Abstract
Purpose As VAD therapy expands, implanting centers face challenges of sustaining growth while maximizing staff productivity. We describe an innovative approach to integrate Heart Failure Cardiology, Heart Transplant, and Mechanical Circulatory Support (MCS) programs and establishing functions supportive of growth and efficiency. Methods and Materials A “LEAN” process analysis (based on renowned Toyota production & efficiency methods) was applied to the patient work-flow process to reduce the time from referral to listing for transplant or MCS implant. During this analysis, synergies between the components of the integrated program were enhanced by creating a single Intake Coordinator, developing a Director of Outreach to expand direct-to-clinician contact, promoting tighter integration of outpatient follow-up, and implementing an information management system to improve patient selection, review outcomes, and provide early feedback to referring clinicians. Results Creating a Single Point Of Contact for referrals improved communication with referring physicians and transmission of patient records. The average time to transplant listing or MCS implant decision was reduced to 22 days, and patient follow-up was improved. All 3 program components benefitted – Heart transplants increased by 50%, MCS implants grew 30% (to 60 implants/yr), and Heart Failure Cardiology Clinic referrals increased over 100%. Adding dedicated clinical outreach and education enhanced clinician engagement and expanded the number of referring centers, while promoting constructive feedback. Conclusions Creation of an integrated Intake pathway and an integrated clinical outreach program foster coordination of the 3major components of the Advanced Cardiac Care program, expand the patient referral base, improve communication with referring partners, and streamline patient triage and work-up processes. Innovative approaches to maximize efficiency will be increasingly required as healthcare organizations reduce costs and grapple with a constrained reimbursement environment.
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