Initial Considerations for Successful PCI Program Expansion to Open Heart Surgery

Many hospitals nationwide have seen the benefits of expanding invasive cardiac services to include PCI (percutaneous coronary intervention) without open heart surgery on-site.   Although these hospitals have the opportunity to provide advanced interventional cardiac care, they are limited as per the SCAI/ACC/AHA Expert Consensus Document:  Update on Percutaneous Coronary Intervention Without On-Site Surgical Backup that recommends avoiding interventions in patients with clinical presentations such as >50% stenosis of left main artery proximal to infarct-related lesions, or patients with long, calcified, or severely angulated target lesions with high risk of PCI failure, etc.

Unless a center becomes “full-service,” they cannot be considered a “one-stop shop” since patients whose best treatment option is OHS must be referred to another facility.  Therefore, programs in this situation often question whether a service expansion to open heart surgery should occur.  This decision should not be taken lightly, nor should hospital leadership choose a “go / no-go” path without first completely evaluating the pros and cons of both expansion and the status quo.

Whether in a competitive tertiary/quaternary marketplace, in a rural area, or a region of high cardiac mortality, the hospital should undertake a sound market analysis as the first step in this process.  As part of a larger, more comprehensive business plan, if market dynamics and patient need yield a viable outcome, the next step would involve determining the resource requirements of the endeavor.   What would it take to expand services to include OHS?  How long until these resources can be obtained?

Some of the areas for initial high-level consideration are:

• • Clinical staffing resources, including physician and non-physician, which can involve cardiac surgeons, advanced practice providers, experienced CVOR teams, and intensive care unit staff. Changes to pharmacy, respiratory therapy, and information services support may also be needed with the addition of surgical services.
  • Other support staff, including anesthesiology and perfusion. Both of these roles may be employed or contracted, so evaluations of the best model will need to take place.  Many of these positions are not easily recruited and can take many months to place.   Corazon recommends recruitment efforts be among the first strategies undertaken, as the timeline can run parallel to other expansion efforts as a means to avoid implementation delays farther along in the process.
  • Facility and equipment requirements. When transitioning a general operating room to a CVOR considerations related to room size, storage, lighting, wall outlets, hemodynamic monitors, as well as basic equipment will need to be evaluated. Those items requiring high electrical power will need special attention as to functionality in existing space.  ICU rooms also need to have the right number of outlets, gases including oxygen, medical as well as suction to handle post cardiac OHS patients, and monitors with multiple channels to accommodate multiple hemodynamic parameters needing to be recorded and evaluated.
  • Careful evaluation related to needs of the sub-specialists. Because OHS affects most all departments within a hospital, ancillary services such as the blood bank, laboratory, pharmacy, respiratory care, radiology, finance, case management, non-invasive cardiology, cardiac rehabilitation, and extended care will need to be reviewed for any new resources needs.

Based on our vast client experience with cardiac program expansions across the country, Corazon has found that programs armed with this information at the outset of any expansion effort will be in a much better position to make wise choices when considering the addition of open heart surgery services to an existing interventional program.  This initial assessment no doubt sets the stage for clinical quality, operational efficiency, and financial viability from the start — which can provide a solid foundation for excellence in moving forward.

To learn more about the next steps in this process, reach out to Corazon today!