanent Pacemaker Implants Total Procedure Volume

500

600391 472 505 483 497 454 431

3068 52 8078

9679 81 102

113 84400

500

36

30 8041 49

78

200

300

277346 358 350 315 300 298

100

200

02007 2008 2009 2010 2011 2012 2013

Summa Akron City Summa Barberton Hospital Robinson Memorial Hospital


y p p


Implantable Cardioverter Defibrillator (ICD)Total Procedure Volume

45 48250

300 283 220 264 277 202 238 239

15

1324

14

2911

45

38

6048

2841 42

200

250

223 215186

1331

29

100

150

169 181143 162 186

50

100

02007 2008 2009 2010 2011 2012 2013



y p p


Cardiac Resynchronization Therapy (CRT)Total Procedure Volume

21 21140

160 92 98 99 149 144 88 125

816

10

21 2117

100

120

120 107 98

1 1 0 221 22 20 11

60

80

70 75 79107

7998

20

40

02007 2008 2009 2010 2011 2012 2013



y p p


Device Implant Adverse Event Failure to Place CS/LV Lead

45 0%

6.0%

4

4

4.0%

5.0%

2.0%

3.0%

% F

ailur

e

0

1.0%

%

2011 2012 2013Summa Akron City 4.4% 5.4% 0.0%ACC-NCDR 2.5% 2.4% 2.3%

00.0%


ACC NCDR 2.5% 2.4% 2.3%

75

Data labels represent number of lead placement failures.


Device Implant Adverse Event Mortality

0.5%

1

0.3%

0.4%

0.2%

Morta

lity

0 0

0.1%% M

2011 2012 2013Summa Akron City 0.4% 0.0% 0.0%ACC-NCDR 0.3% 0.3% 0.3%

0 00.0%


ACC NCDR 0.3% 0.3% 0.3%

76

Data labels represent number of deaths.


All Cardiac AblationProcedure Volume – Summa Akron City

232

250

182150

200

149 140 131 126 132100

150

50

02007 2008 2009 2010 2011 2012 2013

Summa Akron City


y


Ablation OutcomesSumma Akron City Hospital

Arrhythmia Count Successful % SuccessfulAVN Ablation 12 12 100%AVN Ablation 12 12 100%Atrial Flutter 54 54 100%At i l T h di 9 8 89%Atrial Tachycardia 9 8 89%AVRT-AP 17 17 100%AVNRT 48 48 100%Ventricular Tachycardia 25 21 84%Total 165



Heart Rhythm Services 2014 Initiatives

• Sub-Q ICD Placement

• Injectable Loop Recorders

• Leadless Pacing

• Left Atrial Closure Devices

• nContact Procedure



Atrial Fibrillation ProgramSumma Akron City Hospital

73 PVI procedures performed in 201372 6% presented with paroxysmal A-fib72.6% presented with paroxysmal A-fib27.4% presented with persistent A-fib

12.3% were redo PVI procedures

91.8% of patients had all four pulmonary vessels isolated post-ablation

34.2% of patients had additional ablations3 % o pat e ts ad add t o a ab at o s

45.2% of patients had additional lines placed



Atrial Fibrillation ProgramSumma Akron City Hospital

ComplicationSumma Akron City

Second InternationalAblation RegistrySumma Akron City Ablation Registry

Mortality 0.0% 0.2%Tamponade/Perforation 1.4% 1.3%P /H th 0 0% 0 1%Pneumo/Hemothorax 0.0% 0.1%Permanent Diaphragmatic Dialysis 0.0% 0.2%Femoral Pseudoaneurysm 0.0% 0.9%A-V Fistula 0.0% 0.5%Valve Damage 0.0% 0.1%Stroke/TIA 0 0% 0 9%Stroke/TIA 0.0% 0.9%Pulmonary Vein Stenosis req/Stent 0.0% 0.3%30-Day Readmission 2.7% 10.0%



Lead ExtractionsSumma Akron City Hospital

Lead Extractions

(N 16)(N=16)

Number of Leads

Extracted: 18Success Rate

Type of Leads Abstracted

87% of cases w/no

complications2 open hearts

88.9% RV 11.1% RA 1 death




Getting Ready for Kayak.com

Kenneth Berkovitz, MDMedical Director, Cardiovascular Service Line

Summa Health System

Chair, Department of Cardiovascular MedicineSumma Akron City & St. Thomas Hospitals


Summa Health SystemMarket Share

2013 YTD thru December% M k t Sh

Diagnostic CathP d

EPP d

Open HeartP d% Market Share Procedures Procedures Procedures

Summa Akron City & St. Thomas 52.8% (2483/4707)

40.8%(586/1435)

58.2%(290/498)

Summa Barberton 14.2% (670/4707)

5.7%(82/1435)

12.4%(62/498)

Robinson Memorial 6.2% (294/4707)

18.0%(259/1435)

0.0%(0/498)(294/4707) (259/1435) (0/498)

Summa Health System Total 73.2%(3447/4707)

64.6%(927/1435)

70.7%(352/498)

Ak G l M di l C t 26 8% 35 4% 29 3%Akron General Medical Center 26.8% (1260/4707)

35.4%(508/1435)

29.3%(146/498)


Akron Regional Hospital Association 2013 Report.


Total DischargesWholly Owned Hospitals

2,230 2,177 2,146 2 1102,200

2,400

2,110

1,941 2,022

1,971

2,077

1,904 1,914 1,878

2,010

1,852 1 772

2,000

ges

1,772

1,600

1,800

tal D

isch

arg

1 200

1,400

Tot

1,000

1,200

Summa Card iova s cu la r Ins t i tu teSumma Akron City Summa Barberton Summa Wadsworth Rittman

85


Fiscal ResponsibilitySumma Akron City Hospital

$12 000

$14,000

$7 944 $10,000

$12,000

Revenue has steadily increased

th t 11$7,651 $7,944

$6,000

$8,000 over the past 11 years.

Efforts to reduce

$2,000

$4,000 cost of implants has led to stability in cost per case over past decade

$0

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

(p)

decade.


Expense Per Case Revenue Per Case


Contribution Margin-Cardiovascular Service LineWholly Owned Hospitals

$43,023 $43,140 $41 188 $40 821

$50,000

$9,463 $12,334 $10,121 $10,041

$41,188 $40,821 $40,000

s

Contribution margin of Cardiovascular Service Line is decreasing due

$20 000

$30,000

Tho

usan

ds to shrinking inpatient market.

In 2014, need to focus

$33,560 $30,805 $31,067 $30,780

$10,000

$20,000 on market growth.

$0


Contribution Margin Inpatient Contribution Margin: Outpatient


Cardiovascular Service Line Patient SatisfactionSumma Health System

2012 Rank 2013 Rank (%tile)

HCAHPS Item

2012 Rank (%tile)

2013 Rank (%tile)

Doctors treat with courtesy/respect 35th 30thDoctors treat with courtesy/respect 35 30

Nurses treat with courtesy/respect65th 65th

65th 60th

Recommend this hospital65 60



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