William K' Atkinson, Ph'D'

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Johnston Medical Center WakeMed

• William K. Atkinson, Ph.D.
• President CEO
• May 20, 2009

Raleigh, North Carolina
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Tonight

• Tonight
• William Atkinson, Ph.D.President CEO
• Heart Vascular Services at Johnston Health
• Betsy Gaskins-McClaine, RN, BSN, MSN-CVice
  President, Heart Vascular Services
• Certificate of Need Issues
• W. Stan Taylor, MBACorporate Planning Managed
  Care
• Quality Patient Safety
• Meera Kelley, MD
• Vice President, Quality Patient Safety
•  
• Cardiac Services
• Ravish Sachar, MD
• Wake Heart and Vascular Associates
• Wrap-up
• William Atkinson, Ph.D.

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WakeMeds track record

• Air Ambulance
• Trauma Rules
• Acute Care Beds
• Rehabilitation Beds
• Neonatal Beds

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Heart Vascular Services at Johnston Health

• Betsy Gaskins-McClaine, RN, BSN, MSN-CVice
  President, Heart Vascular Services

Raleigh, North Carolina
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A Partnership to Meet the Needs of People with
Heart Vascular Disease / Disease Risk
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Mission Based Partnership Commitment to
Excellence

• Johnston Health Mission
• To improve the health of the people in our
  communities
• WakeMed Mission
• to provide outstanding and compassionate care to
  all who seek our services

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WakeMed Raleigh Campus
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WakeMed Heart Vascular Center
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Johnston County CV Patients FY 2008
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Johnston County Patient Cardiovascular
Procedures FY 08
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WakeMed is 1 in NC for Cardiac Services
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WakeMed Heart Center History Foundation for the
Future

• WakeMed has a strong history of cardiac care
  leadership - began in the late 60s.
• Strong relationships..focused on the patient
• Cutting edge technology, leading research,
  comprehensive services, excellent outcomes, a
  core of highly qualified, experienced and
  dedicated physicians and staff have made the
  WakeMed Heart Center the market volume leader in
  North Carolina.

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Heart Center Leadership Telecardiology Imaging
Communication

• Consultation between MDs using real time images
• Facilitate treatment at referral location
• Potential for remote 2nd opinion MD consultation
  for patient
• Capability of viewing multiple images Cath,
  Interventions, Echos

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WakeMed Heart Center Saving Lives and Quality
of Lives through Clinical Leadership

• Rapid Response Team First in the Triangle
• March, 2005
• Heart Attack STEMI Response Team
• March 13, 2006
• Chest Pain Center Accreditation, March 2006
• Brain Attack Stroke Response Team
• April 3, 2006
• First in the Triangle
• Primary Stroke Center JCAHO, August 2006

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Comprehensive Branded Heart Vascular Center at
Johnston Health

• Cardiovascular testing Cardiac, PV, abdominal,
  and carotid
• Diagnostic Cath Lab
• Chest Pain and AMI Management Program Community
  Education, EMS Rapid Treatment Protocols, ED
  Rapid Assessment, Chest Pain Obs, STEMI and
  NSTEMI treatment protocols inclusive of lytics
  and rapid transport for Primary PCI
• Elective Angioplasty and stent insertions / PCI
  with onsite dedicated transport and off-site OHS
  back-up
• Sudden Death and Arrhythmia Management ALS
  training, AED and Defib placement and training in
  staff
• Electrophysiology Studies

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Comprehensive Branded Heart Vascular Center at
Johnston Health

• Radiofrequency catheter ablations
• Automatic implantable cardiac defibrillator and
  resynchronization (biv) insertions
• Outpatient and inpatient heart failure management
  program
• Cardiac rehabilitation
• Peripheral vascular diagnostic and interventional
  procedures
• Link to diabetes management program and wound
  management program
• Primary Stroke Risk (TIA) and Stroke management
  program including rapid triage, CT evaluation,
  lytic administration, and rapid transport for
  intervention
• Community screenings and education inclusive of
  women and heart disease, children and heart
  disease

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Heart Center Stent Procedures
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Cardiac Rehab Program
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Customer Service

• Two components
• Training program
• Patient satisfaction surveys with standard,
  timely reports
• Desired result A culture of consistent delivery
  of service excellence

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Physician Support

• Promote open medical staff model
• Establish medical staff credentialing criteria
• Clinical case conferences
• CME opportunities
• Evaluate E-ICU

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Live Case Conferences and Peer Review
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Continuous Quality Improvement

• Development of standard order sets
• Implementing plan of care
• Development of patient education teaching
  guidelines
• Monthly quality reports, including volume and
  quality statistics (e.g., mortalities,
  readmissions, transfers, complications)
• Participation in registries ACC-CathPCI,
  CARERegistry, ICD Registry, ACTION Registry

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Executive SummaryPCI and Diagnostic
Catheterization Registry MetricsWakeMed Raleigh
Campus (878567) compared to Rolling Four Quarters
(R4Q) for All Hospitals - 2008Y4
Proportion of STEMI Pts with DBT lt 90 My
Hospital 84.3 (Rank 251 of 906, Rank
Percentile 73)The proportion of primary PCI
patients with DBT (door to balloon time) lt 90
minutes. The goal is to have a DBT of lt 90
minutes for all nontransferred patients pts
having an ST elevated MI and having primary PCI
for all non-transferred patients
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Data Elements Available for Reporting

• Volume Summary
• Whole population Volume Summary
• Admission Information
• Diagnostic Cath with or without PCI Admission
  Information
• Medications
• History on Admission
• Cardiac Status on Admission
• Discharge Information
• Procedure Overview
• Procedure Indications

• Procedure Detail
• Procedure Findings
• Diagnostic Cath (No PCI) Discharge Information
• Procedure Detail - Closure Devices
• Adverse Events
• Length of Stay
• PCI Admission Information
• All PCI patients with STEMI Adverse Events
• All PCI patients without STEMI Adverse Events

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Staffing Plan

• Phased approach
• Phase One Eight hours/day, M-F
• Phase Two Ten hours/day, M-F
• Phase ThreeTen hours/day, M-F, two procedure
  rooms
• Cross-trained
• Dual accountability

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Staff Education

• System wide orientation
• Departmental orientation
• Annual Educational Blitz
• Monthly CEU inservices
• Education of med/surg nursing staff
• Clinical ladder
• Leadership Academy
• Designation as a clinical site for training
  programs
• SIM center training access

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Leadership in Professional Education and Public
Education

• Womens Heart Programs
• Heart Failure Rounds
• PV Physician Training Programs
• Transradial Physician Training
• WHVA Interventional Cardiology Live Case
  Symposium
• Time is Brain Stroke Conferences

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Implementation

• First step Convene joint committee of key
  clinical and executive representatives to
  establish priorities and timeline
• First 90 days
• Announce partnership, sign contract
• Review accreditation criteria for key clinical
  programs, implement appropriate staff education
  and program components
• Develop operational plan

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Marketing Plan

• Developed collaboratively
• Position JMC heart program as an extension of
  WakeMed Heart Vascular
• Target audiences physicians and women 45
• Tools
• Marketing brochures, patient education materials
• Web site
• Press releases, news conferences
• External and internal publications
• Advertising
• Community outreach

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Year One

• Initiate CON strategy to permit PCI
• Initiate space/equipment planning
• Revise credentialing criteria
• Develop community education events
• Implement program components necessary to apply
  for accreditation
• Explore e-ICU, opportunities for other services,
  including PV
• Evaluate need for dedicated ground transport

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Year Two

• Submit applications for accreditations
• Chest pain center
• Congestive heart failure
• Stroke
• ICAVL
• ICAEL
• Grow procedure volumes for PV, EP, implants
• Continue space/equipment evaluations

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Years Three - Four

• Develop plan for equipment replacement and
  facility upgrades
• Complete facility upgrades, equipment replacement
• Initiate staff training for PCI
• Implement PCI, including provision for emergency
  transport

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Years Five - Seven

• Explore potential for offering open heart
  services
• Continue to grow programs

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Heart Center Horizons

• People
• Experience
• Skill
• Dedication
• Relationships
• Leadership

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Listen to your heart
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Certificate of Need Issues

• W. Stan Taylor, MBACorporate Planning Managed
  Care

Raleigh, North Carolina
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Regulatory Environment

• Healthcare is not a free-market, those without
  means do need and receive care, that care is
  highly regulated for good reason
• WakeMeds track record
• PCI Barrier
• Solutions

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WakeMeds track record

• Air Ambulance
• Trauma Rules
• Acute Care Beds
• Rehabilitation Beds
• Neonatal Beds

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The PCI Barrier

• NCHA lobbies state to prohibit PCIs without Open
  Heart back-up rules enacted on March 18, 1993
• Pre-1993 programs are allowed to perform PCIs
  without Open Heart back-up

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Certificate of Need Approaches

• Rule Change
• Demonstration Project
• Exempt Lab
• Open Heart
• Legislative
• Governor

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Patient Safety Quality Improvement

• Meera Kelley, MD
• Vice President, Quality Patient Safety

Raleigh, North Carolina
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Quality and Safety

• Current challenges
• Improving quality and safety

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Medical Errors
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The Internet
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Improving Quality and Patient Safety
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The Problem with Healthcare

• We have out-innovated our infrastructure.
• - Charles Denham MD
• Chairman of the Leapfrog NQF
• Safe Practices program
• NCHA Hospital Quality and Patient Safety
• 1st Annual Conference, Chapel Hill, NC 11/8/06

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Innovation in Healthcare

• The next generation of innovation
• People, process, how we work together
• Charles Denham MD
• Chairman of the Leapfrog NQF
• Safe Practices program
• NCHA Hospital Quality and Patient Safety
• 1st Annual Conference, Chapel Hill, NC 11/8/06

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Bringing Healthcare Into the 21st Century

• Physicians lead the way
• Work with the board, administrators and staff
• Make use of computers and technology when
  appropriate
• Make it the way we do things

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Where Do We Begin?

• National initiatives
• We already collect lots of meaningful data
• We have not yet achieved maximal results

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Cardiac Services

• Ravish Sachar, MD
• Wake Heart and Vascular Associates

Raleigh, North Carolina
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History Wake Heart Vascular Associates

• Founded 1985
• Dr. Tift Mann
• Dr. Michael Zellinger
• Dr. Bill Newman
• 25 cardiologists
• Largest private cardiology group in NC
• gt130 employees

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Locations
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Philosophy

• To partner with communities
• Provide services not locally available
• Respect for the local primary physician
• Always return the patient back to their community
• Sensitivity to the needs of the patient and
  family

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Services Offered by Wake Heart and Vascular

• Clinical Cardiology
• Nuclear Cardiology
• Congestive Heart Failure
• Invasive Cardiology
• Interventional Cardiology
• Electrophysiology

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Services Offered by Wake Heart and Vascular

• Peripheral Vascular Disease
• Claudication
• Critical limb ischemia
• Renovascular disease
• Abdominal aortic aneurysms
• Stroke Prevention and Treatment
• Carotid stenting
• PFO/ASD closure
• Acute stroke intervention

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Teaching for Physicians and Staff

• Peripheral vascular courses
• Carotid/Stroke courses
• Live presentations
• Satellite presentation
• Fellows courses

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Coronary Artery Disease
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Carotid Stenting
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Stroke
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Before
After
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Possibilities.
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What Can We Offer?

• Assistance in patient care, only in those areas
  where you feel you need it
• A true partnership
• A philosophy that has succeeded over the last 20
  years
• Cutting edge technology
• Backed up by the resources of WakeMed

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Wrap-Up

• William K. Atkinson, Ph. D.

Raleigh, North Carolina
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Structure of Relationship

• Options
• Joint venture
• Management agreement
• Selection dictated by level of collaboration,
  joint planning, level of control desired

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WakeMed Health Hospitals
Raleigh, North Carolina
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