Heart Surgery Program Gets Top Kudos for Outcomes
Excellence is a consistency game that’s won in increments, according to Thomas Langdon, MD, medical director of Cardiovascular Surgery at CHI Health Creighton University Medical Center - Bergan Mercy.
“If you do the right thing one time, each time, then in aggregate you’re going to end up with really good outcomes,” he said.
The program is one of three in the United States recognized and visited by Stanford University School of Medicine’s Clinical Excellence Research Center representatives.
“Our practice had been identified as one of the top most valuable practices in the country and that entailed not only being in the top decile of clinical outcomes for coronary artery bypass, but also for providing excellent value to our insurers as far as cost goes for coronary artery bypass surgery,” said Dr. Langdon.
“Combining those —being one of the lowest costs at the greatest value, and having some of the best outcomes — puts us in a very small group of practices in the country,” he said. “We were a little bit surprised because we’re not one of the larger programs in the country, but we obviously are doing some things right with our teams.”
One of those right things is standardization, which touches every aspect of the Cardiovascular Surgery program at CHI Health.
“When you reduce variance, you really reduce the opportunity for medical error. You introduce a lot of consistency in the practice where everybody knows exactly what they need to be doing,” said Dr. Langdon.
Dr. Langdon and his partner, John Batter, MD, have worked to standardize and remove opportunity for medical error, resulting in great patient care, fewer readmissions, less complications and more efficiency. Other improvements include:
- Operating room teams are very efficient and have very short turnover times. “We don’t operate fast, we just operate efficiently,” said Dr. Langdon.
- Postoperatively, heart surgery patients stay in one place, using the universal bed unit approach. “Our patients are not moved around the hospital, but we move the care around the patient,” said Dr. Langdon.
- Staffing is structured for consistency. A finite number of anesthesiologists work with the team. Cardiovascular surgery preoperative nurses handle only preoperative care; postoperative nurses focus on postoperative care. Standard protocols are defined and followed.
“The nurses know exactly how to take care of that patient,” said Dr. Langdon. “By getting a very specialized team of people who are stakeholders, and very engaged in the care of these patients, we get really great patient care.”
Data — decades of it — guide standardization decisions.
“Every single case I’ve done in my 26 years of practice, I have placed into the STS National Database,” said Dr. Langdon. Established in 1989, the Society of Thoracic Surgeons National Database was created by cardiothoracic surgeons as a quality improvement and patient safety initiative.
Drs. Langdon and Batter look at outcomes quarterly and annually to identify opportunities for improvement. “We always have some ongoing quality initiative program where we want to improve something, because you can always make something better,” said Dr. Langdon.
Readmission rates are currently under the team’s microscope. Concerned that patient confusion about medications may be leading to readmissions, the team instituted a protocol that has patients seen by a cardiologist within 72 hours of hospital discharge.
“Although we go over them meticulously in the hospital, this gives them the opportunity to make sure that patients really do understand and it’s being executed the way we think it’s being done,” said Dr. Langdon. “That has helped us in our readmission rate a lot because we pick up some things like fluid retention earlier, before it becomes a problem. You can take care of it as an outpatient as opposed to the patient all of a sudden being readmitted because they’re volume overloaded a week or 10 days after the surgery.”
Dr. Langdon and team follow up on that data after six months to see if new protocols are moving the needle.
Data is essential, but it’s merely a tool.
“Success in cardiac surgery is a team sport,” said Dr. Langdon. “We are blessed with great teams who have a common goal of taking really good care of our patients just like they are our own family, and that starts from the top down. Everyone has that same attitude and everyone wants to do the right thing.”
Cardiothoracic surgeons practicing at CHI Health include:
- Lincoln – Nebraska Heart: Dr. Sagar Damle, Dr. James Wudel
- Omaha – Bergan Mercy: Dr. Tom Langdon and Dr. John Batter
- Kearney – Good Samaritan: Dr. Michael Bibler