Integration of Cardiology and Cardiac Surgery in the Cardiovascular Intensive Unit

Background. In 2006, the Vanderbilt Heart and Vascular Institute significantly expanded its clinical operations, in part through the acquisition of cardiology, cardiac surgical, and vascular surgical practices. This article will describe the integration that has taken place since clinical expansion, the outcomes achieved, and discussion of key drivers of success. Results. In 2011, Vanderbilt Heart and Vascular Institute University HealthSystem Consortium (UHC) data show 3863 cardiology cases in addition to 1201 patients who underwent cardiac surgery. Compared with 2005, the 2011 cardiac surgical volume increased by 267%. Among the cardiology/cardiac surgical patients, the UHC mean ICU days were 2.9/3.37 in 2008 and 2.72/3.05 days in 2011. The UHC mortality index was .95/.90 in 2008 and .72/.53 in 2011 for cardiology and cardiac surgery, respectively. Key benchmarks for blood stream infections, ventilator-associated pneumonia, and urinary tract infections have all improved since September 2006. Quality improvement initiatives included vent bundle, identification of high-risk ventilator-associated pneumonia, glucose control, falls, Foley catheter education, and central line maintenance education to name a few. Conclusion. The Vanderbilt experience shows one way to integrate practices that can help in improving patient outcomes and therefore increase value. Future work will need to address how this relates to institutional cost and translates into the bundled payment world.