BOISE, Idaho - Heart disease has been the second leading cause of death for Idahoans since 2010, down from No. 1 previously, according to Idaho Vital Records.
In the past few years, Dr. Andrew Chai and his team at St. Luke’s Idaho Cardiology Associates have been building a comprehensive Heart Failure Clinic to best serve patients with a continuum of care from their hospital beds to their homes.
“The key is patient education and the involvement of the patient and their families in their care,” Chai said. “It is also important to be able to see them in a timely fashion, and when it’s convenient for the patient and not necessarily for the physician or the office. This population of patients can get sick without much warning, and you need to get them in and taken care of when this happens. Sometimes we need to see these patients multiple times a week. And we’ve developed IV protocols for these people so we don’t need to send them to the Emergency Room as much or back to the hospital as much. We also have access to point of care labs to expedite their care and decision making.”
St. Luke’s heart failure program started with Nurse Practitioner Anna McCreath dedicated to outpatient care and heart failure program coordinator Justin Baines, assessing and educating patients in the hospital. Under Dr. Chai’s leadership, the program has grown to a staff of nine at the Heart Failure Clinic, including two physicians’ assistants and two additional nurse practitioners, two nurse coordinators and a scheduler. A nurse navigator joined the program in May to see patients in their homes. In St. Luke’s Meridian and Boise hospitals, two heart failure coordinators assess and educate patients, and communicate with clinic staff, especially identifying high-risk patients who have multiple trips to the Emergency Room or stays in the hospital in the past year.
“We really wanted to go beyond the measures,” Baines said. “We’re trying to align as an accountable care organization and create a healthier population of heart failure patients.”
Processes and paperwork have been streamlined and coordination reaches from hospital to clinic to home. The goals are to reduce unneeded emergency room visits, prevent hospitalization and help heart failure patients live full lives.
The Heart Failure Clinic also is surveying nursing homes to find out how they treat heart failure patients and to share best practices and standards in order to close any gaps in care.
All of these efforts are showing results.
“Our numbers have never been better,” said Bruce DeLawyer, manager of Quality and Operations for St. Luke’s Heart.
The number of patients readmitted within 30 days of release from the hospital to 17 percent in 2011/12 from 24 percent prior to the start of the Heart Failure Clinic. At the same time, the number of patients receiving all Medicare-required therapies and education has increased to 97 percent from 92 percent.
Nurse Navigator Linda Mikitish visited patients at home to provide physical assessments, care planning, clinical interventions if needed and follow-up education. Her efforts paid off with a control group readmission rate of 22 percent compared to the navigator group’s rate of 15 percent.
Assembling a good team has been most important, Chai said.
“It’s not about me or Anna,” he said. “We’re all here to help the patient, and what each of us do is important. There’s no way I could do my job, or Anna do her job, without all the people here.”
Clinic staff members say they appreciate Dr. Chai’s leadership.
“His leadership is critical to the Heart Failure Clinic,” said Dina Sanford, an RN and clinic nurse coordinator. “His knowledge and expertise allows us to provide quality care to our population of patients. He also is not afraid to challenge our current way of thinking or systems in place to find better and more effective ways to care for our patients while making sure we do not overwhelm staff. We have implemented many changes that relieved unnecessary stress on patients and staff.”
Sanford says Dr. Chai often discusses complicated patients with staff to give them a better understanding of caring for those patients.
“I also enjoy that he is a staff advocate,” she said. “If we run into barriers taking care of our patients, he will help contact the appropriate person to get the help or approval we need to care for our patients.”
Nurse Practitioner Anna McCreath says staff and patients enjoy Dr. Chai’s sense of humor.
“It makes the work day positive and a great learning environment,” McCreath said. “The patient’s love it. They see him as human. They also see our relationship as mutual respect, which helps with my patient relationship. “
McCreath said the clinic would not have come about without physician backing.
“I have wanted the Heart Failure Clinic since I started with SLICA 10 years ago,” she said. “I could not do this alone, and without his support it would not have happened. He is a great liaison with hospital administration and medical staff. He has made me a better clinician. He makes me think and reason through problems. He expects me to problem solve and create plans with him, not just sit back and let him do the work. He is a great team-player. He is a smart and caring cardiologist and really cares for the patients. I respect that about him and working with him day after day improves my skills.”
Heart Month Events
Feb. 10-16 is National Heart Failure Awareness Week. Here are some of the events going on this month within the St. Luke’s Health System:
Thursday, Feb. 21, from 6:30 to 7:30 p.m. in the Forest Street Center, 100 Forest St.: Cardiologist Dr. Stefanie Fry will present “Solving the Heart Healthy Diet Dilemma.” Anti-inflammatory, Paleo, South Beach, DASH – so many diets, so many claims. Dr. Fry will cut through the clutter and help you discover which are heart-healthy and sustainable. Register online at mccallhosp.org or call the St. Luke’s McCall Center for Health Promotion at 630-2420.
Wednesday, Feb. 20 at 801 Pole Line Road, Twin Falls, in the Oak Rooms, lower levels:
Ken Dey served as Public Relations Coordinator at St. Luke's from 2008-2014.