Open Heart Surgery at UPMC Passavant:
Focused on Quality Outcomes
 With
today’s medical expertise and technology, more people are surviving
coronary artery bypass (CAB) procedures than ever before. But the path
to recovery isn’t easy; it takes a team of medical professionals
working with each patient from the pre-surgical stage through
discharge to make sure that the highest quality of care is provided to
ensure a positive outcome.
At UPMC Passavant, a concentrated effort has been made to monitor and
improve the quality of care provided to patients who are undergoing
heart bypass surgeries. This intense focus has resulted in the
hospital surpassing even the national standards in a number of areas
related to quality patient care.
In 2006, UPMC Passavant began subscribing to the Society of Thoracic
Surgery (STS) database, which provides an overview of the outcome and
process measures for coronary artery bypass (CAB) and coronary bypass
and aortic valve (CAB + valve) procedures. The database is considered
the gold standard for cardiovascular surgery leadership and rates
hospitals on a number of clinical indicators with three stars being
the best in each category.
“UPMC Passavant had a long way to go to meet the quality expectations
set by the Society of Thoracic Surgery,” explains Douglas Heusey,
program administrator, Cardiovascular Services. “When cardiovascular
surgeons Giovanni Speziali and Chris Cook started working at UPMC
Passavant, they looked to see where there was room for improvement and
then made it their goal to improve quality.”
In fiscal year 2010, UPMC Passavant improved from one star to two
stars in a number of categories, and also moved up in quality rankings
among hospitals. In fiscal year 2011, the hospital earned two stars in
all categories, which include avoidance of mortality; avoidance of
morbidity; use of IMA (a specific type of graft conduit) and
medications. “Our next step is to reach three stars, which is the
highest rating,” says Heusey. “This is an impressive direction for the
UPMC Passavant Open Heart Program and Heart and Vascular Services as a
whole.”
The latest STS numbers, which came out in June 2011, show that UPMC
Passavant is making major strides in its goal of providing quality
patient care, both within the western Pennsylvania region and compared
to hospitals nationwide. “We have some of the best numbers in the
region, as well as some of the best numbers when compared against
national participants in the STS database,” says Heusey. “For example,
in our latest numbers in June 2011, UPMC Passavant had a 1.12 percent
mortality rate for the calendar year, compared to the 1.9 percent
national STS participant benchmark.”
According to Heusey, UPMC Passavant’s rise in quality numbers can be
credited to surgical expertise and techniques in the operating room
and the hospital’s dedicated nursing staff. “The surgeons at UPMC
Passavant are very focused on quality outcomes and measures while
caring for patients,” he says. “All of the heart and vascular
physicians and staff at UPMC Passavant are pushing the best practice
agenda to ensure that quality is a top priority.
“The dedicated cardiovascular-trained nursing staff is also ensuring
quality patient care by walking our patients through every step in the
process from pre-surgery to discharge,” he adds.
According to cardiothoracic surgeon Chris Cook, it takes a team effort
to ensure that nothing is missed when it comes to patient care. “Seven
days a week, two times a day, we do rounds as a team that includes two
cardiac surgeons, a critical care physician, a critical care nurse
practitioner, two physician assistants, the charge nurse for the unit
and the nurses for each individual patient,” he explains. “Two times a
week these multidisciplinary rounds include all of the above plus a
Pharm.D and someone from case management/social services to help work
out issues such as arranging for skilled nursing care after
discharge.”
Each night, a dedicated in-house resident covers the open heart
patients from 6 p.m. to 6 a.m., staying in constant contact with the
surgeons. In addition, during their stays, patients are seen by
physical therapists, occupational therapists and cardiac rehab experts
who help with mobility issues, preventing falls and anything that
could affect patient outcomes. “We are extremely aggressive about
dealing with problems; everybody on the team recognizes that they
should speak up because they all have a say in what’s going on,” says
Cook. “With so many people noticing every detail, it prevents problems
that could occur. While this process is not unique to UPMC Passavant,
I would say that we take a more intense, more organized, more
consistent approach on a 365-day a year basis.
“Rather than relying on new techniques to improve care, we emphasize
consistently hitting the mark on traditional things,” he continues.
“We know what it takes to help patients survive. It’s about not
letting your guard down. Hyper-vigilance takes a hospital from a 2
percent mortality rate to a 1 percent mortality rate—and everybody
here is working hard to make that happen.”
“As a general rule, it takes a lot of effort to increase a 95 percent
success rate to a 99 percent success rate, with efforts being produced
in a variety of situations from pre-operative optimization to
post-operative management to discharge planning,” says Giovanni
Speziali, MD. “We are fortunate to work in an environment that doesn’t
put pressure on us to discharge patients early or to move patients
from ICU to the floor sooner. We are free to treat patients the way
that we feel is best for them; we never feel pressured to introduce
other considerations into their care.”
In August of 2011, a new program for improving patient care at UPMC
Passavant was introduced—the minimally invasive mitral valve surgery
program. “When we sought specific training for mitral valve surgery,
we took our entire team with us, including the scrub nurse, operating
room nurse, perfusionist, physician assistants and anesthesiologist;
everyone who participates in these operations was involved in the
training,” says Cook. “This is important because everybody there is
thinking about different aspects of each case; the nurses are
concerned with things that I’m not thinking of; the anesthesiologist
is paying attention to issues that may go unnoticed by others.”
According to Maggie Lattanzio, advanced practice nurse, Cardiovascular
Services, this team approach with its emphasis on education is
beneficial to both the medical staff and patients. “Learning never
stops here; the hospital continues to offer educational opportunities
for staff to keep up-to-date on how to ensure quality outcomes,” she
explains. “It is very important for the nursing staff to be engaged in
the whole process. Everyone, from the critical care physicians to the
cardiologists and surgeons, are very committed to helping the nursing
staff gain the knowledge that they need. It is a very positive thing.”
Lattanzio credits the high quality of cardiac patient care at UPMC
Passavant to having a consistent nursing staff in the ICU, step-down
unit and in cardiac rehab. “These same nurses work with cardiovascular
patients every day, so they become very skilled in this area,” she
says. “Interdisciplinary rounds also help keep everyone on the same
page; everyone who works with the patient or interacts with his or her
family has the opportunity to know exactly what the plan of care is
and what the goals are.”
While much attention is paid to patients, bringing the family on board
in the healing process can play a large part in quality outcomes as
well. “Our nurses have a real focus on patient-centered care, which
means understanding the importance of the entire family and support
system,” says Lattanzio. “When you engage the family and recognize
them as part of the team, it improves communication and helps to
decrease stress and support healing. This especially impacts the
recovery phase, where families play an important role in getting
patients active and mobilized after surgery, and also in education.
“We work with patients and their families from admission all the way
through discharge planning,” she adds. “We take a holistic approach to
patient care.”
More than a Number:
Cardiovascular Services from a Patient’s Perspective
When Gloria Furge of Hampton Township went to UPMC Passavant for a
double bypass and an aortic valve replacement in September, she was
expecting to have a lot of pain. “Instead, I had a nice vacation!” she
laughed. “There were a couple of small bumps in the road, but overall,
the entire experience was great.”
Furge says that she was especially impressed by how well organized the
entire process was, and by the friendliness and attentiveness of the
staff. “The nurses were just fantastic; when I couldn’t eat because I
wasn’t allowed sodium, I mentioned that what I’d really like was an
apple. The next day, one of the nurses brought me an apple—she was out
shopping and thought of me!” says Furge.
She was pleased that she and her husband were kept informed about the
entire process, and were told every step of the way about what would
happen next. “They didn’t just tell me what they were doing, but why
they were doing it,” she says. “I didn’t expect that.
“I also didn’t expect my surgeons—Dr. Cook and Dr. Speziali—to watch
over me like mother hens,” she adds. “They would check on me several
times during the day; there was always someone there. When I went back
in for my check-up, I felt like I was going home to see my brothers.
“Believe it or not, it was a pleasant experience,” she continues. “I
know that sounds silly, but that’s how it felt.”
Louis Lev had a similar experience when he went in for a quintuple
bypass in June of 2010. A violinist for the Pittsburgh Symphony, he
was on tour abroad when he began showing cardiac symptoms. When he
arrived home, he went for a stress test, and the next day he was in
surgery.
“I felt confident that I was in good hands; without question, UPMC
Passavant is the best hospital in this area for the treatment of this
condition, and its people are first-rate,” he says. “Everyone I talked
to around the country recommended UPMC as leaders in the field, and
their surgeons are very highly regarded. I got lucky—I had my heart
issues in the right place.”
After his surgery, Lev attended cardiac rehab and today he is doing
well, though he is still adjusting to a new diet and lifestyle.
“Everyone was first-rate; very kind and supportive,” he says. “I got a
lot of good attention and very good advice in cardiac rehab. I still
keep in touch with them—there are a couple of concertgoers working
there.”
Lev’s wife and children were also treated well when they came to
visit. “My wife was very much kept in the loop; they told her the same
information they shared with me about what I needed to do,” he says.
Though he missed the summer concert season, Lev has since returned to
performing. “What’s really neat is that Dr. Cook called me the other
day to tell me that he’d been to a concert,” says Lev. “He told me
that it had special meaning for him, seeing me up there.”
UPMC Passavant-McCandless
9100 Babcock Blvd.
Pittsburgh, PA 15237
412-367-6700
UPMC Passavant-Cranberry
One St. Francis Way
Cranberry Township, PA 16066
724-772-5300
For more information or a physician referral, call 1-800-533-UPMC
(8762) or visit upmc.com/passavant
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