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Abstract P141: Integration of Cardiology and Cardiac Surgery in the Cardiovascular Intensive Unit: Formation of a Multidisciplinary Approach to Optimize Patient Outcomes


 Background:
 In 2006, the Vanderbilt Heart and Vascular Institute significantly expanded its clinical operations, in part through the acquisition of large cardiology and cardiac surgical practices.
 
 
 Objective:
 In order to optimize patient (pt) outcomes in the face of rapidly growing inpatient volume and complexity, we sought to deliver seamless care across the spectrum of cardiovascular disease with the same nursing and core physician personnel.
 
 
 Methods:
 Important operational features of the integrated cardiovascular intensive care unit (CVICU) include:
 
 
 Bedside nurses trained to care for both cardiology and cardiac surgical pts, and participate in all work rounds
 
 
 A cardiovascular intensivist based full-time in the CVICU
 
 
 A single cardiology team in charge of all nonsurgical pts
 
 
 Daily interaction of the cardiology and cardiac surgical teams, including formal and informal consultation as needed
 
 
 Availability of the intensivist to assist with the care of all complicated nonsurgical pts
 
 
 A multidisciplinary team, including a cardiologist, a cardiovascular surgeon, and an intensivist that conducts daily rounds on cardiac surgical pts
 
 
 Creation of multidisciplinary teams to acutely manage critical pts, such as those presenting with cardiogenic shock and pts treated with therapeutic hypothermia post cardiac arrest
 
 
 A core leadership team (CL) comprised of a nurse manager, a clinical nurse specialist, a medical director, and a surgical director
 
 
 Formal weekly meetings of the CL to discuss quality/operational initiatives, core measures, and clinical outcomes data
 
 
 
 
 Results:
 In 2009, 2154 pts were admitted to the CVICU, including 1201 pts who underwent cardiac surgery, a 267% increase from 2005. In nonsurgical pts, the prevalence of heart failure and cardiogenic shock was 63% and 9%, respectively. For all CVICU pts, the in-hospital mortality was 3.9%. Among the cardiac surgical pts, the observed/expected mortality ratio (Society of Thoracic Surgery data) was 0.80, compared to 0.85 in 2005.
 
 
 Conclusions:
 From 2006-2009, the number and complexity of CVICU pts increased significantly, with a dramatic increase in cardiac surgical pts. Through the creation of an integrated CVICU, multidisciplinary collaboration was enhanced, and pt outcomes remained excellent.
