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Cardiac critical care team leverages technology to manage patients after procedures
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The cardiac critical care process can be a haphazard one, but some institutions have put together cardiac critical care teams, which bring together cardiologists, intensive care specialists and personnel from other disciplines, to manage each cardiac critical care patient comprehensively after their procedure.
One such institution is the Sanger Heart & Vascular Institute at Carolinas HealthCare System in Charlotte, North Carolina, which utilizes virtual critical care technology as part of its system. Specialized nurse practitioners, known as advanced clinical practitioners (ACPs), can monitor cardiac critical care patients at two locations and alert intensivists when a critical issue arises. The patients are able to communicate with ACPs through a camera.
Kevin Lobdell, MD, director of quality at the institute, spoke to Cardiology Today about the structure of its cardiac critical care team and how it has benefited patients.
Q: How did the cardiac critical care team come into existence?
A: The ICU technology was in its infancy in 2003. We grew to where our system embraced that technology and I quickly saw the opportunity to leverage our expertise, particularly of nurse practitioners, to help us deliver high-quality cardiac critical care. While there are other institutions utilizing electronic ICU technology, we’re the first in the region to offer specialized cardiac critical care and certainly the first that has it largely driven by our ACPs.
I came to Carolinas HealthCare System in 2004 and our first addition was a nurse practitioner. At that point, we took care of the adults and the children in the same unit. Subsequently, we built Levine’s Children’s Hospital, and after that, the 14 beds that we shared, we utilized for adults only. Our adult volume and complexity increased and we added nurse practitioners, to where we now have six. With our specialized team of ACPs, we can provide expert care for cardiac patients 24 hours a day, seven days a week at two different locations. The ability to virtually partner with other intensivists when critical care issues arise enables our patients to have a robust care team at their bedside quickly.
Each day, the ACPs are asked patient care questions and when the ACPs need the help, I’m available. Our system can be flexed up to cover more patients by hiring more ACPs and more doctors. What it really allows us to provide expert patient care and also to have each member of the team doing the things they are uniquely qualified to do. We divide work up in a proactive and thoughtful fashion so that we’re each doing the work we’re best trained to do.
Q: Aside from you and the ACPs, who else is involved in the cardiac care team?
A: Twice daily we make multidisciplinary rounds, including representatives from nursing and respiratory therapy. We also have a pulmonary critical care physician, and at least one surgeon will round with us.
Q: How are appropriate patients identified and how is the team activated for their care?
A: The aforementioned team cares for all of the patients, every day, in our unit, which is dedicated to cardiac, thoracic and vascular critical care. Patients that need postprocedural intensive care after cardiac, thoracic and aortic cases all come to our unit.
Q: How have patients benefit ed from this structure?
A: We did a survey in 2013 to investigate our efforts. We wanted to determine whether evolution of our efforts with the team and with the technology was actually beneficial and asked about the team’s ability to deliver exceptional care. The overwhelming majority of the team said it improved their ability to deliver exceptional care. Additionally, it improved teamwork and communication, and even helped with the onboarding process of new teammates.
Q: What are the main factors driving these results?
A: The keys are to be proactive, interactive and precise, and to have experts with continuity. By developing an expert team as we described and leveraging them with technology, ie, the rounding tools, called telepresence, or the electronic ICU technology, which is installed in each of the patient rooms, we can utilize a smaller, expert team and apply it to patients across our networked system.
Q: How do you see this team and system of care evolving in the next few years?
A: We aim to spread to additional cardiothoracic and vascular units across our system and beyond. Additionally, the same approach could be utilized across all phases of periprocedural care. It could be applied to anything from preoperative evaluation to pre-rehabilitation to post-ICU and to post-acute care after the patient has left the hospital. – by Erik Swain
Disclosure: Lobdell reports no relevant financial disclosures.