bryanlgh heart institute annual report
DESCRIPTION
2010 Annual Report of the BryanLGH Heart InstituteTRANSCRIPT
2 0 1 0 a n n u a l r e p o r t
4 0 y e a r s o f e x c e l l e n c e | i n n o v a t i o n | e x p e r i e n c e
Patients First.
Our commitment to quality outcomes
In June 2010 we will mark the second anniversary of our
enhanced relationship with BryanLGH Medical Center,
one that established a specialty heart hospital within
a hospital. Thank you for your support and the referrals
you have made to BryanLGH Heart Institute.
The purpose of this report is to provide you with a concise
update on the latest services and technologies available
for your patients, as well as to share with you clinical
outcomes that demonstrate our commitment to the
highest quality heart care for Nebraska and the region.
Our goal is to provide you with an unparalleled level
of service, and your patients an exceptional healthcare
experience. Please let us know if there are ways
BryanLGH Heart Institute can be of additional
assistance in your practice.
Sincerely,
highlights
(Front row, left to right): Clyde Meckel, MD; Ryan Whitney, MD; Dale Hansen, MD
(Back row, left to right): Scott Coatsworth, MD; Robert Hibbard, MD; Andrew Merliss, MD; Steven Krueger, MD; Joseph Kummer, MD; Keith Miller, MD; Todd Tessendorf, MD; Timothy Gardner, MD; David Hughes, MD; Edward Raines, MD
Clyde Meckel, MDExecutive Medical Director
Edward Raines, MD, JDSurgical Director
BryanLGH Heart Institute is the region’s most experienced heart care provider.
500 p a t i e n t s t h o u g h t o f u s f i r s t f o r h e a r t s u r g e r y l a s t y e a r.m o r e t h a n
Dual recipientBryanlgh is the only hospital in Nebraska to have received both awards and is one of only 74 dual award recipients in the United states for 2010.
highlights
The BryanLGH Heart Institute specializes in cardiology and cardiothoracic surgical care, offering world-class diagnosis and treatment of heart disease. BryanLGH Medical Center and the
BryanLGH Heart Institute, the specialty cardiac hospital within BryanLGH Medical
Center, are proud to have received both the 2010 Distinguished Hospital Award
for Clinical Excellence™ and the Patient Safety Excellence Award™ by HealthGrades®.
BryanLGH is the only hospital in Nebraska to have received both awards and
is one of only 74 dual award recipients in the United States for 2010.
• �Heart�Surgeries�—�More than 500 cases, increase of 12%
• �Diagnostic�Heart�Caths�—�More than 3,200 cases, increase of 10%
• �PCI/Stents�—�More than 900 cases, increase of 28%
• �EP,�Pacers�and�ICD�—�More than 950 cases
• �Cardiac�and�Nuclear�Stress�Testing�—�More than 10,000 cases
v o l u m e h i g h l i g h t s , f i s c a l y e a r 2 0 0 9• �Echocardiograms�—�More than 14,900
• �Electrocardiograms�—�More than 26,900
• �Holter�Monitors�—�More than 2,000
• �Cardiac�Patient�Days�—�More than 3,570 critical care, more than 10,000 cardiac care
• �Chest�Pain�Clinic�Patients�—�More than 700
• �Clinical�Research�—�More than 40 trials
www.bryanlgh.org
This past year, three new technologies have become part of the
advanced cardiac care at BHI, including: aquapheresis,
advanced technology for fluid removal for patients with CHF; the
impella Device, a temporary left ventricular assist device for
complex cardiac intervention and cardiogenic shock patients; and
hypothermia core boDy cooling to prevent or reduce
anoxic brain injury.
te
c h N o l o g i es3
BHI has a consistent history of being first in heart and vascular care delivery.
30 c o m m u n i t i e s a c r o s s f o u r s t a t e s a r e p r o v i d e d a d v a n c e d s e r v i c e s f r o m B h i .
m o r e t h a n
highlights
As the leading provider of cardiac and vascular services in Nebraska and the surrounding region, BHI has a consistent history of being first in heart and vascular care delivery.
Back in the 1960s, Bryan Memorial Hospital
was first in the region to perform cardiac
angiography and open heart surgery. In
the 1970s, the hospital performed the first
CABG surgery and pacemaker implants.
In the 1980s, Bryan Memorial was the
first to perform angioplasty, and in the
same decade, introduced mobile cardiac
and vascular services.
The 1990s brought coronary stenting,
advanced electrophysiology studies, ICD
implants and LVADs. In the 2000s came
cardiac robotic surgery, minimally invasive
valve repair surgery, and cardiac CT.
The year 2009 continues that legacy of advanced
cardiac care for Nebraska and the surrounding
region. Echocardiography and vascular services,
including mobile services, were reaccredited
by the national accreditation bodies ICAEL and
ICAVL. 3D imaging for echocardiography and
valve imaging is used daily. HeartAware, the
computer online risk assessment tool, is now
available for public access. And our mobile
screening services, including a semi trailer
fully equipped for public screening, has
traveled throughout the region.
Second generation upgrades have been made to
the robotic surgery system. And we’ve adopted
new innovations and improved techniques for
minimally invasive valve surgery. The cardiac
Maze procedure, for atrial fibrillation, is now
performed by our highly acclaimed and
recognized cardiac surgery program.
All of these advances, along with the experience
and dedication of the most skilled and qualified
clinicians, makes BryanLGH Heart Institute
the First Name in Heart Care.
www.bryanlgh.org
surgery advances• Robotic Surgery Upgrade: daVinci Robot upgraded
to facilitate enhanced cardiac procedures.
• Minimally Invasive Valve Surgery training site for other cardiac surgeons.
• Maze Procedure: Enhanced Atrial Fibrillation surgical treatment.
surgical cardiac procedures More than 500 cases (12% increase)
cabg-only surgeries:
More than 300 cases
Five Star rated for Valve Replacement Surgery 2009-
2010
The BryanLGH Heart Valve Center of Excellence brings together a team of experienced experts from multiple disciplines to offer the most complete and fully integrated care in the region for patients with valvular heart disease.
• �New�patient�evaluations by cardiologists, cardiac surgeon and other specialists as needed, complete in one stop
• �Non-invasive�evaluation including cutting edge quantitative and 3-dimensional echocardiography techniques
• �Minimally�invasive�surgical�options to reduce patient morbidity
• �Full�perioperative�support�services from on-site pulmonary/intensive care specialists
• �Most�experienced�cardiac�anesthesiology�and perfusionist teams in the area
• �Immediate�availability of all subspecialty and ancillary services for complex patients
• �Complete�postoperative�care and follow-up, including rehabilitation and long-term outcomes tracking
Heart Valve Center of excellence team
edward Raines, MD Surgical Director
Keith Miller, MD, PhD, FAcc Cardiology Director
terry Bejot, MD Anesthesia Director
Rhonda olmsted, APRN Valve Center Coordinator
H E A LT H G R A D E S®G U I D I N G A M E R I C A T O B E T T E R H E A L T H C A R E ®
H E A LT H G R A D E S®G U I D I N G A M E R I C A T O B E T T E R H E A L T H C A R E ®
H E A LT H G R A D E S®G U I D I N G A M E R I C A T O B E T T E R H E A L T H C A R E ®
H E A LT H G R A D E S®G U I D I N G A M E R I C A T O B E T T E R H E A L T H C A R E ®
H E A LT H G R A D E S®G U I D I N G A M E R I C A T O B E T T E R H E A L T H C A R E ®
cARDiAc sURgeRy
Mitral Repair Mitral Replacement
Bhi ActualNational Predicted
Valve Replacement
30 Days Post Discharge
4.0%
6.0%
2.7%
5.3%
3.5%
6.2%
Valve Replacement Mortality Rates
Bryanlgh vs. National Predicted Rates
2.0%
CABG (RISK-ADJUSTED)
2.0 % (2004-2009)
2.0 % (2009)
MITRAL VALVE REPAIR
0.0 % (2008-2009)
1.2 % (2008-2009)
MITRAL VALVE REPAIR/CABG
0.0 % (2008-2009)
5.3 % (2008-2009)
Bryanlgh heart institute
society of thoracic surgeons
Valve Procedure Mortality Rates
Bryanlgh vs. society of thoracic surgeons
dIStRIbUtIon oF
MItRAl VAlVEPRocEdURES
80%
20%
– 2009 –cY
Minimally invasive open
54%
46%MItRAl VAlVE
PRocEdURES
– 2009 –cY
Bhi is the most experienced minimally invasive cardiac surgery
program in the region
i n n e B r a s k a f o r c a r d i a c s u r g e r y ( hea l t hgrades 2010 )1r a n k e d #
a n g i o p l a s t y / s t e n t p r o c e d u r e s i n 2 0 0 9875
iNteRVeNtioNAl cARDiology
Bryanlgh heart instituteNational Average
Key
1 day 2 days 3 days
for Angioplasty/Stent Procedure
average Length of stay
3.0Bhi
National2.25
Door-to-Balloon Time Measured (Less than 90 Minutes)
CMs OrYX time Compliance
25% 50% 75% 100%
92%78.9%
BhiNational
for Angioplasty/Stent Procedurerisk-adjusted Mortality rate
Bhi
1.0%0.77%
1.3%
.5%
1.5%
National
www.bryanlgh.org
3,110 Heart Caths Performed
875 Angioplasty/Stent Procedures
in
2009
Program advances include:• thoracic stent grafting for trauma and dissection
• treatment of renovascular disease
• Abdominal stent grafting variations made possible with the latest generation of grafts
• Reconstructing aortic disease
• Infrapopliteal intervention for peripheral vascular leg disease
iNteRVeNtioNAl cARDiology
Robert Hibbard, MD, FACC, has performed more than 600 percutaneous carotid procedures in patients at high risk for carotid endarterectomy (with MACE of less than two percent).
NUMBER oF PATIENTS
BryanLGH Heart Institute, (Robert Hibbard, sole enroller) Lincoln, NE 151
cardiovascular Associates Kingsport, TN 143
Wake Heart & Vascular Associates Raleigh, NC 140
Vascular and transplant Specialists Norfolk, VA 132
First coast cardiovascular Institute Jacksonville, FL 119
University of texas Houston/Memorial Hermann Heart and Vascular Institute Houston, TX 113
e n r o l l e r i n s a p p h i r e w o r l d w i d e c a r o t i d s t e n t t r i a l s1n u m B e r
sapphire over all top enrollers ( 352 centers worldwide )
Diagnostic Peripheral Angiograms NUMBER oF CASES By yEAR
731
785
2007
2008
2009 853
endovascular Peripheral Procedures NUMBER oF CASES By yEAR
498
526
2007
2008
2009 617
Aortic stent graft Procedures NUMBER oF CASES By yEAR
22
39
2007
2008
2009 66
three-ye ar trends Bryanlgh medical center
www.bryanlgh.org
p a c e m a k e r d e v i c e s i m p l a n t e d400m o r e t h a n
The Electrophysiology department utilizes state-of-the-art Stereotaxis® magnetic navigation and 3D mapping.
electRoPhysiology (eP)
The electrophysiology department utilizes state-of-the-art Stereotaxis® magnetic navigation and 3D mapping technology to assist in cardiac ablation procedures. Use of this technology helps to ensure the best possible outcomes for patients. BryanLGH was the first in our area to embrace this technology.
150 ablation procedures from December 2008-2009
• �Ablations of the following tachycardia:
�– AV node re-entrant tachycardia
– Atrial fibrillation
� �– Pulmonary vein isolation
– AV nodal ablation
• �Accessory pathway tachycardia
• �Atrial flutter
• �Atrial tachycardia
• �Ventricular tachycardia
First in the region to utilize state-of-the-art stereotaxis® magnetic navigation and 3D mapping technology
• �400 pacemaker devices were implanted
• �250 ICD procedures
�– 53% are biventricular implants
www.bryanlgh.org
Nebraska
Kansas
Wyoming
Iowa
Missouri
Arkansas
Illinois
the bryanlgh Heart�Improvement�Program��
serves patients across a seven-state region.
heARt FAilURe
700,000p e o p l e a r e d i a g n o s e d w i t h h e a r t f a i l u r e e a c h y e a r .
n e a r ly
The BryanLGH Heart Improvement Program is a comprehensive heart failure treatment program featuring advanced medical and surgical therapy, as well as experimental treatments.
The backbone of the program is standard
treatments. However, these are supplemented
with advanced surgical therapies that
distinguish BryanLGH from other heart
failure treatment programs.
Director Steven K. Krueger, MD, FACC,
Coordinator Pat VerMaas, APRN, and 10 nurses
and assistants have performed more than 70
experimental studies. Many of them have led
to what is now our standard and current
medical treatment. Among these are:
angiotensin receptor blockers, carvedilol,
and resynchronization therapy. On average
we are involved in 18 active ongoing protocols
including new uses of standard medications
and gene therapy.
Number of Patients BryanLGH Heart Improvement Program
375
550
2002
2005
2009 700
Bhi
70%
100%95%
85%
Appropriate Care Measures
Bryanlgh vs. National comparison
60%
80%
90%
National
BryanLGH is Five Star rated for Congestive Heart Failure
2007-2010
H E A LT H G R A D E S®G U I D I N G A M E R I C A T O B E T T E R H E A L T H C A R E ®
H E A LT H G R A D E S®G U I D I N G A M E R I C A T O B E T T E R H E A L T H C A R E ®
H E A LT H G R A D E S®G U I D I N G A M E R I C A T O B E T T E R H E A L T H C A R E ®
H E A LT H G R A D E S®G U I D I N G A M E R I C A T O B E T T E R H E A L T H C A R E ®
H E A LT H G R A D E S®G U I D I N G A M E R I C A T O B E T T E R H E A L T H C A R E ®
www.bryanlgh.org
942y e a r s o f n u r s i n g e x p e r i e n c e o n o u r i n t e n s i v e c a r e a n d c a r d i a c u n i t s
cARDiAc MeDiciNe
40 years of excellence, innovation and experience ASSURES oUR PATIENTS THE BEST PoSSIBLE CARE.
• �Highly trained cardiac nurses available in cath lab, ICU and cardiac unit
• �Total years of experience for ICU and cardiac unit: 942
• �Chest Pain Center established to rapidly evaluate symptoms of chest pain in a safe setting
• �Latest technology, including:
– Ultrafast Cardiac CT Imaging
– Impella (Ventricular Assist Device)
– Inner Cool for hypothermia used post arrest
– ECMO (Extracorporeal Membrane oxygenation)
– CRRT (Continuous Renal Replacement Therapy)
– Critical Care Intensivist Coverage
• �Benefits of heart hospital with skills and technology, plus the benefits of a full-service hospital for specialists and services
• �Newer enhancements:
– 3D Echocardiography
– Definity Contrast Imaging
– Aquapheresis
www.bryanlgh.org
in emergency situations when time is critical
and expert care can save a patient’s life, our
starcare helicopter team, on call 24 hours
a day, includes a critical care flight nurse
and respiratory therapist.
the Physicians of BryanLGH Heart institute
Scott Coatsworth, MD, FACC / [email protected] native of Lincoln, Nebraska, Dr. Coatsworth attended the University of Nebraska–Lincoln and went on to the University of Nebraska College of Medicine, where he received his medical degree with high distinction. He then attended the University of Iowa for both his residency in internal medicine and a fellowship in cardiology, where he served as Chief Fellow in Cardiology.
Dr. Coatsworth is certified by the American Board of Internal Medicine and the American Board of Internal Medicine Subspecialty Board of Cardiovascular Diseases. He has achieved fellowship status with the American College of Cardiology, Society for Cardiac Angiography and Interventions, and the American Heart Association Clinical Council.
Timothy Gardner, MD, FACC / [email protected]. Gardner pursued his undergraduate education at Portland State University. He attended Baylor College of Medicine in Houston, Texas and graduated with honors. Dr. Gardner completed internal medicine residency and a cardiovascular fellowship including interventional cardiology at the Johns Hopkins Hospital in Baltimore, Maryland in 1996.
Dr. Gardner is board certified in Cardiovascular Diseases and Interventional Cardiology. He is a fellow in the American College of Cardiology and has been recognized several times as one of America’s Best Cardiologists by the Consumer’s Research Council of America. His special interests are in coronary and peripheral interventions and pacemaker implantations.
Dale A. Hansen, MD, FACC / [email protected] native of Hartington, Nebraska, Dr. Hansen attended the University of Nebraska–Lincoln, where he graduated with distinction and was a member of Phi Beta Kappa. He went on to the University of Nebraska College of Medicine in Omaha, where he received his medical degree and was a member of ACA. Dr. Hansen served his residency in internal medicine and a fellowship in cardiology at the University of Nebraska Medical Center. He also completed a fellowship in cardiology at Creighton University Affiliated Hospital in Omaha.
Dr. Hansen is certified by the American Board of Internal Medicine and the American Board of Internal Medicine Subspecialty Board of Cardiovascular Diseases. He has achieved fellowship status in the American College of Cardiology and the American College of Chest Pain.
Robert N. Hibbard, MD, FACC / [email protected]. Hibbard completed his undergraduate studies at the University of Wyoming and then attended the Creighton University School of Medicine in Omaha, Nebraska. He completed his internship, residency in internal medicine and fellowship in cardiology at the Creighton University School of Medicine.
Dr. Hibbard is certified by the American Board of Internal Medicine and the American Board of Internal Medicine Subspecialty Boards of Cardiovascular Diseases and Interventional Cardiology. He is a fellow of the American College of Medicine, American College of Cardiology, American College of Chest Physicians and the American Society of Angiography/Intervention.
David Hughes, MD / [email protected]. Hughes attended the Baylor College of Medicine and was a general surgery resident and later a thoracic surgery resident at the University of Michigan Hospitals in Ann Arbor. He completed a fellowship in cardiovascular surgical research at the Texas Heart Institute in Houston where he helped investigate the potential for nuclear-powered artificial hearts.
Since finishing residency, Dr. Hughes has served as Chief of the Cardiac and Thoracic Surgery Division at Creighton University School of Medicine, as assistant clinical professor of surgery at the University of Nebraska College of Medicine and as Chief of Cardiothoracic Surgery at Clarkson Hospital in Omaha. Dr. Hughes specializes in valve surgery, coronary artery bypass graft surgery, aortic root surgery, and surgical treatment of lung cancer. He is board certified by the American Board of Surgery and the American Board of Thoracic Surgery.
Steven Krueger, MD, FACC / [email protected] native of Kearney, Nebraska, Dr. Krueger attended Nebraska Wesleyan University in Lincoln where he earned his B.S. in Biology. He received his medical degree from the University of Nebraska College of Medicine in Omaha. He completed his internship and residency at Stanford University Medical Center in Palo Alto, California. Dr. Krueger served fellowships at the University of Utah in Salt Lake City in cardiology, electrophysiology and congestive heart failure.
Dr. Krueger manages the care of over 800 patients in the Heart Improvement Program and has served as principle investigator on over 75 clinical research trials. He is certified by the American Board of Internal Medicine and the American Board of Internal Medicine Subspecialty Board of Cardiovascular Diseases. He also has achieved fellowship status in the American College of Physicians and the American College of Cardiology.
Joseph L. Kummer, MD, FACC / [email protected] native of Omaha, Nebraska, Dr. Kummer attended Saint Louis University, where he received two undergraduate degrees and completed pre-medical studies in 1996. He then attended the University of Nebraska College of Medicine in Omaha where he earned his medical degree in 2000. He completed his internship and residency in Internal Medicine at Northwestern University in Chicago. He went on to complete his fellowship in cardiology and cardiovascular disease at Henry Ford Hospital in Detroit, Michigan.
Clyde Meckel, MD, FACC / [email protected] native of Burwell, Nebraska, Dr. Meckel attended the University of Nebraska–Lincoln, where he graduated with high distinction. He then went on to the University of Nebraska College of Medicine where he received his medical degree and graduated with high distinction. He served his internship at Brigham and Women’s Hospital and Harvard Medical School in Boston, Massachusetts. He also completed his residency in internal medicine and his fellowship in cardiology at Brigham and Women’s Hospital.
Dr. Meckel is board certified by the American Board of Internal Medicine and the American Board of Internal Medicine Subspecialty Board of Cardiovascular Disease and Interventional Cardiology. He is a fellow of the American College of Cardiology, a member of The Society for Cardiac Angiography and Interventions and a member of the American Society of Nuclear Cardiology.
Andrew Merliss, MD, FACC / [email protected]. Merliss attended Colgate University for his undergraduate studies. He then attended the George Washington University School of Medicine, where he also completed his internship. From there, he completed his residency at Harvard Medical School and went on to serve his cardiology fellowship at Boston University Hospital. He completed his fellowship in cardiac electrophysiology at Harvard Medical School, where he taught for five years.
Dr. Merliss is certified by the American Board of Internal Medicine and the American Board of Internal Medicine Subspecialty Board of Cardiovascular Diseases, as well as the Subspecialty Board of Cardiac Electrophysiology. He is a fellow of the American College of Cardiology and is a member of the North American Society for Pacing and Electrophysiology and Project Pacemaker International.
Keith Miller, MD, PhD, FACC / [email protected] native of Omaha, Nebraska, Dr. Miller attended Cornell University in Ithaca, New York where he completed his undergraduate studies. He went on to earn his medical degree and his PhD in molecular biology from the University of Nebraska College of Medicine in Omaha. He completed his residency in internal medicine at the University of Iowa Hospitals and Clinics in Iowa City and his cardiology fellowship at the University of Chicago Hospitals.
Dr. Miller is certified by the American Board of Internal Medicine, the National Board of Echocardiography and the Certification Board of Nuclear Cardiology.
Edward Raines, MD, FACS, JD / [email protected]. Raines attended the University of Nebraska College of Law and received his medical degree from the University of Nebraska College of Medicine. He then attended the University of Utah Affiliated Hospitals in Salt Lake City for his general surgery residency, serving as Chief Resident, as well as completing his fellowship in cardiothoracic surgery.
Dr. Raines specializes in minimally invasive cardiac surgery, robotic thoracic surgery, and mitral valve repair. He is among fewer than 10 surgeons in the country successfully performing the Ross heart valve replacement surgery. Additionally, Dr. Raines has been the principle investigator of several national research studies in cardiac surgery and artificial hearts. Dr. Raines is board certified by the American Board of Surgeons and American Board of Thoracic Surgery; he is also a member of the Cardiothoracic Surgery Network, the International Society for Minimally Invasive Cardiothoracic Surgery and the Society of Thoracic Surgeons.
Todd Tessendorf, MD, FACC / [email protected] native of Columbus, Nebraska, Dr. Tessendorf received his undergraduate degree from Nebraska Wesleyan and his medical degree from the University of Nebraska College of Medicine. He completed his internship and residency at University of Nebraska Medical Center and a cardiology fellowship at the University of Missouri-Kansas City. Dr. Tessendorf has a focus in coronary catheterization, nuclear cardiology, and echocardiography.
Dr. Tessendorf is certified by the American Board of Internal Medicine Subspecialty Board of Cardiovascular Diseases.
Ryan Whitney, MD, FACC / [email protected] native of Omaha, Nebraska, Dr. Whitney attended the University of Nebraska–Lincoln for his undergraduate studies and went on to the University of Nebraska College of Medicine in Omaha where he received his medical degree. He completed his residency in internal medicine at the University of Iowa Hospitals and Clinics in Iowa City. He returned to Omaha to serve his fellowships in cardiology and interventional cardiology at the University of Nebraska Medical Center.
Dr. Whitney is certified by the American Board of Internal Medicine Subspecialty Boards of Cardiovascular Diseases and Interventional Cardiology.
www.bryanlgh.org
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