July 24, 2009

VHVI volumes, quality measures show gains

VHVI volumes, quality measures show gains

Vanderbilt Heart & Vascular Institute (VHVI) reports a highly successful fiscal year, including record-setting cardiac surgery volume and outstanding door-to-balloon times for heart attack victims.

Between July 1, 2008, and June 30, Vanderbilt performed 2,139 cardiac surgery procedures, which include coronary artery bypass grafts, heart valve replacement and repair, ventricular assist devices and heart transplants for both adult and pediatric patients.

The surgical volume reflects procedures performed at Vanderbilt University Hospital (1,286), the Monroe Carell Jr. Children's Hospital at Vanderbilt (562), Nashville Veterans Affairs Medical Center (161) and Maury Regional Hospital (131), with which VHVI has a professional service agreement.

By comparison, Vanderbilt performed approximately 900 surgeries in fiscal year 2004-2005.

John Byrne, M.D., chair of the Department of Cardiac Surgery, said that the increase in volume makes Vanderbilt not only the largest cardiac surgery program in Tennessee, but among the largest programs nationwide.

According to 2008 University HealthSystem Consortium (UHC) data, Vanderbilt was among the top eight hospitals for cardiac surgery volume. UHC is an alliance of 103 academic medical centers and 217 of their affiliated hospitals representing approximately 90 percent of the nation's non-profit academic medical centers.

“This growth is due to the alignment of interests to deliver better overall value to patients and referring physicians,” Byrne said. “This alignment includes close collaboration among cardiologists and cardiac surgeons, two groups of physicians that historically have competed for patients.”

Byrne said many medical centers “are organized as a loose affiliation of aligned interests, resulting in internal competition instead of collaboration, but VHVI is a tight team.”

“At Vanderbilt, a team approach is taken to decide the best course of treatment — medicine or surgery. This type of collaboration between two groups of doctors who are typically rivals at other heart centers is what makes Vanderbilt Heart unique.

“We are organized as a team, and we reward team performance and it's that culture, and the value system it represents, which is unique,” he said.

Collaboration between Cardiology and the Emergency Department was key to achieving excellent door-to-balloon (D2B) times for the past year. D2B measures the time of a patient's arrival in the Emergency Department to the opening of the blocked coronary artery with a balloon catheter, also known as percutaneous coronary intervention (PCI).

For the fiscal year, Vanderbilt had D2B times of 90 minutes or less for 100 percent of patients. The median D2B time was 58 minutes. The national standard set by the American College of Cardiology Door-to-Balloon (D2B) Alliance recommends 90 minutes or less for 75 percent of patients receiving PCI.

“I am extremely proud of this accomplishment. It is the result of dedication and teamwork and a commitment to providing outstanding care to our heart patients,” said Joseph Fredi, M.D., assistant professor of Medicine and director of the Acute MI Network, Vanderbilt's rapid response program for heart attack patients.

“The faster we can open a blocked artery, the less damage to the heart, which results in lives saved.”