How a three-campus heart service line improves clinical processes and outcomes

Area of Science:

• Healthcare Management
• Clinical Process Improvement
• Cardiac Surgery

Background:

• Intermountain Health Care established service lines in 1993, including heart services across three Salt Lake Valley Hospitals.
• Organizational restructuring led to the formation of a cardiac executive council and specialty work teams for unified planning.
• A case study focused on the open-heart team to improve care for patients undergoing coronary artery bypass graft (CABG) surgery.

Purpose of the Study:

• To identify and improve areas within the patient care process for coronary artery bypass graft (CABG) surgery.
• To analyze the factors influencing extubation times in post-cardiac surgery patients.
• To develop and implement strategies for reducing mechanical ventilation duration.

Main Methods:

• The open-heart team mapped current care processes for CABG patients.
• Analyzed practice patterns related to patient extubation from mechanical ventilation.
• Developed and implemented a standardized "weaning path" protocol.

Main Results:

• Identified extubation timing as influenced by staffing patterns rather than patient readiness.
• Average patient extubation time was reduced from 20.41 hours to 8.89 hours.
• The implemented "weaning path" significantly decreased the duration of mechanical ventilation.

Conclusions:

• Integrated healthcare services require a common vision and supportive organizational structure.
• Cross-training staff ensures consistent care standards across multiple hospital campuses.
• Fostering a cohesive "cardiac culture" among medical staff and departments drives performance improvement in cardiac patient care.