Volume and Vision in Vascular Care

Joe Cantlupe, for HealthLeaders Media , October 5, 2011
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Patients usually return to normal activity more quickly after endovascular procedures, and have less pain than with the traditional open surgery approach, Lee says. Patients also stay in the hospital for a shorter period of time and have a faster recovery than those who have conventional open surgery.

More than a year ago when Lee was named to his position as chief surgeon, Boca Raton Regional hospital officials made a concerted effort to improve its vascular program, especially in light of competition from other hospitals. “We now have the hybrid room and a full complement of staff to perform procedures in that one comprehensive area.”

The changes already have delivered ROI for Boca Raton, Lee says, with the kind of tertiary care that ordinarily would not have been available in the Southeast Florida region. For now, Lee says he and his team are concentrating on complex cases, and he anticipates that volume will be increased, as well as the potential need for more vascular specialists in the near future.

Success Key No. 3:
Hybrid OR

More hospitals are finding ways to reduce patient length of stays by opening hybrid operating rooms for vascular surgery cases, broadening their high-resolution imaging capabilities, compared to traditional operating rooms. Under the hybrid OR, increasing numbers of percutaneous surgical procedures can be performed because imaging and other technological equipment can be used in one room instead of separate operating rooms, says Murray, the service line director at St. Joseph’s. “We now have the full gamut of skill sets to diagnose and treat medical conditions.”

Although the demand for hybrid OR continues seemingly unabated in hospitals, Murray acknowledges that the hybrid OR may not be for everyone. Healthcare leaders must evaluate spacing and staff needs as well as the availability of the hybrid OR for various procedures, Murray says. For some health systems, the multimillion-dollar costs also may be prohibitive, she adds.

St. Joseph’s Hospital believed it was important to initiate a hybrid OR especially to maintain and increase its high-volume vascular program, says Murray. The hospital reported seeing less than 1,000 patients in the hybrid OR for a year.

Murray and other proponents of hybrid OR say the process results in more efficient workflows, optimized throughput, and streamlined care, combining minimally invasive and interventional surgical technologies.

While many of the procedures ordinarily would require three to seven days in the hospital, patients often go home the next day or have a significantly shortened stay, Murray says. For the patient, the impact is “not having to go to multiple areas of the hospital with multiple hospital encounters,” Murray says. The vascular procedures involved include aneurysm repair and carotid stents as well as endovascular surgery.

Murray added that some type of surgical procedures typically take up to six hours to perform, but in the hybrid OR some of those same procedures can be accomplished within a two-hour time frame.

Murray says that St. Joseph’s executives weighed the pros and cons of having a hybrid OR before making the multi-million dollar purchase. “The decision to open a hybrid is not always a slam dunk,” she says. “The imaging equipment you use is fixed and it’s not moveable. The benefit it gives you is that you have optimal high-quality equipment in one place, but it makes it challenging to use [the operating room] for other procedures. It is sort of a trade-off that does limit the cases that can be done in that room.

“But purchasing every possible gadget doesn’t guarantee full service,” Murray adds. “You’ll need to have the right skilled surgeons, having the hospital staff highly trained, and an infrastructure to support it.”

For the hybrid OR, the cost was $3 million, with the imaging equipment alone costing more than $2 million, which Murray describes as expensive. “We always thought of it as a hefty investment on our part,” she adds. “If you look at the ROI, we can draw more patients in and offer these services. It’s going to be slow to reap savings on our ROI, but at the end of the day we’re making the right decision for our patients. I think there are certain procedures that we couldn’t do before that were perhaps done at larger regional vascular centers.”

Having a hybrid OR requires that St. Joseph’s officials are consistently evaluating operating room needs as well as management of patient load. “We have the challenge, as well as the fortune, of having very busy operating rooms,” Murray says. The hospital master plan, however, calls for more general operating rooms to pick up the slack. There are currently 12 operating rooms, with expansion plans for five more rooms.

“We’ll fill the need,” Murray says, “and then we’ll have more patients.”


Expanding Reach

When the Methodist Hospital and the Baylor College of Medicine went their separate ways after a half-century together, officials of the Methodist DeBakey Heart & Vascular Center worked to strengthen its vascular program with a network of physicians in partnerships with community hospitals within the Methodist system that lacked vascular care.

The Methodist Hospital Aortic Network program expanded Methodist’s reach in vascular care by placing surgeon specialists in aortic disease in locations throughout the region. The hospital has built imaging, ICU, and surgical capabilities so patients can have the same level of care in their communities as they would at the main location in Houston, says Jerry Broderick, administrator of the Cardiovascular Surgery Associates for Methodist DeBakey Heart & Vascular Center.

CSA also has expanded its outreach to community hospitals by conducting clinical treatments at those facilities of patients with diabetes conditions that may be linked to other vascular problems. While the hospital has only begun to expand its efforts this year “our short-term results have been most positive, with an increase in referral volumes from dialysis centers to the hospital,” especially through physician
groups, Broderick adds.

CSA also conducted three vein seminars at hospitals aimed “at a population that has high prevalence of varicose and spider veins,” Broderick says. The seminars have drawn 100 people each, “with about one-quarter of those appointments resulting in some sort of procedure [in the hospital],” he says.

“We have enjoyed an uptick in referral volume from community hospitals,” Broderick says. “We are ramping up in a very competitive and mature market.”

Alan B. Lumsden, MD, RVT, FACS, chief of vascular surgery at the Methodist DeBakey Heart & Vascular Center, says it was important that the hospital offer “treatments in a community hospital as part of the aortic network” in part because therapy for aortic disease “is changing rapidly, with many more minimally invasive approaches.”

This article appears in the September 2011 issue of HealthLeaders magazine.

Joe Cantlupe is a senior editor with HealthLeaders Media Online.
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