Ask Jason Nance who is most responsible for the success of the Indian River Medical Center’s heart patient navigator program – as it approaches its one year anniversary – and it won’t take long to get an answer.
In the blink of an eye Nance, the hospital’s associate vice president of patient care services, turns in his chair and points to registered nurse Diane Loveday.
“Diane is the person who is really driving the patient navigator program,” says Nance. “She’s done a great job at not only bringing in the pharmacy and other hospital services but she’s also been able to reach outside the hospital and include home health agencies and skilled nursing facilities.”
Just last February IRMC became one of only 35 hospitals in the nation – and the only hospital in the state of Florida – selected to participate in the American College of Cardiology’s fledgling heart patient navigator program.
The ACC’s study of post-surgical statistics revealed alarmingly large numbers of heart attack and heart failure patients nationwide being re-admitted to hospitals within 30 days of their initial discharge.
Some factors including a patient’s age, physical fragility and pre-existing conditions are largely beyond a hospital’s control.
But the ACC did cite problems with patients and caregivers not properly following discharge instructions as one entirely correctable reason for many of those re-admissions.
The college’s solution? Develop a multi-disciplinary team approach to better prepare those patients for discharge and then follow up with them on a regular basis in the days and weeks after they leave the hospital.
Nance, who was IRMC’s director of cardiovascular services when the navigator program launched, says that while the hospital’s re-admission rates were already below the national average, they are significantly lower now.
“The overall numbers are greatly improved,” says Loveday, who refers to herself simply as a “nurse navigator” when her actual title is “Heart Failure and Acute Myocardial Infarction Care Coordinator.”
“Most of the time,” she confides, “I just tell my patients I’m the jack-of-all-trades in cardiac. They seem to enjoy that.”
Enjoyment aside, the real question is how low are IRMC’s cardiac re-admission rates now?
“We were at 22.1 percent, which was well within the national averages,” Loveday explains, “but at this time we’re looking at about 18 percent. That might seem like a small change, but it’s (actually) huge.”
Indeed there have been months in this past year, according to Nance and Loveday, when the re-admission rates flirted with the 5 percent mark.
Will coronary re-admission rates ever reach zero? Nance says no.
“You’re never going to prevent all re-admissions,” admits Nance. “It’s not appropriate and it’s not possible. There are times when people need to come back. These are your chronic patients with multiple disease processes going on who need to be in a hospital.”
Nonetheless, patients like Vero Beach’s Edward Brittingham have undoubtedly benefited from the hospital’s new, multi-disciplinary approach. He was admitted to IRMC for pneumonia but blood tests revealed he had also suffered a heart attack. He was treated, given a post-discharge routine he understands and now says he’s hoping to return to his job at By the River senior housing soon.
While Nance is quick to laud individual members of the IRMC cardiac care team including Loveday, surgeons Mark Malias and Cary Stowe, Matt Lambie in the hospital’s pharmacy department and fellow associate vice president, Devon Bloom, it is the navigator program itself that gets his highest praise.
“It is really fostering a culture of transparency and honesty within the hospital,” says the youthful Nance. “That just leads to better outcomes because we are able to talk about where we need help and where we’re not doing as well as we want. And, we’re able to direct resources to those areas. No one is embarrassed to raise their hand and say they need help.”
That culture, according to Nance, has already helped the hospital win yet another award from the American Heart Association for “implementing the highest standard of care for heart attack patients” and will be essential as IRMC embarks on a new “cardiac electrophysiology” program that, Nance says, “we’ll hopefully be getting into here very soon.”
(Cardiac electrophysiology looks at the electrical activity inside the heart and helps physicians determine the best course of treatment for arrhythmias and other problems. It can also include the minimally invasive “ablation” or destruction of cells that are firing abnormal electrical impulses.)
The American College of Cardiology had already the named IRMC a “top-ten” cardiac care provider based on its 2014 re-admission rates and with a full 4 percentage point drop in those rates this year, Nance and his navigators appear to be headed in the right direction.
There is, however, one potential bump in the road ahead. The $80,000 grant from the American College of Cardiology through the pharmaceutical giant AstraZeneca that helped launch the program last February will expire in December of 2016.
Nance, however, is optimistic. “I think,” he says calmly, “based off the past year, we’ve shown it’s a great benefit to our patients and to our community, and I fully expect we’re going to continue to fund this going forward.”
The heart failure management clinic at IRMC can be reached at 772-563-4415. No physician referral is required.
