Patient Satisfaction Improvement and Lower Costs: A New Approach to Arterial Access

Tell us about Silver Cross Hospital.

Since 1895, Silver Cross has grown from a 33-bed, two-story hospital into a rapidly growing community hospital featuring a 6-story, 289-bed, acute care hospital with a team of more than 3,000 employees, physicians and volunteers. In 2012, we opened a replacement hospital with an environment that helps to promote patient healing and allows for greater efficiencies between departments. By updating technology, we improve the patient experience. Our goal is to provide the highest possible levels of clinical quality, personal service, and patient safety. Silver Cross is also known for its customer service, currently ranking as one of the highest hospitals nationally for our patient satisfaction scores.

What elements of your new facility focus on improving the patient experience?  

We have a patient and family centered care concept. The hospital layout was carefully conceived to promote a natural flow from one area to another. One of the highlights is our procedural care unit (PCU). The PCU encompasses all of surgical services, interventional cath labs, and endoscopy. It also features a CT scanner and minor procedure room. Immediately adjacent to the PCU on the second floor is the intensive care unit (ICU), which makes the transfer of ST-elevation myocardial infarction (STEMI) and trauma patients from the PCU incredibly convenient.

Every inpatient room is private, with large windows that bring in natural light.  Part of our patient and family centered concept is that we encourage patient family members to stay and visit with their loved ones. My wife recently delivered our second son at Silver Cross. We found the inpatient rooms to be quite comfortable and hospitable.

What areas of the hospital fall under your responsibility?

I am responsible for diagnostic and interventional cardiology, interventional radiology, endovascular neuroradiology, endoscopy, and cardio pulmonary rehabilitation. There are approximately 100 total employees that work throughout these areas. Along with the nurses and technologists in the cath labs, we have a scheduler, inventory coordinator, nurse practitioner, and a data abstractor. All of the physicians practicing in the cath labs are in private practice. We run 4 labs and since this is a relatively new facility (less than 2 years old), all of our equipment is state-of-the-art technology. Our post procedure care area has 14 rooms (6 private and 8 bays). We have an excellent pre/post staff of 10 individuals that oversee patient care in that area. 

What was the expectation for growth when the new Silver Cross Facility first opened?

When we moved into our new hospital, we hoped for 8% growth, but we have seen in excess of 22% percent growth in many of our areas, particularly in emergency department visits and inpatient admissions. In the cath labs, we have seen about 16% growth over the past two years. We do approximately 3800 cases per year in our labs, with about 1400 cardiac procedures, 1100 electrophysiology cases, and 1300 peripheral/interventional radiology cases. In December of 2012, we opened our state-of-the-art endovascular/neuro radiology bi-plane lab. 

You mentioned adopting new technology. Can you give us an example of how new technology has supported your hospital goals?

We pride ourselves on our ability to provide a positive patient experience. In the past, when our patients would undergo a cardiac procedure requiring arterial access, our results have been good; however, our nurses and cardiovascular technologists would typically hold manual compression for anywhere up to 45-60 minutes on the arterial site. The patient then had to remain flat in bed for 3 hours, sometimes more. By looking at the way in which we approach the artery during a catheterization, we found we could establish a lower time to hemostasis and ambulate our patients much more rapidly than we had done previously.

What do you mean by approaching the artery?

Our use of the AXERA Access device (Arstasis) (Figure 2) allows us to create a long, shallow-angle arteriotomy that delivers significant tissue-on-tissue overlap through the femoral artery wall (Figure 3). This creates a self-sealing opening that requires only minimal compression for rapid hemostasis and secure closure (Figure 4). We have found that the self-sealing access provides excellent patient comfort and quick ambulation. 

What improvements have you seen since adopting this technology?

Our average time to hemostasis is 5 minutes for diagnostic catheterizations and 10 minutes for cases that turn to interventions. We are able to sit the patients up within 30 minutes of hemostasis and ambulate them in 1-2 hours. This translates to a better patient experience. Our outpatients are out of the facility sooner and resting at their homes.  

Bringing on new technology comes with a cost. How did the AXERA device fit into the hospital budget?

As the manager for this lab, I was skeptical about adding cost to the procedure when we already had good results. What convinced me was the outcome of the validation process (Figure 5). When we looked at how our processes improved — less hold times, quicker discharge times for outpatients, more rapid ambulation, and improved cardiac telemetry unit nursing time — it became increasingly obvious that this technology would not only save us money, but improve patient and staff experiences.

What comments have you heard from staff as you implemented the device?

Our pre and post care nurses love it. The inpatient floor managers were saying, “Hey, please don’t stop using that device!”  

You seem to have found a balance between new technology, patient satisfaction, and staff satisfaction. What’s next for Silver Cross?

We plan to continue to grow our volumes as we provide care to one of the fastest-growing counties in the nation. We have implemented new services, particularly our endovascular neuro radiology program and have earned Primary Stroke Center accreditation from the Joint Commission. Within the cath labs, I plan to continue to develop and train our staff, and look to stay ahead of the curve of the health care reform changes. One of my biggest goals for our department is to discharge outpatient percutaneous transluminal coronary angioplasty (PTCA) patients home the day of their procedure. 

Brendan Casey can be contacted at bcasey@silvercross.org.