Cardiosciences, A Look Back Over The Last Year

Home / Physicians News / Cardiosciences, A Look Back Over The Last Year

Cardiosciences, A Look Back Over The Last Year

28-Aug-2017

Cardiosciences has had another very busy year with the completion of a number of projects, some of which are cross functional and various program developments.

GMS Cardiac Rhythm Device Clinic

Within the Pacemaker Clinic there was a growing need to expand the actual clinic layout simply because the program had grown to a point where health care providers were assessing patients in a chart storage area.  The program was fortunate to have Group Medical Services (GMS) generously donate money to allow the clinic space to be renovated, providing additional space for the clinic staff to assess patients. Taking the teaching from Lean methodology, once the renovations were complete, most of the large patient waiting room space was converted into usable clinic/assessment spaces.  Even though the waiting room was significantly reduced in size, maximizing clinic space has allowed for minimal patients waiting and an ability to increase the number of patients being assessed daily, contributing to enhanced cardiac outpatient department flow.

Digital ECG Storage System Project

The second aspect of this donation allowed the program an ability to purchase software for electrocardiograms (ECGs) and holters to be stored electronically.  Up until June 29, 2017, all regional ECGs were stored in a paper format which had the potential to pose readability issues, as ECGs were often faxed to the cardiologist for their interpretation and subsequent care and management.   Also, ECGs are stored in the form of old health record charts. These actual tracings can fade over time, further contributing to difficulty in reliably reading ECGs.  Monthly, the number of ECGs ordered between the Pasqua and Regina General hospitals is approximately 4,000-5,000 ECGs and rural areas order almost 500 ECGs, all of which contributes to storage/space problems.

Having an electronic ability to view previous and current ECGs simultaneously allows for the safest and highest quality of care as diagnosis and disposition plans for patients can now take place almost immediately, assisting to maximize as much cardiac function as possible. There is also no longer going to be a need for porters to retrieve old files afterhours so previous and current ECGs can be compared. This allows for these non-medical health care employees to have other equally vital duties assigned. In late August, this system will also have wireless capabilities.
   
Due to the vast cross functional aspects of this project, the ECG storage system has been divided into three distinct phases:

Phase 1: Relating to the RGH and PH having an ability to view ECGs electronically. This phase went live June 29, 2017.  Now all physicians and nurses with access to SCM who have a need to view ECG results will have an ability to view preliminary and confirmed ECGs online.  Another perk of this new system is that physicians with ECG billing privileges will have the ability to create ECG billing reports, facilitating easier billing.   

Phase 2: All ECGs from Moosomin, Wolseley, Fort Qu’Appelle, Indian Head and in the Surgical Pre-Admission Centre (Crossings) will go online and have their ECGs stored electronically. 

Phase 3: Entails the work required for holters from both regional and non-regional locations to be stored electronically.

Project completion for all phases is tentatively set for late fall. With any new system, merging old infrastructure with new technology can result in growing pains. Plans have been devised to remedy the concerns which have been identified.

Integrated Hospital Solutions (IHS) Project

IHS was developed as a way to work through the rapidly expanding implant device technology. This is a first of its kind in Canada and includes a partnership with the company Medtronic as a way to incorporate Lean methodology into the Group Medical Services (GMS) Cardiac Rhythm Device Clinic. No additional regional resources are being used during this three-year partnership.

Key objectives include:

1) educational needs assessment and subsequent plan for multiple generations of employees within the clinic, including a cross-over coverage training plan;

2) optimize/standardize device clinic appointments as a way to optimize clinic throughput;

3) creating best operational procedures for a constantly expanding technological market; and

4) optimize clinic efficiencies including paperless opportunities  and implement latest implant device database software known as Pace Art Optima.

Lab Information System (LIS) Project

One year ago, the Cardiac Care Unit went live with an electronic ability to order all blood work. As a result, blood work requisitions are no longer lost in the system prior to the blood being drawn. Laboratory staff receive the order almost immediately after the information is electronically entered which facilitates timely care and management, as needed. 

Targeted Temperature Management Project

New hypothermic technology in the form of equipment called the Artic Sun was introduced in 2016 as another adjunct to our existing hypothermic protocol for ventricular fibrillation arresting patients. The outcomes associated with this newer technology will assist to improve our survival to discharge cardiac arrest patients.  This technology to set to be rolled out within Medical Intensive Care Unit.

Left Atrial Appendages (LAA) Structural Heart Program

The prevalence of non-valvular Afib in Saskatchewan is approximately one per cent of the population but the incidence increases dramatically with age: those under 55 have a 0.1 per cent chance of having non-valvular Afib while those older than 80 have as much as a nine per cent chance.

This procedure gives the cardiac program the opportunity to offer a therapy that can reduce the risk of stroke among those patients who are unable to safely use anticoagulation. Being able to offer this allows patients to be treated closer to home rather than travel outside the region or province, especially as many of these patients are older and have other comorbid health conditions.

The primary benefit of this procedure is reducing the risk of stroke safely without blood thinners. From a sustainability perspective, the length of stay (LOS) is 24 hours or less and performing the procedure has potentially significantly reduced costs incurred by the region should any of these patients have suffered a stroke. The program has been approved to perform 25 procedures/fiscal with no additional regional resources. Existing cardiac operational resources have been used to fund this structural heart procedure. During the last year, there have been minimal complications seen as a result of performing this procedure and LOS has been 24 hours or less.

Saskatchewan TAVI or Trans-Aortic Valve Implantation Program

Severe aortic stenosis is a common valvular heart disorder that increases in frequency in elderly patients. The usual treatment for this condition is surgical valve replacement but not all patients are surgical candidates. Trans-aortic valve implementation (TAVI) is now a well-accepted procedure that has become the standard of care for the treatment of high-risk patient with aortic stenosis in patients who have been refused surgery. Previously, patients in Saskatchewan have had to travel out of province to have this procedure performed, leading to time delays (sometimes with serious consequences), inconvenience to patients and family and additional costs.  These challenges have led to some patients refusing to proceed with the procedure. A program partnership has been developed between Saskatoon and Regina Qu’Appelle Health Region resulting in Saskatchewan being funded to perform 25 TAVI cases each year, with RQHR being chosen to commence performing initially. Saskatoon is set to begin performing cases in two to three years but both health regions are working in complete collaboration during all aspects of the TAVI programming. Average length of stay (ALOS) for a typical aortic value replacement surgery is 12-14 days and TAVI ALOS is two to four days with four rarely being evident.

Chest Pain Assessment Clinic

Commencing Oct 2, 2017, there will be ability for patients presenting to the Emergency Department with typical and atypical cardiac symptoms. This will be a joint partnership between the ER and Cardiosciences Program that will see weekly several stress lab spots allocated to this clinic as a way to rule in or rule out the existence of cardiac disease allowing for the most efficient flow through the system and use of regional resources. 

Cardiac Oncology Clinic

Due to load leveling of the cardiac outpatient diagnostic schedule, this clinic will become operational out of the Pasqua Hospital effective Oct 2, 2017.  Certain side effects from chemotherapy agents have a tendency to be cardio toxic and, as a result, cancer patients require timed echocardiograms which are needed for both diagnosis and surveillance. By making adjustments to the current outpatient schedule, the cardiac program will have an ability to offer this specific patient population access to required cardiac assessments and subsequent care as required.

Submitted by: Vicki Ehrlich, Director, Cardiosciences Program