Kevin Nicholas will discuss the move that Baptist Health and – in particular the Miami Cardiac & Vascular Institute - took in starting to open cardiovascular ASCs. He’ll share considerations they had and their future plans for ASC care sites.
Welcome to Cath lab conversations today we're talking with kevin Nicholas. MsN RN C. V. B. C. Director M. C. V. I. Clinical operations? Miami cardiac and vascular institute baptist health South florida. We will discuss the moves that baptist health south florida and in particular the Miami cardiac and vascular institute took in starting to open cardiovascular ambulatory surgical centers for A. S. C. S. As well as considerations and future plans for A. S. C. Care sites. This video is supported by phillips O. B. L. And A. S. C. Solutions. Thank you for joining us, Kevin. Can you introduce yourself and share some of your role? Absolutes, thank you for having me. So my name is Kevin Nicholas. I'm a registered nurse by trade, but in the field for about 15 years I'm the corporate director of invasive clinical operations for baptist health south florida. And in that role I oversee all minimally invasive service lines throughout the enterprise and that includes cardiac cath E. P. I. V. R. And interventional neuro and interventional vascular. Can you share a bit more about baptist health South florida? Yes, so baptist health South florida. We're a nonprofit faith faith based health care organization spanning from the florida keys all the way up to Palm Beach. We have 11 hospitals and growing and numerous outpatient centers, physician's offices, urgent care centers. Um you know, we're one of the largest employers in the area with over 24,000 employees. And we have about 4000 physicians working in virtually all specialties. And what about the Miami cardiac and vascular institute. Okay, so M. C. V. Were a Center of excellence for baptist health and we provide our patients with the latest and greatest high quality cardiac and vascular care, both diagnostic and interventional. So the institute itself spreads across multiple hospitals and other entities throughout south florida. So to give you an idea of the size and scope of our hospitals and invasive labs, our main campus, we have 15 interventional suites of those. We have three dedicated cath labs and two hybrid advanced and vascular sweets. Um this facility performs over 10,000 procedures annually, All encompassing and about 3000 of those are cardiac in nature. We also have a smaller sister hospital in the institute with six interventional suites. They have to cath labs and they perform about 6000 procedures annually. And 23:00 of those are are cardiac in nature. How is it different than the services offered at baptist health? So being a center of excellence, you know, M. C. V. I. Is provided with a massive support structure for ensuring that high quality care. And you know, one of the biggest difference is that we have from the other service lines in the health system is that we have a management company set up to continuously engage and incentivize physicians and the teams to meet ever increasing quality metrics. Can you talk more about some of your bread and butter procedures and the overall size um And how those reinforce each other. Uh Well the bread and butter procedures like I said, we have interventional cardiology, we do do structural heart, we have interventional radiology, interventional neurology. Um So it's very unique in that we have all those service lines together under one umbrella. Um So it's very beneficial to our to our patients and physicians to have that support and all that complexity around each other to work together harmoniously. How can you talk more about how you work together and how you complement each other in serving the community? Yeah, so the setup is unique, like I mentioned in M. C. B. I. That we have all those service lines together in one space. Um Oftentimes you'll see in health hospitals, you'll see these services in silos separated from each other cardiac in one area you may see vascular imaging, but the vision of dr barry katzen and our ceo carol Melbourne Was to bring these services together under one space. And so the needs of our patients are complex and the services often overlap. And so under this structure we have a stronger ability to provide for the needs of those patients. How do you determine where patients are seen and treated? So every decision for a patient obviously is determined by their physician. Um but with the complexity of our service line we often see a collaborative approach to the care that involves other physicians leadership, staff administration and for example we have weekly heart team meetings where we discuss complex cardiac cases and part of that discussion maybe a determination of where the most appropriate care setting would be. For example you know our most complex cases may go to our main campus to be performed in the advanced Endovascular Suite where we have more support baptist health and in particular M. C. V. I seem to move faster than other health systems in the cardiovascular ambulatory surgery center space. What initially caused the health system to think about moving cardiac procedures into the A. S. C. Setting? Well I think we recognized very early on that the movement of Catherine the sc space was inevitable. Um So our outpatient services team as well as the MTB administrators um that oversee all that a sc operation. We always kept that in mind um You know and from equality and cost aspect it makes sense. And of course when CMS opens things up you know it's coming. And so we wanted to ensure that we were at the forefront of that evolution. So can you talk more about why they decided to move forward? You mentioned that it seemed inevitable um And and talk more about the approach to opening your first A. S. C. Yeah so a few years ago um health system was presented with an opportunity to partner with a local cardiology group that was operating primarily at that smaller M. C. B. I. Facility that I mentioned previously and they wanted to open up a cath lab in the S. C. That was actually located right across the street from that hospital in the medical arts building that S. C. Had 50. R. S. And what they were going to do is turn one of those O. R. S. Into the first Cath lab to perform diagnostic interventional cath as well as ep cases. So they're going to do pacemakers. I see. And procedures such as that during the construction phase of the Cath lab they began performing those procedures and the general lowers. So when this was actually being planned I was the manager for the invasive lab across the street in the hospital. So every day I could walk to my office, look out the window, look across the street and see that A. S. C. That was going to have a cath lab in it and it wasn't my cath lab and I can tell you as the same doctors that I worked with every day and I had some emotions about that. It was a bit of an internal struggle, but you know, I understood where that wave of the future was coming and what ended up happening was I became a subject matter expert to the sc team. Um We decided to develop a collaborative model where we involved all the resources that we had available in CBI supply chain billing coding data abstraction for registries. Um and our tech and digital teams. Um because this is a highly technical service line and it requires strong smart highly skilled text nurses you know support structure. So that collaborative model we were able to leverage all of that from the hospital and cross cover the S. C. Across the street. Um So essentially what we did is we actually added FTS to the hospital. We trained up all those new nurses and texts, added them to the to the pool of staff and the physicians are able to have the same team they have in the hospital right across the street and that a at sea and we treated it like an extra room for the hospital. One of the unique things is we're actually able to visualize that lab across the street. We use the Philips performance bridge application, that's our electronic whiteboard that we initiated recently. So we can actually see the flow of that room and we treat it Just like a 7th room for the hospital. Can you talk more about your partners and who helped you get that? A. S. C. Site up and running? So we've had a very successful relationship with phillips over the years and they were a very important partner for this project. Um The technology that they have in the phillips Missourian platform and the interest site is second to none. So we wanted to make sure that our positions had the best of the best and with that phillips came right along to it and like I mentioned, they were there right beside us the entire time. Um taking into account all the subtle nuances, it is of having this um lab separated from the hospital. Um it was very comforting to have those individuals involved in the process and to have the technology that they provided us. You know, it's just been a great experience. Oh it's interesting because of course they provided the technology but then also they were able to help you with strategy and collaboration. Are there specific examples you may have of that or some um some more you can share. Yeah, I think um when it came to uh let me think, I think the most important thing that they had provided us was the ability to make sure that the operational workflow worked out very well for us and that's where that performance bridge application came into play. Um You know, we're able to operate that lab knowing exactly what's going on over there. Um We're able to collaborate with the teams across the street very easily. So from an operational standpoint it was very, very helpful to have that, can you talk more about the experience how it's been for the various rules like the administration physicians and staff and also patients. Yeah, so physicians for physicians, it's been great, you know, we provided them with the latest and greatest technology um that phillips Missourian and inter site platform that we have in that lab uh is brand new and something that they actually don't have in the hospital just yet. And we're working on getting them that technology in the hospital very soon because we often hear from physicians and the staff that they'd rather be across the street now working in that a sc because of that great technology we have over there and we look forward to expanding that at the hospital. Um For patients when it comes to the A. S. C. That model is convenience and efficiency. And for us we wanted to make sure that that convenience and efficiency was matched with high quality the same level of quality care that you would get in the hospital setting. I think we've been able to meet and exceed those needs with this lab for staff. Is it helping with retention? It is helping with retention honestly. Um This is a unique model because what we're doing is we are cross covering the lab with the hospital staff. So what we've done is we've increased the volume of staff at the hospital to be able to provide the extra team to go across the street to perform procedures. So with that um we have more staff in the mix for covering on call purposes um and you know with call outs and staff shortages everywhere, it's been a challenge. But so far it's been very successful and and keeping the team satisfied and staffed for patients. What have you seen differently in terms of satisfaction and their interest in having procedures done in these? Well, um like I mentioned, the sc is, is built around efficiency and convenience, You know, for patients coming out of the hospital Nowadays, some patients don't even want to set foot in the hospital, especially with covid and everything going on. But when it comes to having a procedure in the hospital, you know, you have to go downstairs, go to registration. You may have to walk three Flights of stairs or you know, however many steps it takes up an elevator to two different floors to get to a pre and post area into the invasive lab. You know, you have the hustle and bustle of in patients all around you. Also having procedures when it comes to the sc um, it's concierge, you are that soul individual coming in to have that procedure. You don't have all of that around you. Um, you know, you get dropped off in the morning, you walk right in, you register your in the same spot very convenient and same day you're going home and you know, it's almost like you're having an office visit of course you haven't invasive cardiac procedure. But um, you know, we've seen the safety and efficacy of having it done in this environment and it's just, you know, extremely satisfying to have it so convenient. You mentioned earlier that um, you were able to reframe this as sort of having another, another lab. Just another lab at the hospital despite its differences. Can you talk about how you envision it going forward? And and was that reframing does that still apply today? It applies depending on the geographic location of the lab. So for us in South Miami where this lab is built, we have the hospital, we have the S. C. Right across the street. Um If you have an opportunity, of course if you're the same health system to provide all those resources from the hospital and have a collaboration that way, you know, it ensures mutual success. You know, you never have to worry about not having staff um not having competent individuals to help operate that lab. You know, the A. S. C. Folks, this is the first time they ever had anything in a cardiovascular space in their area and they were quite intimidated by it. It's very complex. So they were comforted by having that support from the hospital to be able to pull it off. Now, I understand geographically that may not work for everybody and you know, we are planning on opening more of these in the future. Many of them are going to be freestanding and they're not going to be anywhere near hospital. So we have to take that into consideration. Um It's gonna be a challenge in finding individuals to make sure it's and operates just like it does in the hospital, but it's a challenge we look forward to. And how do you expect that your various partners will will be able to help you um as you choose to open more of these around the area. Mhm. Well um they're obviously gonna help us by providing us with the the best technology out there, you know with this lab that we're looking at opening up in West Palm Beach phillips is going to be deeply ingrained in this project. You know, we want to make sure that the physicians have all the tools that are needed. Um You know for patient outcomes, physicians need to be comfortable with what they're working with and for our physicians they want the best and the best has been phillips and with that tool in their hands, you know, we have no no concerns whatsoever about their ability to operate and provide our patients with the care they need. And then of course with the staff um this is what they're used to working with, so we want to provide them with that familiarity in these settings. Um So it's been a it's been a great collaboration with our with our vendor partners. Is there anything else you can share about your plans to open more a SCS and how are you evaluating um How to go forward. And has your experience with your current site informed that decision? Yeah, definitely looking to expand. Um We already have plans in the very near future of opening a freestanding cardiovascular A. S. C. Up in the West Palm Beach area that will not be anywhere near a hospital. So we're looking at ways to ensure that we have the support structure built even from a corporate standpoint up in that area so that they're successful. Um Biggest issue out there obviously is staffing supplies, um having all that available. So from a corporate level we're looking at ways to make sure that we can support them as best we can. I think the experience of having this collaborative effort down at the first A. S. C. Has taught us a lot. Um We've had, you know, everything wasn't as smooth as you would imagine. Um We had our challenges but those became opportunities to improve where we can also make sure that we can improve in the future when we build out these new labs. Okay. Is there anything that we haven't covered that you'd like to review or share highlight just um you know, we're very excited about the evolution in cardiovascular care. This is the wave of the future. So you need to ride that wave or you will get barreled over by it. Um don't be intimidated by it. We are experts in the field and and we know what needs to be done. We know that it's safe. We know that care can be provided in this area. Sky has come out with the paper um with guiding statement for us to follow to be able to ensure the high quality care in this environment. Um And we really appreciate the partnership we've had with phillips to ensure our program exceeds and meets the needs and expectations of our patients. Thank you. That's wonderful, appreciate your time talking with me.