bryanlgh heart institute annual report

2 0 1 0 a n n u a l r e p o r t

4 0 y e a r s o f e x c e l l e n c e | i n n o v a t i o n | e x p e r i e n c e

Patients First.

Our commitment to quality outcomes

In June 2010 we will mark the second anniversary of our

enhanced relationship with BryanLGH Medical Center,

one that established a specialty heart hospital within

a hospital. Thank you for your support and the referrals

you have made to BryanLGH Heart Institute.

The purpose of this report is to provide you with a concise

update on the latest services and technologies available

for your patients, as well as to share with you clinical

outcomes that demonstrate our commitment to the

highest quality heart care for Nebraska and the region.

Our goal is to provide you with an unparalleled level

of service, and your patients an exceptional healthcare

experience. Please let us know if there are ways

BryanLGH Heart Institute can be of additional

assistance in your practice.

Sincerely,

highlights

(Front row, left to right): Clyde Meckel, MD; Ryan Whitney, MD; Dale Hansen, MD

(Back row, left to right): Scott Coatsworth, MD; Robert Hibbard, MD; Andrew Merliss, MD; Steven Krueger, MD; Joseph Kummer, MD; Keith Miller, MD; Todd Tessendorf, MD; Timothy Gardner, MD; David Hughes, MD; Edward Raines, MD

Clyde Meckel, MDExecutive Medical Director

Edward Raines, MD, JDSurgical Director

BryanLGH Heart Institute is the region’s most experienced heart care provider.

500 p a t i e n t s t h o u g h t o f u s f i r s t f o r h e a r t s u r g e r y l a s t y e a r.m o r e t h a n

Dual recipientBryanlgh is the only hospital in Nebraska to have received both awards and is one of only 74 dual award recipients in the United states for 2010.

highlights

The BryanLGH Heart Institute specializes in cardiology and cardiothoracic surgical care, offering world-class diagnosis and treatment of heart disease. BryanLGH Medical Center and the

BryanLGH Heart Institute, the specialty cardiac hospital within BryanLGH Medical

Center, are proud to have received both the 2010 Distinguished Hospital Award

for Clinical Excellence™ and the Patient Safety Excellence Award™ by HealthGrades®.

BryanLGH is the only hospital in Nebraska to have received both awards and

is one of only 74 dual award recipients in the United States for 2010.

• �Heart�Surgeries�—�More than 500 cases, increase of 12%

• �Diagnostic�Heart�Caths�—�More than 3,200 cases, increase of 10%

• �PCI/Stents�—�More than 900 cases, increase of 28%

• �EP,�Pacers�and�ICD�—�More than 950 cases

• �Cardiac�and�Nuclear�Stress�Testing�—�More than 10,000 cases

v o l u m e h i g h l i g h t s , f i s c a l y e a r 2 0 0 9• �Echocardiograms�—�More than 14,900

• �Electrocardiograms�—�More than 26,900

• �Holter�Monitors�—�More than 2,000

• �Cardiac�Patient�Days�—�More than 3,570 critical care, more than 10,000 cardiac care

• �Chest�Pain�Clinic�Patients�—�More than 700

• �Clinical�Research�—�More than 40 trials

www.bryanlgh.org

This past year, three new technologies have become part of the

advanced cardiac care at BHI, including: aquapheresis,

advanced technology for fluid removal for patients with CHF; the

impella Device, a temporary left ventricular assist device for

complex cardiac intervention and cardiogenic shock patients; and

hypothermia core boDy cooling to prevent or reduce

anoxic brain injury.

te

c h N o l o g i es3

BHI has a consistent history of being first in heart and vascular care delivery.

30 c o m m u n i t i e s a c r o s s f o u r s t a t e s a r e p r o v i d e d a d v a n c e d s e r v i c e s f r o m B h i .

m o r e t h a n

highlights

As the leading provider of cardiac and vascular services in Nebraska and the surrounding region, BHI has a consistent history of being first in heart and vascular care delivery.

Back in the 1960s, Bryan Memorial Hospital

was first in the region to perform cardiac

angiography and open heart surgery. In

the 1970s, the hospital performed the first

CABG surgery and pacemaker implants.

In the 1980s, Bryan Memorial was the

first to perform angioplasty, and in the

same decade, introduced mobile cardiac

and vascular services.

The 1990s brought coronary stenting,

advanced electrophysiology studies, ICD

implants and LVADs. In the 2000s came

cardiac robotic surgery, minimally invasive

valve repair surgery, and cardiac CT.

The year 2009 continues that legacy of advanced

cardiac care for Nebraska and the surrounding

region. Echocardiography and vascular services,

including mobile services, were reaccredited

by the national accreditation bodies ICAEL and

ICAVL. 3D imaging for echocardiography and

valve imaging is used daily. HeartAware, the

computer online risk assessment tool, is now

available for public access. And our mobile

screening services, including a semi trailer

fully equipped for public screening, has

traveled throughout the region.

Second generation upgrades have been made to

the robotic surgery system. And we’ve adopted

new innovations and improved techniques for

minimally invasive valve surgery. The cardiac

Maze procedure, for atrial fibrillation, is now

performed by our highly acclaimed and

recognized cardiac surgery program.

All of these advances, along with the experience

and dedication of the most skilled and qualified

clinicians, makes BryanLGH Heart Institute

the First Name in Heart Care.

www.bryanlgh.org

surgery advances• Robotic Surgery Upgrade: daVinci Robot upgraded

to facilitate enhanced cardiac procedures.

• Minimally Invasive Valve Surgery training site for other cardiac surgeons.

• Maze Procedure: Enhanced Atrial Fibrillation surgical treatment.

surgical cardiac procedures More than 500 cases (12% increase)

cabg-only surgeries:

More than 300 cases

Five Star rated for Valve Replacement Surgery 2009-

2010

The BryanLGH Heart Valve Center of Excellence brings together a team of experienced experts from multiple disciplines to offer the most complete and fully integrated care in the region for patients with valvular heart disease.

• �New�patient�evaluations by cardiologists, cardiac surgeon and other specialists as needed, complete in one stop

• �Non-invasive�evaluation including cutting edge quantitative and 3-dimensional echocardiography techniques

• �Minimally�invasive�surgical�options to reduce patient morbidity

• �Full�perioperative�support�services from on-site pulmonary/intensive care specialists

• �Most�experienced�cardiac�anesthesiology�and perfusionist teams in the area

• �Immediate�availability of all subspecialty and ancillary services for complex patients

• �Complete�postoperative�care and follow-up, including rehabilitation and long-term outcomes tracking

Heart Valve Center of excellence team

edward Raines, MD Surgical Director

Keith Miller, MD, PhD, FAcc Cardiology Director

terry Bejot, MD Anesthesia Director

Rhonda olmsted, APRN Valve Center Coordinator

H E A LT H G R A D E S®G U I D I N G A M E R I C A T O B E T T E R H E A L T H C A R E ®





cARDiAc sURgeRy

Mitral Repair Mitral Replacement

Bhi ActualNational Predicted

Valve Replacement

30 Days Post Discharge

4.0%

6.0%

2.7%

5.3%

3.5%

6.2%

Valve Replacement Mortality Rates

Bryanlgh vs. National Predicted Rates

2.0%

CABG (RISK-ADJUSTED)

2.0 % (2004-2009)

2.0 % (2009)

MITRAL VALVE REPAIR

0.0 % (2008-2009)

1.2 % (2008-2009)

MITRAL VALVE REPAIR/CABG

0.0 % (2008-2009)

5.3 % (2008-2009)

Bryanlgh heart institute

society of thoracic surgeons

Valve Procedure Mortality Rates

Bryanlgh vs. society of thoracic surgeons

dIStRIbUtIon oF

MItRAl VAlVEPRocEdURES

80%

20%

– 2009 –cY

Minimally invasive open

54%

46%MItRAl VAlVE

PRocEdURES

– 2009 –cY

Bhi is the most experienced minimally invasive cardiac surgery

program in the region

i n n e B r a s k a f o r c a r d i a c s u r g e r y ( hea l t hgrades 2010 )1r a n k e d #

a n g i o p l a s t y / s t e n t p r o c e d u r e s i n 2 0 0 9875

iNteRVeNtioNAl cARDiology

Bryanlgh heart instituteNational Average

Key

1 day 2 days 3 days

for Angioplasty/Stent Procedure

average Length of stay

3.0Bhi

National2.25

Door-to-Balloon Time Measured (Less than 90 Minutes)

CMs OrYX time Compliance

25% 50% 75% 100%

92%78.9%

BhiNational

for Angioplasty/Stent Procedurerisk-adjusted Mortality rate

Bhi

1.0%0.77%

1.3%

.5%

1.5%

National

www.bryanlgh.org

3,110 Heart Caths Performed

875 Angioplasty/Stent Procedures

in

2009

Program advances include:• thoracic stent grafting for trauma and dissection

• treatment of renovascular disease

• Abdominal stent grafting variations made possible with the latest generation of grafts

• Reconstructing aortic disease

• Infrapopliteal intervention for peripheral vascular leg disease

iNteRVeNtioNAl cARDiology

Robert Hibbard, MD, FACC, has performed more than 600 percutaneous carotid procedures in patients at high risk for carotid endarterectomy (with MACE of less than two percent).

NUMBER oF PATIENTS

BryanLGH Heart Institute, (Robert Hibbard, sole enroller) Lincoln, NE 151

cardiovascular Associates Kingsport, TN 143

Wake Heart & Vascular Associates Raleigh, NC 140

Vascular and transplant Specialists Norfolk, VA 132

First coast cardiovascular Institute Jacksonville, FL 119

University of texas Houston/Memorial Hermann Heart and Vascular Institute Houston, TX 113

e n r o l l e r i n s a p p h i r e w o r l d w i d e c a r o t i d s t e n t t r i a l s1n u m B e r

sapphire over all top enrollers ( 352 centers worldwide )

Diagnostic Peripheral Angiograms NUMBER oF CASES By yEAR

731

785

2007

2008

2009 853

endovascular Peripheral Procedures NUMBER oF CASES By yEAR

498

526

2007

2008

2009 617

Aortic stent graft Procedures NUMBER oF CASES By yEAR

22

39

2007

2008

2009 66

three-ye ar trends Bryanlgh medical center

www.bryanlgh.org

p a c e m a k e r d e v i c e s i m p l a n t e d400m o r e t h a n

The Electrophysiology department utilizes state-of-the-art Stereotaxis® magnetic navigation and 3D mapping.

electRoPhysiology (eP)

The electrophysiology department utilizes state-of-the-art Stereotaxis® magnetic navigation and 3D mapping technology to assist in cardiac ablation procedures. Use of this technology helps to ensure the best possible outcomes for patients. BryanLGH was the first in our area to embrace this technology.

150 ablation procedures from December 2008-2009

• �Ablations of the following tachycardia:

�– AV node re-entrant tachycardia

– Atrial fibrillation

� �– Pulmonary vein isolation

– AV nodal ablation

• �Accessory pathway tachycardia

• �Atrial flutter

• �Atrial tachycardia

• �Ventricular tachycardia

First in the region to utilize state-of-the-art stereotaxis® magnetic navigation and 3D mapping technology

• �400 pacemaker devices were implanted

• �250 ICD procedures

�– 53% are biventricular implants

www.bryanlgh.org

Nebraska

Kansas

Wyoming

Iowa

Missouri

Arkansas

Illinois

the bryanlgh Heart�Improvement�Program��

serves patients across a seven-state region.

heARt FAilURe

700,000p e o p l e a r e d i a g n o s e d w i t h h e a r t f a i l u r e e a c h y e a r .

n e a r ly

The BryanLGH Heart Improvement Program is a comprehensive heart failure treatment program featuring advanced medical and surgical therapy, as well as experimental treatments.

The backbone of the program is standard

treatments. However, these are supplemented

with advanced surgical therapies that

distinguish BryanLGH from other heart

failure treatment programs.

Director Steven K. Krueger, MD, FACC,

Coordinator Pat VerMaas, APRN, and 10 nurses

and assistants have performed more than 70

experimental studies. Many of them have led

to what is now our standard and current

medical treatment. Among these are:

angiotensin receptor blockers, carvedilol,

and resynchronization therapy. On average

we are involved in 18 active ongoing protocols

including new uses of standard medications

and gene therapy.

Number of Patients BryanLGH Heart Improvement Program

375

550

2002

2005

2009 700

Bhi

70%

100%95%

85%

Appropriate Care Measures

Bryanlgh vs. National comparison

60%

80%

90%

National

BryanLGH is Five Star rated for Congestive Heart Failure

2007-2010






www.bryanlgh.org

942y e a r s o f n u r s i n g e x p e r i e n c e o n o u r i n t e n s i v e c a r e a n d c a r d i a c u n i t s

cARDiAc MeDiciNe

40 years of excellence, innovation and experience ASSURES oUR PATIENTS THE BEST PoSSIBLE CARE.

• �Highly trained cardiac nurses available in cath lab, ICU and cardiac unit

• �Total years of experience for ICU and cardiac unit: 942

• �Chest Pain Center established to rapidly evaluate symptoms of chest pain in a safe setting

• �Latest technology, including:

– Ultrafast Cardiac CT Imaging

– Impella (Ventricular Assist Device)

– Inner Cool for hypothermia used post arrest

– ECMO (Extracorporeal Membrane oxygenation)

– CRRT (Continuous Renal Replacement Therapy)

– Critical Care Intensivist Coverage

• �Benefits of heart hospital with skills and technology, plus the benefits of a full-service hospital for specialists and services

• �Newer enhancements:

– 3D Echocardiography

– Definity Contrast Imaging

– Aquapheresis

www.bryanlgh.org

in emergency situations when time is critical

and expert care can save a patient’s life, our

starcare helicopter team, on call 24 hours

a day, includes a critical care flight nurse

and respiratory therapist.

the Physicians of BryanLGH Heart institute

Scott Coatsworth, MD, FACC / [email protected] native of Lincoln, Nebraska, Dr. Coatsworth attended the University of Nebraska–Lincoln and went on to the University of Nebraska College of Medicine, where he received his medical degree with high distinction. He then attended the University of Iowa for both his residency in internal medicine and a fellowship in cardiology, where he served as Chief Fellow in Cardiology.

Dr. Coatsworth is certified by the American Board of Internal Medicine and the American Board of Internal Medicine Subspecialty Board of Cardiovascular Diseases. He has achieved fellowship status with the American College of Cardiology, Society for Cardiac Angiography and Interventions, and the American Heart Association Clinical Council.

Timothy Gardner, MD, FACC / [email protected]. Gardner pursued his undergraduate education at Portland State University. He attended Baylor College of Medicine in Houston, Texas and graduated with honors. Dr. Gardner completed internal medicine residency and a cardiovascular fellowship including interventional cardiology at the Johns Hopkins Hospital in Baltimore, Maryland in 1996.

Dr. Gardner is board certified in Cardiovascular Diseases and Interventional Cardiology. He is a fellow in the American College of Cardiology and has been recognized several times as one of America’s Best Cardiologists by the Consumer’s Research Council of America. His special interests are in coronary and peripheral interventions and pacemaker implantations.

Dale A. Hansen, MD, FACC / [email protected] native of Hartington, Nebraska, Dr. Hansen attended the University of Nebraska–Lincoln, where he graduated with distinction and was a member of Phi Beta Kappa. He went on to the University of Nebraska College of Medicine in Omaha, where he received his medical degree and was a member of ACA. Dr. Hansen served his residency in internal medicine and a fellowship in cardiology at the University of Nebraska Medical Center. He also completed a fellowship in cardiology at Creighton University Affiliated Hospital in Omaha.

Dr. Hansen is certified by the American Board of Internal Medicine and the American Board of Internal Medicine Subspecialty Board of Cardiovascular Diseases. He has achieved fellowship status in the American College of Cardiology and the American College of Chest Pain.

Robert N. Hibbard, MD, FACC / [email protected]. Hibbard completed his undergraduate studies at the University of Wyoming and then attended the Creighton University School of Medicine in Omaha, Nebraska. He completed his internship, residency in internal medicine and fellowship in cardiology at the Creighton University School of Medicine.

Dr. Hibbard is certified by the American Board of Internal Medicine and the American Board of Internal Medicine Subspecialty Boards of Cardiovascular Diseases and Interventional Cardiology. He is a fellow of the American College of Medicine, American College of Cardiology, American College of Chest Physicians and the American Society of Angiography/Intervention.

David Hughes, MD / [email protected]. Hughes attended the Baylor College of Medicine and was a general surgery resident and later a thoracic surgery resident at the University of Michigan Hospitals in Ann Arbor. He completed a fellowship in cardiovascular surgical research at the Texas Heart Institute in Houston where he helped investigate the potential for nuclear-powered artificial hearts.

Since finishing residency, Dr. Hughes has served as Chief of the Cardiac and Thoracic Surgery Division at Creighton University School of Medicine, as assistant clinical professor of surgery at the University of Nebraska College of Medicine and as Chief of Cardiothoracic Surgery at Clarkson Hospital in Omaha. Dr. Hughes specializes in valve surgery, coronary artery bypass graft surgery, aortic root surgery, and surgical treatment of lung cancer. He is board certified by the American Board of Surgery and the American Board of Thoracic Surgery.

Steven Krueger, MD, FACC / [email protected] native of Kearney, Nebraska, Dr. Krueger attended Nebraska Wesleyan University in Lincoln where he earned his B.S. in Biology. He received his medical degree from the University of Nebraska College of Medicine in Omaha. He completed his internship and residency at Stanford University Medical Center in Palo Alto, California. Dr. Krueger served fellowships at the University of Utah in Salt Lake City in cardiology, electrophysiology and congestive heart failure.

Dr. Krueger manages the care of over 800 patients in the Heart Improvement Program and has served as principle investigator on over 75 clinical research trials. He is certified by the American Board of Internal Medicine and the American Board of Internal Medicine Subspecialty Board of Cardiovascular Diseases. He also has achieved fellowship status in the American College of Physicians and the American College of Cardiology.

Joseph L. Kummer, MD, FACC / [email protected] native of Omaha, Nebraska, Dr. Kummer attended Saint Louis University, where he received two undergraduate degrees and completed pre-medical studies in 1996. He then attended the University of Nebraska College of Medicine in Omaha where he earned his medical degree in 2000. He completed his internship and residency in Internal Medicine at Northwestern University in Chicago. He went on to complete his fellowship in cardiology and cardiovascular disease at Henry Ford Hospital in Detroit, Michigan.

Clyde Meckel, MD, FACC / [email protected] native of Burwell, Nebraska, Dr. Meckel attended the University of Nebraska–Lincoln, where he graduated with high distinction. He then went on to the University of Nebraska College of Medicine where he received his medical degree and graduated with high distinction. He served his internship at Brigham and Women’s Hospital and Harvard Medical School in Boston, Massachusetts. He also completed his residency in internal medicine and his fellowship in cardiology at Brigham and Women’s Hospital.

Dr. Meckel is board certified by the American Board of Internal Medicine and the American Board of Internal Medicine Subspecialty Board of Cardiovascular Disease and Interventional Cardiology. He is a fellow of the American College of Cardiology, a member of The Society for Cardiac Angiography and Interventions and a member of the American Society of Nuclear Cardiology.

Andrew Merliss, MD, FACC / [email protected]. Merliss attended Colgate University for his undergraduate studies. He then attended the George Washington University School of Medicine, where he also completed his internship. From there, he completed his residency at Harvard Medical School and went on to serve his cardiology fellowship at Boston University Hospital. He completed his fellowship in cardiac electrophysiology at Harvard Medical School, where he taught for five years.

Dr. Merliss is certified by the American Board of Internal Medicine and the American Board of Internal Medicine Subspecialty Board of Cardiovascular Diseases, as well as the Subspecialty Board of Cardiac Electrophysiology. He is a fellow of the American College of Cardiology and is a member of the North American Society for Pacing and Electrophysiology and Project Pacemaker International.

Keith Miller, MD, PhD, FACC / [email protected] native of Omaha, Nebraska, Dr. Miller attended Cornell University in Ithaca, New York where he completed his undergraduate studies. He went on to earn his medical degree and his PhD in molecular biology from the University of Nebraska College of Medicine in Omaha. He completed his residency in internal medicine at the University of Iowa Hospitals and Clinics in Iowa City and his cardiology fellowship at the University of Chicago Hospitals.

Dr. Miller is certified by the American Board of Internal Medicine, the National Board of Echocardiography and the Certification Board of Nuclear Cardiology.

Edward Raines, MD, FACS, JD / [email protected]. Raines attended the University of Nebraska College of Law and received his medical degree from the University of Nebraska College of Medicine. He then attended the University of Utah Affiliated Hospitals in Salt Lake City for his general surgery residency, serving as Chief Resident, as well as completing his fellowship in cardiothoracic surgery.

Dr. Raines specializes in minimally invasive cardiac surgery, robotic thoracic surgery, and mitral valve repair. He is among fewer than 10 surgeons in the country successfully performing the Ross heart valve replacement surgery. Additionally, Dr. Raines has been the principle investigator of several national research studies in cardiac surgery and artificial hearts. Dr. Raines is board certified by the American Board of Surgeons and American Board of Thoracic Surgery; he is also a member of the Cardiothoracic Surgery Network, the International Society for Minimally Invasive Cardiothoracic Surgery and the Society of Thoracic Surgeons.

Todd Tessendorf, MD, FACC / [email protected] native of Columbus, Nebraska, Dr. Tessendorf received his undergraduate degree from Nebraska Wesleyan and his medical degree from the University of Nebraska College of Medicine. He completed his internship and residency at University of Nebraska Medical Center and a cardiology fellowship at the University of Missouri-Kansas City. Dr. Tessendorf has a focus in coronary catheterization, nuclear cardiology, and echocardiography.

Dr. Tessendorf is certified by the American Board of Internal Medicine Subspecialty Board of Cardiovascular Diseases.

Ryan Whitney, MD, FACC / [email protected] native of Omaha, Nebraska, Dr. Whitney attended the University of Nebraska–Lincoln for his undergraduate studies and went on to the University of Nebraska College of Medicine in Omaha where he received his medical degree. He completed his residency in internal medicine at the University of Iowa Hospitals and Clinics in Iowa City. He returned to Omaha to serve his fellowships in cardiology and interventional cardiology at the University of Nebraska Medical Center.

Dr. Whitney is certified by the American Board of Internal Medicine Subspecialty Boards of Cardiovascular Diseases and Interventional Cardiology.

www.bryanlgh.org

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We provide advanced services to more than 30 communities

bryanlgh heart institute annual report

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