Challenging Convention in Cardiac Care

Heart Health Steward Health Care

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St. Elizabeth’s Medical Center is among the 50 top cardiovascular hospitals to use data to implement evidence-based practices. Pulled from Modern Healthcare


joseph-p-carrozza-mdWithin the past six months, the cardiology division at Steward St. Elizabeth’s Medical Center, a teaching hospital in Brighton, Mass., which has appeared on the Truven top 50 list five times in 18 years, observed that patients receiving transcatheter aortic valve replacements spent five or six days in the hospital—longer than patients in other hospitals. So the hospital deconstructed the entire stay, scrutinizing 12-hour chunks of time and asked: What can we streamline?

Rarely does a single thing keep a patient in the hospital. “It’s usually a combination of things, and in order to figure out how to affect those things, you have to break it down,” said Dr. Joseph Carrozza, chief of the cardiology division at Steward St. Elizabeth’s. The hospital developed a timeline looking at the first 12 hours of stay, then the next 12. Could any of what happened between 12 and 24 hours happen during the zero to 12-hour window?

One conclusion was that some patients could spend less time on breathing machines, which slow their recovery. “The sooner we’ve found that we can get patients out of bed, the sooner we can get them to start doing rehab in the hospital, which gets them out the door quicker,” Carrozza said. The hospital hopes to trim average length of stay to two or three days.

Such improvements are a balancing act, and they require everyone in the hospital to pitch in. Nursing staff play a huge role in removing catheters and tubes placed during procedures, switching patients to oral medications from intravenous, and above all, noticing when a patient isn’t ready for a change in care.

“It’s very easy to change processes in hopes of making them more efficient, but at the end of the day you have to make sure you’re not compromising patient care,” Carrozza said. The key to keeping patients safe, he said, is to accept that not all best practices and standards can be met all the time.

For hospitals, knowing when to allow evidence to guide practices, even if they depart from what doctors have always done, and when to ease off if such protocols should not apply to individual patients, is key.


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To find a doctor or schedule an appointment, visit Steward DoctorFinder™.