May 10, 2012

VHVI receives certification from Joint Commission to offer destination therapy

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The HeartMate II provides up to 10 years of circulatory support for advanced heart failure patients and is the approved device for destination therapy.

VHVI receives certification from Joint Commission to offer destination therapy

While Vanderbilt Heart & Vascular Institute (VHVI) has long had a program for which ventricular assist devices (VAD) are used as a “bridge to transplant,” it recently received certification from the Joint Commission to offer “destination therapy,” which uses a VAD to permanently restore a heart failure patient to good health without transplantation.

Following a two-day site visit and survey in mid April, the Joint Commission recently notified VHVI that it may now offer destination therapy to Medicare patients, which means Vanderbilt can offer a comprehensive advanced heart failure evaluation tailored to each patient’s needs.

Destination therapy is reserved for patients for whom transplantation is not an option. The concept is fairly new, and the time is right for Vanderbilt to embrace the advances in technology that have made these devices smaller, more portable and longer lasting, said Simon Maltais, M.D., Ph.D., assistant professor of Cardiac Surgery and surgical director of Mechanical Circulatory Support and Heart Transplantation at Vanderbilt.

“When you have a really effective VAD program you are able to bring a lot of referrals for heart transplants. So, the hope is that by building the VAD program, we will grow our transplant program,” Maltais said.

“The plan is to bring our program that is doing two VAD implants a year to 15 per year within the next year. Then we’ll increase by 10 to 15 every year, so at five years we are doing 50-60, which would be competitive with major centers in the United States,” Maltais said.

During the site visit, the Joint Commission reviewed practice guidelines, performance metrics, patient and staff education, outreach endeavors, and multidisciplinary care of advanced heart failure patients.

“The commission focused on the staff and ancillary departments to make sure that the patients were cared for based on the practice guidelines, protocols and processes,” said Lenys Biga, MSN, R.N., administrative lead for the VAD program and co-chair of the survey steering committee, along with Mary Keebler, M.D., assistant professor of Medicine and medical director of the Mechanical Circulatory Support Program.

The steering committee worked closely for eight months to incorporate the VAD program into the day-to-day operations of Vanderbilt Heart.

Members of the committee from cardiology and cardiac surgery wrote practice guidelines, protocols and order sets and gathered and crafted patient and staff education, monitored finances and quality metrics, and implemented communication and hand-over processes.

“Preparing for the survey required collaboration between Cardiology and Cardiac Surgery that is unique to Vanderbilt, where we work in tandem every day to do what is best for our patients,” said Keith Churchwell, M.D., executive medical director of VHVI.

The team worked with ancillary departments such as the Emergency Department, Radiology, Physical Therapy, Occupational Therapy, Cardiac Rehab, Social Work, Vanderbilt Preoperative Evaluation Center, Operating Room and Perfusion to prepare for the Joint Commission survey.

“Obtaining Joint Commission certification for destination therapy is a major milestone for Vanderbilt Heart. Collaboration and teamwork made this possible,” said John Byrne, M.D., William S. Stoney Professor of Cardiac Surgery and chair of the department. “Certification allows us to offer the full complement of treatment for advanced heart failure patients, which includes durable ventricular assist devices.”