Article by: Dr. Theresa Brennan, MD, Director of Clinical Cardiovascular Services
When the Heart Center was established a few years ago, it really was a virtual center: it had a name but no physical structure. There was no common thread except the diseases of the patients we cared for. We continued to be in separate departments and were a bit isolated from each other. But we came together to try to have a more patient-centered approach to the care of cardiac patients; the cardiac surgeons and the medicine cardiologists in this hospital began to work more closely together. We began having clinics in the same area, patients were admitted to the same units, and we tried to develop a more collegial and cooperative approach to the care of the patients as opposed to maintaining our practices as separate entities that happened to care for the same patients.
"In the traditional academic center, you are divided based on what your educational background is; in this center we are united based on the patient’s disease."
Recently, we have increased the number of faculty involved in that center and have renamed it UI Heart and Vascular Center (HVC). It now includes the cardiac surgeons, the thoracic surgeons, the vascular surgeons, and the medicine cardiologists. In areas, such as heart failure, electrophysiology, interventional cardiology, cardiac imaging, vascular surgery, heart and lung transplantation, etc., we are presently working toward becoming a fiscal entity that would be separated from the departments we come from. In most academic institutions, the department of internal medicine is responsible for the duties, responsibilities, cost, and revenues generated by medical doctors. This center allows us to take cardiology out of the internal medicine department, to take cardiac and vascular surgery out of the surgery department, and put them together into an autonomous center. The beauty of that is that the integration is really based on the patient. We can have all of these people physically located in a single area, and we can have better cooperation between the surgical and medical services. We have finally created not only a virtual, but also a real center where we have clinics together. It is a different concept from the traditional academic center, where you are divided based on what your educational background is; in this center, we are united based on the patient’s disease.
"There is a single common interest: the patient."
It makes very good sense for a cardiac surgeon and a cardiologist to partner in caring for the patient in a single location. Most patients with cardiac disease would have some degree of vascular disease. And vice versa, patients who have vascular disease that requires surgery usually have some degree of cardiac disease that actually is severe and requires cardiologists to participate in the care around the time of the operation. And we think that having the patients come to a single location where they can get all of this care instead of going to a multitude of places within the hospital is much better for the patient. Through the HVC, we provide care for a good number of patients who have common disorders.
We have already put all our patients in the same inpatient wards, where they are housed during their stay in the hospital. There exist three different inpatient units, respectively, and we will be sharing resources and improve efficiency. But most importantly, this new arrangement allows us to care for the patients without any consideration of who is doing it. We become equal partners. The care provided to the patients is based on the patients' needs, not on the doctor they see. There is a single common interest: the patient.
"We work as a team based on the clinical needs of the patient."
The sharing includes also our nurses. Already the nurses that are in the outpatient area are part of the HVC. We’re moving toward the time when we will all be part of the team. We will have much better interaction and communication between the nurses and the physicians, particularly, the physicians in leadership position. The nurses are our mainstay. They are used to taking care of all these different kinds of patients, they have expertise in all of the areas.
"We have much better interaction and communication between nurses and doctors."
Clearly, relationships work better when people know each other and work together more often than when they don’t know each other and have never worked together. Our goal is to enhance that collaboration so that we can work side by side just as I work side by side with my cardiology partners, and I have no concern or issue or difficulty when going down the hallway and asking my cardiology partners what they think about this and that. We can do the same now with the cardiothoracic surgeons or the vascular surgeons. It makes us much more of a team; a team based on the clinical needs of the patient. Because of the complexity of bringing staff of different departments together to a single center, we haven’t yet included all specialists who belong here.
"The finances will be maintained and distributed within the center."
The fiscal processes are currently under discussion. The problem with the original heart center was exactly that there was no financial arrangement, so that it truly was not a separate cost center. It did not maintain its own expenses and its own revenues, and the finances always went back to the individual departments. In this new center, the finances will be maintained within the center, so that the cost of the center will be there and the revenues of the center will be there and then, any profit will be distributed to help build and strengthen the center by retaining faculty and staff, recruiting new faculty and staff, and having cutting edge technology.