Opening New Doors to Cardiovascular Excellence
EDITOR’S NOTE: This is the second in a series detailing BWH’s five Centers of Excellence: Cancer, Cardiovascular, Women’s Health, Neurosciences, and Orthopedics and Arthritis.
This summer’s opening of the Carl J. and Ruth Shapiro Cardiovascular Center marks a new era for BWH’s Cardiovascular Center of Excellence, which extends throughout the hospital’s distributed campus and the growing network of referring physicians.
“Our cardiovascular service line is far more than bricks and mortar,” said Peter Libby, MD, chief of the Division of Cardiology. “We are rethinking cardiovascular services across the board for the clinical core, training and investigative pursuits, and the Shapiro Center gives us the opportunity to achieve an even greater integration of services than we’ve enjoyed in the past.”
Earlier this year, BWH reorganized the Cardiovascular Center of Excellence Leadership Committee with Department of Medicine Chairman Joseph Loscalzo, MD, PhD, as its chairman. The committee is charged with leading the hospital’s innovative efforts to integrate Cardiovascular Medicine, Cardiac Surgery and Vascular Surgery into a novel care model that brings a multi-disciplinary cadre of clinicians around the patient.
Advanced Heart Disease/Heart Failure
Brigham Cardiac Valve Center
Coronary Artery Bypass Surgery
Heart Transplant Program
Advanced Heart Disease/Heart Failure
Brigham Cardiovascular Consultants
Cardiac Arrhythmia Service
Cardiovascular Genetics Center
Clinical Cardiovascular Services
Exercise Testing Laboratory
Vascular Diagnostic Laboratory
Carotid Occlusive Disease
Peripheral Artery Disease
Renal Artery Disease
Positron Emission Tomography
Vascular CT and MRI
Exercise Testing Laboratory
“Care will be more efficient, cooperative and collaborative for the patient, and we have the opportunity to establish a more widespread approach similar to the cooperation between BWH and the Dana-Farber Cancer Institute, or between Orthopedic Surgery and Rheumatology in the Arthritis Center working so well together,” Loscalzo said.
The Cardiovascular Center of Excellence focuses on the integration of care with the most comprehensive team of cardiologists, cardiac surgeons, vascular surgeons, cardiac anesthesiologists, cardiovascular radiologists, cardiovascular nurses and other health care professionals who work as a team to bring the most advanced care to each patient. The integrated care model for ambulatory patients comes to fruition with the structure of the Watkins Cardiovascular Clinic in the Shapiro Center.
“Vascular surgery and vascular medicine physicians now share clinical space for the first time, and this truly is an advantage for patients and trainees as we interact around individual cases,” said Michael Belkin, MD, division chief of Vascular Surgery.
Cardiovascular leaders are analyzing inpatient and ambulatory volumes and net revenues in order to identify opportunities and specific strategies to improve the hospital’s market share while staying faithful to the hospital’s tripartite mission. In fiscal year 2007, the hospital’s net margin for cardiac inpatients was $12.1 million, and for outpatient it was $5.8 million.
BWH has identified opportunities to expand its market share in certain services within the Cardiovascular Center of Excellence in an effort to build upon the hospital’s strong foundation of Cardiology, Cardiac Surgery, Advanced Heart Disease/Heart Failure and Transplantation. For example, the hospital this year has recruited physicians who specialize in treating atrial fibrillation and arrhythmia. In addition, BWH vascular and cardiac surgeons are leading efforts to use new technologies to treat thoracic aortic aneurysms.
In network building, Dale Adler, MD, vice chairman of Medicine for Network Development and Strategic Planning, is leading efforts to improve and expand BWH’s cardiovascular network to realize growth, strengthen ties to referral groups and maintain rapid, effective communications.
“We need to ensure we say, ‘Yes, beds are available,’ and the advantages of more beds and a larger recovery area in the Shapiro Center will play a role in this effort,” Loscalzo said.
Several distinct surgical specialties will come together around the patient in state-of-the-art operating rooms in the Shapiro Center. The new hybrid OR, which will come online in the fall, will feature several imaging modalities used for endovascular surgery, coronary angiography, fluoroscopy and CT.
The hybrid OR combines a table designed by the TRUMPF Group, a global medical technology manufacturer headquartered in Germany, and a newly-approved Siemens fluoroscopy/CT unit, said R. Morton “Chip” Bolman III, MD, chief of Cardiac Surgery. “Until now, when combining a specialized table for imaging with an operating table, there have been compromises with respect to either the imaging or surgery functions of the hybrid arrangement.” Bolman said. “This will be the best combination of equipment with the fewest compromises.”
Both insertion of a coronary stent followed by a minimally-invasive valve repair, a common combination of procedures, can be completed in the hybrid OR. Also, with arteriography, fluoroscopy/CT and intravascular ultrasound available in one OR, BWH clinicians will be in a position to design and deliver treatment for thoracic aortic aneurysms or for an emergency aortic dissection, as examples.
“BWH is setting the standard for patient-centeredness in the OR, and we’ve only scratched the surface of the possibilities by bringing together several disciplines and providers with varied expertise right there in one room,” Bolman said. “With this equipment and configuration, we are limited only by our imagination.”
The Cardiovascular Center of Excellence is home to a new program that integrates noninvasive imaging services, including Cardiac CT, Cardiac MRI, Vascular CT and MRI, Nuclear Cardiac and PET, Cardiac and Vascular Ultrasound, and Cardiac Non-Imaging Stress/Cardio Pulmonary Testing, in the Non-invasive Cardiovascular Imaging Program jointly overseen by Cardiology and Radiology and led by Marcelo Di Carli, MD, BWH’s chief of Nuclear Medicine.
“This significantly differentiates Brigham and Women’s Hospital from other academic medical centers,” Di Carli said. “This integrated cardiovascular imaging program offers an unprecedented opportunity to build upon our strengths in basic science and molecular medicine, the advanced imaging infrastructure and rich tradition in imaging science, and our large clinical trials network to facilitate the validation of advances in imaging and translation into clinical applications to improve patient care.”
Through this new structure for imaging, BWH radiologists will specialize in cardiovascular imaging, putting division staff in position to construct critical pathways for patients with multiple imaging modalities. Faculty will lead advances in research and training in cardiovascular imaging, and the new structure and patient volume will pave the way for researchers to analyze patient outcomes related to cost of care and effectiveness of certain modalities in certain circumstances through a comprehensive integrated approach rather than separate parallel tracks.
In addition, BWH Radiology and Cardiology anticipate a research and training grant from the National Heart Lung and Blood Institute to provide advanced resident training in Radiology, Medicine and Cardiology.
“There has never been a time when we could do more for our patients, learn more about disease and reap so many fruits of clinical investigations,” Libby said.