Small changes with big payoffs for heart programs: 2 cardiologists weigh in


The field of cardiovascular medicine is ripe with technological advancements, new research findings and therapies to improve care for patients with heart conditions. But sometimes it's not about getting that brand new technology or drug. 

A panel of oncology leaders discussed how small, but strategic changes can be just as important for a cardiology program's clinical, financial or operational outcomes during a Sept. 14 session at the Becker's Cardiology Virtual Forum. Panelists included:

  • Zayd Eldadah, MD, PhD, director of cardiac electrophysiology at MedStar Heart and Vascular Institute in Washington, D.C.
  • Christopher Granger, MD, cardiologist at Durham, N.C.-based Duke Health

Here are two excerpts from the conversation, lightly edited for clarity. To view the full session on-demand, click here.

Question: What changes have you made to your cardiology programs in the last year or two that have reaped big benefits?

Dr. Christopher Granger: At a place like Duke, we're proud of being on the cutting edge of many technologies and doing trials with new devices and drugs that haven't really been tested before. But the most important opportunity we have, including in academic medical centers, is to do something simple. It's to take the treatments that we're so fortunate in cardiology to know now, after years and years of development, are very effective at improving patient outcomes and make sure they're systematically applied. That task requires systems of care. Really, we can go down the list of almost any of our cardiology problems, and we see the same thing. We see that there's substantial opportunity for more systematic application of treatments. 

For example, I spend most [of my] time in the cardiac intensive care unit treating patients with acute myocardial infarction. How do we get patients quickly from the community to having the artery opened in the context of STEMI? Even more of a challenge is getting patients from a small referral hospital to the tertiary care center in an efficient way. It requires integration of data from emergency medical services, networks of hospitals, emergency medicine, cardiology and hospital administrators. You have to have regular meetings that include emergency medical services, and then representatives from various hospitals need to review the data and continue to look for opportunities on how to improve that integrated care. 

Dr. Zayd Eldadah: Over the past couple of years, we have focused on building a distributed care network. Our system is built not just on the 10 hospitals that anchor the health system, but clinics and operations all throughout our geographic area. Particularly in cardiology, it's been important that we take our providers and deliver them in a distributed care network all through our geography. Physicians get in their cars and travel tens of miles — 20, 30, 40 or 50 miles in some cases  — to be in communities and come close to patients. We think that's going to be an important service. It's important to be in physical proximity with your patients to be able to tell them that we are here for you. We are not just sitting in our ivory towers waiting for them to come to us, but we are here to deliver whatever we can in terms of quality and high-end, world-class care, close to home, to the best of our ability. So maybe a patient would need to drive to the hospital once for a procedure, but the follow-up would be at home. That kind of paradigm has been important for us to build in cardiology. It's been built particularly in our organization around the three service lines of advanced heart failure, cardiac surgery and cardiac electrophysiology.

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