Perspectives on PCI Program Accreditation in Pennsylvania: Value, Rationale, and Results

As percutaneous coronary intervention (PCI) legislation continues to change in many areas across the country, varying perspectives exist regarding the ideal requirements necessary to improve access while keeping clinical quality and patient outcomes as key priorities. Program accreditation has swiftly moved to the strategic forefront for PCI programs in states that employ more strict criteria related to the ability to offer this life-saving clinical service. In states without formal guidelines, accreditation can be equally valuable for verifying best practice, and in the process, provide a competitive advantage for a service that’s becoming more widespread into all hospital settings.  

Corazon has achieved status as an official accrediting body by several state regulatory bodies, Pennsylvania (PA) being one, based on vast experience with program planning, development, and improvement on both small and large scales in this state and elsewhere. Essentially, the Commonwealth of PA requires program accreditation as the single way for the Pennsylvania Department of Health (PADOH) to recognize that high-quality patient care will remain of ultimate importance. Accreditation has also evolved into a way to ensure that more rural, (often lower-volume) programs achieve and maintain stellar outcomes while also enforcing strict patient selection criteria.   

Today, and for many years, volume has been the most sensitive (and debated) issue for hospitals seeking to expand services in their existing diagnostic cardiac cath labs. As part of the current PA PCI Exception Procedures, the PADOH recognizes these volume concerns as part and parcel to offering PCI; in fact, here in our home state, program accreditation has become the new gold standard for hospitals.  
As the pressure for accreditation mounts in relation to quality outcomes, the state has mandated program accreditation on a timed basis (determined by volumes) for all PCI programs with open-heart surgery off-site in Pennsylvania. A third-party accrediting body, such as Corazon, must perform an operational review and provide a comprehensive report of quality and any areas requiring further development or improvement in order to meet the rigorous standards.  

Corazon has fine-tuned a unique and proven process for program review, accreditation, and quality improvement that brings unparalleled results. We asked some of our Pennsylvania clients to share their experience with this relatively new process, hoping their perspectives will help other program leaders in the state with the decision to move forward with program accreditation.  

PERSPECTIVE FROM: 

Sandra Thorpe, Executive Director, Patient Flow/Critical Care, Uniontown Hospital, Uniontown, Pennsylvania:

Uniontown Hospital is unique, as the hospital was a part of an initial “demonstration project” in Pennsylvania in 2002. During this time, across the state, many programs came together to develop a strong consortium to petition the PADOH to allow their organizations to offer PCI without open-heart surgery on site. The successful execution of the Consortium’s goal significantly changed the regulatory landscape across the Commonwealth over the next several years.  Uniontown continues to provide excellent patient care and stellar cardiac quality outcomes since their PCI program inception in 2003. Corazon has continued to work with Uniontown through the accreditation process and with continued quality outcomes review.   

How does your experience with the accreditation process drive performance improvement initiatives?

Sandra Thorpe, Executive Director, Patient Flow/Critical Care: Working through the accreditation process has been a pivotal part of our continued development of best practices for our catheterization lab. With Corazon, we gain invaluable insight into cardiology as a whole, including the labs. They provide specific understanding of cath labs with off-site surgical programs, and this information is vital to us as we continually strive to improve outcomes and performance goals. Corazon offers detailed education plans to help our team better interpret data, and assistance with implementing action plans moving forward. Uniontown Hospital has worked with Corazon for more than 15 years, and through this partnership, our cardiology department has continued to grow and flourish into one of the most accredited and successful in the state. We are quite thankful for this continued relationship, and look forward to working with them for years to come.

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PERSPECTIVE FROM:  

Kathy A. Miller, RN, BSN, MHA, Administrative Director of Heart & Vascular Services, Hanover Hospital, Hanover, Pennsylvania

Hanover Hospital is centrally-located in a rural area of the state, thus, their recent expansion to offer angioplasty services was a welcome addition to this agricultural community that has an aging population with a higher than normal incidence of cardiovascular diseases.   Hanover Hospital went “LIVE” with PCI without surgical backup on September 8th, 2014, and since the inception of these services, Hanover has saved many lives within its community, thus allowing patients to stay close to home for their heart care.  Additionally, many of these patients have also been able to stay at Hanover for the management of other vascular diseases that otherwise would require they travel across state lines, which can in many circumstances be a burden to the patients and their families. 

Can you share your experience with PCI accreditation? How has your program been positively impacted in terms of performance improvement?

Kathy A. Miller, RN, BSN, MHA, Administrative Director of Heart & Vascular Services: It was extremely helpful to have the assistance of the seasoned team from Corazon. They knew the PA regulations and were actually instrumental in assisting the DOH with the development of the guidelines, which was an added bonus of working with them. Corazon provided the  A-Z of all of our needs, helping to establish the types of committees needed to ensure employees throughout the hospital had a say in the program, which allowed our team to become engaged in the program and thus instrumental to its success. Corazon also provided education, examples of policies and procedures, and sound advice for navigating through some politically delicate issues unique to our program. When starting a new program, quality is of utmost importance. As an organization, we decided to have an outside reviewer of all PCI cases, which Corazon provided via peer review. This unbiased viewpoint assisted us in improving our program right from the beginning. We have a very strong program and passed our recertification in the year, far exceeding the volumes we predicted. Though our predictions were conservative, we still reached our 300th PCI just ahead of our first anniversary.
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PERSPECTIVE FROM:  

Daniel L. Bair, FACHE, VP of Cardiovascular & Radiology Service Lines, Mercy Health System/Nazareth Hospital, Philadelphia, Pennsylvania

Nazareth Hospital, located just outside of Philadelphia, is another great example of a solid PCI program providing expanded cardiovascular services to the local community served. The expansion of PCI services has provided patients with state-of-the-art cardiac care, while also facilitating the development of strong relationships with pre-hospital providers. Nazareth Hospital continues to provide the highest quality of care, and hosts regular cath conferences with those pre-hospital providers in order to give direct feedback regarding acute myocardial infarction patients brought to Nazareth to receive primary angioplasty.  

What is the greatest benefit you received during your accreditation survey?  What do you feel has brought the most positive impact to your cath lab?

Daniel L. Bair, FACHE, VP of Cardiovascular & Radiology Service Lines: At Nazareth Hospital, our program has realized several benefits as a result of our PCI accreditation with Corazon. The continuous process improvement associated with meeting the accreditation standards has helped us thoroughly evaluate all of our program components and significantly decrease the time to reperfusion for acute myocardial infarction patients. Our strengthened relationship with pre-hospital care providers has established a sense of collaboration and trust through real-time feedback to staff in the field. The accreditation allows us to maintain the privilege of performing PCI without on-site cardiothoracic surgery backup, which gives our community a strong network of PCI-capable facilities and better access to life-saving treatment. But, the most important benefit specifically to our cath lab is the sense of ownership and pride that our team feels about their collective efforts in caring for a critically ill and potentially vulnerable population — this serves as the solid foundation upon which we’ve built a great program.  
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PERSPECTIVE FROM:  

Lisa E. Brinckman, RN, Director of Heart and Vascular Services, Evangelical Community Hospital, Lewisburg, Pennsylvania

Evangelical Community Hospital was at one time a participant in the Cardiovascular Patient Outcomes Research Team (CPORT) Trial, which concluded in the spring of 2011. Evangelical was very successful during their participation in the C-PORTe trial; however, the randomization aspect of the trial impacted program volume. As the Commonwealth worked diligently to address both the early “demonstration project” and C-PORTe participants, thus coming to an agreed-upon process in 2013, Evangelical was able to re-apply to continue to offer PCI services without on-site open heart surgery.  

As Corazon provides quarterly data review (ACC-NCDR), have you seen any marked improvements relative to outcomes?  How so?

Lisa E. Brinckman, RN, Director of Heart and Vascular Services: Evangelical Community Hospital has seen marked improvements relative to outcomes. Corazon provides an extra layer of quality assurance that is essential in the success of any cardiac catheterization program. Through the support from Corazon and our medical director, Evangelical Community Hospital has not only achieved, but consistently maintained, positive outcomes. Even with these positive results, Corazon also provides identification of areas for improvement according to the top benchmarks across the nation. With early recognition and timely implementation of change, Evangelical has seen our outcomes steadily soar. With Corazon as our accrediting body, we have a “safety net” for our quality program.
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Corazon continues to work with PCI programs in Pennsylvania, bringing national expertise in cath lab and PCI excellence to guide more than half of the programs in the state through the accreditation process and PADOH procedures. We are also working in Michigan, having been formally named as an accrediting body on behalf of the Michigan Department of Community Health. We continue to provide “verification” and “quality oversight” for programs across other states such as Georgia, Florida, California, and Kentucky, to name a few. Our accreditation processes and work with all facets of PCI programs continues across the United States. Our accreditation services are proven and methodical; we offer programs a “best practice” approach to provide the highest quality level of patient care that directly correlates with stellar quality outcomes.

Corazon also offers PCI program implementation support, including regular on-site consultative services, which gives us even greater experience and expertise with quality assurance, best-practice program operations, and financial viability. This scope of services has been at the heart of Corazon’s business since the company’s inception over a decade ago. With a step-by-step methodical approach that assists programs with meeting and/or exceeding compliance standards, we partner with hospitals to create successful PCI programs. Our historical involvement with cardiac program implementation has engrained a solid understanding of PCI programs as a whole into our proven process, regardless of the hospital’s home state.

Amy Newell is a Vice President with Corazon, Inc., offering strategic program development for the heart, vascular, neuro, and orthopedic specialties. Corazon holds a full continuum of consulting, software solution, recruitment, and interim management services for hospitals, health systems, and practices of all sizes across the country and in Canada. 

To learn more, visit www.corazoninc.com or call (412) 364-8200. To reach the author, email anewell@corazoninc.com.