I have been a cardiac physician assistant (PA) for 38 years and have seen what it takes to make a cardiac program function successfully. While I still love being in the Operating Room (OR), I also like taking a more global view of a cardiac program. I have helped start three cardiac programs from scratch, so I know the intricacies of how each unit needs to function within the hospital to not just deliver quality care, but also be operationally sound.
Setting up a cardiac program can be a challenge if the hospital has never done heart surgery before. This is due to the highly specialized procedures that are performed and the elevated risk of morbidity and mortality of cardiothoracic patients. This program’s critical nature calls for quick-to-act teams, so when we order stat labs, they truly need to be stat – not in an hour. When we need respiratory in the ICU, it needs to be there instantly, not in 10 minutes.
There are a lot of things that people take for granted, like how we enter orders. Cardiac order sets need to be built and there are drugs that need to be stored within the unit itself. For example, a cardiac unit uses vasoactive drugs, which are rich, intensive medications. Normally, these would be ordered from the pharmacy, but because the patient’s condition can change so quickly, they actually have to be stocked in the cardiac unit. Processes and implementations like these can make or break the success of a program; it takes communication, systems and procedures to initiate a heart surgery program successfully.
Staffing Essential for Operational Success
Once a cardiac program is set up, the biggest factor determining operational success is staffing. This doesn’t just mean finding the right team member for the right surgeon – it’s also finding the right people for the OR, for the ICU and for the floor.
You really need to be able to match the right staff with what needs to be done, because not everybody can do everything. There are advanced practitioners that can first assist but cannot do an endoscopic vein harvest. There are some that can do an endoscopic vein harvest but not an endoscopic radial harvest. Then, there are others who are excellent in surgery but don’t have the clinical background to do intensive care management. In addition, there are practitioners who are very good at making rounds on the floor but not experienced enough to do ICU management. To have a successful program, you need to attract and retain staff that excel in all areas of cardiac care. And, you need to be able to adjust staffing to meet the inevitable ebbs and flows of activity and patient volumes.
Hospitals Find Staffing Challenging
Many hospitals face challenges when staffing a cardiac program because the unique skill set that is required puts these highly-skilled practitioners in high demand. Furthermore, they often don’t have the ability to adjust staffing to flex up and down with volume as needed. As a result, they tend to be understaffed, especially when volumes are high. Staff are often required to be on call every other day, every other weekend or every other night. This offers no work-life balance, which subsequently leads to high turnover. I know this because I’ve spent most of my career working for either a hospital or a physician group, and I know that on-staff burnout and turnover has fueled AP Health’s growth in cardiothoracic care.
At AP Health, we manage three different cardiac programs in South Florida. We have a deep bench of advanced practitioners, and most have privileges in more than one hospital. This allows us to match the right people to the right jobs and move our staff around our clients’ needs. This provides our practitioners with a more manageable work-life balance and a variety of different assignments. The result is that they don’t suffer burnout like many of their hospital-employed counterparts. Alternatively, our hospital customers benefit by receiving both a high performing staff and cost savings which benefits overall operations. It’s a win-win scenario.
Jupiter Awarded ‘Best Heart Center’
In 2020, I was brought on to direct AP Health’s team of cardiothoracic advanced practice providers at Jupiter Medical Center and to help build their new cardiothoracic program. AP Health provides advanced practitioners for all pre-op, intraoperative and postoperative care. Last month, the readers of the Palm Beach Post named Jupiter the “Best Heart Center” in the county. That’s quite an achievement for a program that started just over a year ago. Jupiter’s success is due to the leadership of Dr. Arthur Katz, one of the most respected cardiothoracic surgeons in the region. I also think the quality of care delivered by our experienced practitioners has made an impact on patients’ opinions of the program.