Enhancing Patient Outcomes: Inside Tampa General Hospital’s Innovative NeuroCardiac Program

Podcast Discussion With Bibhu D Mohanty, MD, and Elizabeth Schetina, BSN, RN

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EP LAB DIGEST. 2025;25(3):1,15-17.

Podcast discussion edited by Jodie Elrod

In this discussion, EP Lab Digest highlights Tampa General Hospital’s NeuroCardiac Program, a unique, collaborative approach to patient care that is shaping the future of heart-brain health. Bibhu D Mohanty, MD, Director of the NeuroCardiac Program, and Elizabeth Schetina, BSN, RN, NeuroCardiac Nurse Navigator, discuss the evolution of the program, what a typical patient journey looks like, and how their multidisciplinary model is improving outcomes. They also explore the latest research and what is ahead for this innovative field. Dr Mohanty also serves as Director of Interventional Training Programs and Director of Clinical Research, Division of Cardiology, at the University of South Florida, Morsani College of Medicine and Tampa General Hospital. 

Bibhu D Mohanty, MD: Thank you for having us today. My name is Bibhu Mohanty. I am an associate professor at the University of South Florida (USF) at Tampa General Hospital. I direct our training program as well as direct and founded the NeuroCardiac program in 2019. The driving force in our program is Liz, and I will let her introduce herself.

Elizabeth Schetina, BSN, RN: My name is Liz Schetina. My title is nurse navigator for the NeuroCardiac program. I am the coordinator who reaches out to patients. I help them through their journey through procedures in our department at Tampa General.

Bibhu D Mohanty, MD: I will start by giving a little background in terms of how the program was established and the concept, which is truly unique and something we are very proud of. I arrived here 8 years ago. One of the things my mentor told me to do was to seek out our neurologist and ask him how we could help him. I took that to heart, and when I brought this to his attention, he told me one of their challenges was that they had a lot of stroke patients with cardiac care needs, but they did not know where to send them in a consistent fashion. They did not know how to make sure those patients did not get lost to follow-up, fall through the cracks, or end up with delayed care sometimes months later, often exceeding the point of their returning with recurrence stroke.

I said, if that is the issue, we should formalize a pathway that will ensure these patients are not lost to follow-up and bring them from the neurovascular setting directly to cardiology, where we can attend to their cardiac care needs. It turns out there are a lot of cardiac therapies that are directly involved with stroke prevention, and this probably does not get as much attention, but we have a very important role to play. So, we went about with our neurology colleague defining care pathways within specific arenas where we knew we could help them and help their patients prevent future strokes. That was the origin of this program. 

A lot of times in siloed care settings, which is common, you have neurologists who deal with their pathology, you have cardiologists dealing with our pathology, and what we lose in this is the actual clinical conundrum that the patient faces. An example might be atrial fibrillation (AF), which is obviously a cardiac care issue, but it is probably one of the more common causes of stroke. So, how do we bridge this gap between the 2 specialties? One of the things that happens with AF is that patients require blood thinners, which is first-line therapy. What happens if you have a patient who has a stroke who also has a head bleed, which is a very common scenario after stroke and is the kind of stroke we fear the most. Those patients might be best served with a mechanical or a nonpharmacologic means of stroke prevention, such as left atrial appendage occlusion (LAAO). That is something we do on the cardiology side, but how do we get those patients who are debilitated, have gone to rehab, might have been transferred to a nursing home, cannot communicate, maybe they cannot write or make phone calls like they used to, or might have multiple health care needs in their post-stroke care environment. They are not thinking, “I have AF—I need to go see this provider and get this particular procedure done.” They are thinking about not having another stroke. So, they are doing everything in their power to help that. We can then come in and say, let’s make a standardized pathway where the patient does not have to figure all that stuff out. After the patient experiences a stroke and the neurologist has done their part in the hospital, starting from that point all the way through to follow-up to clinic visits to procedures, we are going to manage the entire process for the patient from the cardiology side. That is really the construct of the program. 

We have 3 core pathways. One is LAAO. The second is patent foramen ovale (PFO) closure. The third is ambulatory rhythm monitoring, which is for the purpose of diagnosing AF. We have a whole spectrum of monitors, whether that is implantable or patch-based monitors to facilitate that. There is also clinical follow-up. In these patients, we cannot just give them procedures or devices. We need to have a person be the intermediary and guide them from neurology to cardiology in a clinical outpatient setting. We have an outpatient clinic that is manned by our providers on the cardiology side that facilitates this connection. 
That is the program in a nutshell. I think the reason it has gotten a lot of attention and that it works, is that although it is driven by cardiology for procedures and devices and things that can prevent stroke, we have created this based on the emphasis of stroke prevention. Patients and providers can really relate to that. So, that is a quick summary. 

Liz, you have a tremendous amount of experience with helping these patients traverse this pathway. Can you describe a patient journey from stroke through to procedure?

Elizabeth Schetina, BSN, RN: Basically, everything begins with the referral from the physician. I work with several different physicians from the EP side. So, when patients who have been already getting treated for their AF or patients who have already had a stroke and their initial referral comes from the neurology side, I reach out to the patient as their first point of contact at Tampa General. We have a discussion, go through the screening process for the procedures that they are referred for, and take care of the scheduling. Since my title is nurse navigator, I am helping patients navigate through their journey in our program. From the preprocedural side, I stop by and introduce myself when they are here at the hospital for their procedure, and I keep in touch after the procedure to make sure all their scheduling appointments are all set up.

Bibhu D Mohanty, MD: I know patients really appreciate that continuous contact from the time that they are in the hospital all the way through to the very end. One of the ways we have managed to capture this patient base in the hospital is to have our own preset consult link that is embedded in our electronic medical record (EMR). So, anyone in the hospital, regardless of what service they are on at any time, can request a neurocardiac referral. That is offered in button format; all they have to do is click which pathway they want their patients to be taken through. With about 3 or 4 clicks, the patient’s referral is done from the referring side, and then we take it over from that point forward. We have our nurse navigators involved in terms of communication and helping orchestrate. We have our clinic nurses help schedule these patients in the neurocardiac clinic, which is held twice a week. Then, within the inpatient environment and the transition to the clinic environment, we have templated notes or documentation that allow us to capture all the necessary criteria to make sure the reimbursement is set up at the tail end of all this without any issue. There are always nuances and struggles that come with this that we try to adapt to, but we have tried to make this as streamlined as possible for the patient and providers so there is the least amount of ambiguity and variability. 

Liz, do you want to talk about some of the evolution? We started with LAAO. Your role has continued to morph since then and will continue in the future as well. Can you describe some of the other things that you do with other procedures as well?

Elizabeth Schetina, BSN, RN: Yes. So, I help coordinate a lot of what is going on through the patient’s journey. What I love the most about our program is that we try to give patients very personalized customer service. Patients get very apprehensive about coming into the hospital, especially if they have not undergone a procedure in the past, or if they have and did not have a very good experience. It helps them to have somebody hold their hands through the process and for them to have one main person to contact for everything that happens. 

I am also in touch with physicians who work outside of Tampa General or the USF Association, including for PFO procedures. There is a lot of coordinating that happens before and after. There are a lot of preprocedural appointments that patients need to complete before they come in. There are a lot of things that happen behind the scenes too, so we try to make the experience as seamless as possible for patients. Sometimes it takes a lot of communication with the families. Patients can be very nervous and cautious about proceeding with things, especially if they have already had a stroke or are high risk for a stroke, so we try to do whatever we can to make this process a little easier for them.

Bibhu D Mohanty, MD: One of the things that you do extremely well is managing all our patients with various backgrounds. Some have had strokes and are terrified of having another. Some are worried about bleeding. Some have had cardiac procedures and experienced complications, and are concerned about those types of things occurring again. We have patients coming in from our EP colleagues for the purpose of stroke prevention. We also have patients coming in from primary care and general cardiology. So, it helps to have all these patients assessed and screened, and it gives us the opportunity to let them know in a consistent fashion that we are here to help them prevent stroke. We have done some outreach in the community, both locally and nationally, and talked about disease-specific factors. For example, we have talked about AF, and done work groups and direct-to-patient sessions. We have talked about taking PFO closure. We have talked about the importance of rhythm monitoring. It turns out that a lot of these sorts of facets are physician centric, so we understand what we are talking about, but patients can get confused in the mix of the purpose of all of it. So, it helps to tell them that we are in the business preventing stroke. Patients seem to understand that, regardless of where they are coming from, whether it is an EP provider or general practice cardiologist, primary care doctor, or interventionalist, they all fall under this umbrella of stroke prevention. That is what has made this program unique. 

There are a lot of systems out there that have LAAO programs, PFO closure programs, or even neurocardiac programs, but they are very device or disease focused. What is unique to us is that we can do all those things, but let’s shift the focus instead of a device or procedure to stroke prevention. Having a single person at the hub of all that is our nurse navigator Liz, who has a wealth of experience in managing all these folks and their concerns. She guides them through what they are going to need, discusses how we are going to approach their procedure, shares the screening and imaging that they might require. So, there is a lot of variability that having a centralized hub in her expertise allows us to do.

Elizabeth Schetina, BSN, RN: It is also an opportunity to provide a lot of patient education. I think a lot of times patients go into their visits knowing what is recommended for them to do, but then they go home and have follow-up questions, or maybe there are things they still do not understood, or the family gets involved in the decision-making process. So, I really enjoy that aspect of being able to communicate with patients and being able to explain things that maybe were missed.

Bibhu D Mohanty, MD: That is very true. I know for a fact that patients really appreciate that. Liz, our referring providers see folks coming in from a variety of sources for their procedures. One of the unique tenants and what is advantageous for our program is that we are receptive to all these providers. Our goal is to make all their lives easier regardless of what procedures they are doing or how we are approaching their stroke prevention methodology. What is some of the feedback you have received?

Elizabeth Schetina, BSN, RN: I think everybody has been pretty happy with the service we have been able to provide. We are trying to fit in. There is a lot of coordinating that happens with both physician and patient schedules. It is trying to coordinate and find the right timing for patients. I have gotten great feedback from everybody. I talk to people before, during, and after, and everyone seems to be very content with the way the program is run. I am very happy to be a part of that. I tell everyone they have a specific contact person, so call anytime they like. They actually will get a live person to talk to—they do not have to call a number and go through a lot of menus and leave a message, or anything like that. I think that is really what sets our service apart.

Bibhu D Mohanty, MD: The one thing that we are in need of is more support and more people like Liz. We have grown tremendously. We started the program on January 1, 2019. After about a year of discussion with our neurovascular colleagues, we preset the pathways and had them vetted. We had an entire document with our guidelines and principles, and made sure we had administration and the hospital on board, including the catheterization and EP labs. Since then, our inpatient consult volume has grown to over 1000 per year, which is in alignment with our volumes from a stroke perspective. So, we are a stroke center of excellence. Our neurology colleagues provide every level of expertise and service for acute stroke care, including thrombectomy and advanced interventional techniques from their end. As part of their standard operating process in the post-acute phase, so now in the secondary phase of prevention where they involve us from cardiology, it has become standardized that they routinely assess each patient for a consultation to our service. It is not something that is a one-off, as they go through their post protocol, the neurocardiology consult is something they consider for every patient. It leads to a huge volume of consultation from the inpatient setting. As we have grown, I know Liz, as amazing as she is, could definitely use some help, and we are very happy about that. It speaks to the success of the program in the eyes of the referring providers, the hospital, and our stroke neurologists. We have been able to accommodate a variety of our subspecialists, whether it is EP, interventional, general cardiology, or stroke doctors to this. 

We have also talked a lot with other services that refer to our program using the procedures that we can offer, such as the emergency department (ED). Sometimes folks will come in with bleeding and AF, and they may not need the stroke service, but they will refer to us directly from the ED. Similar to our gastroenterology (GI) colleagues, patients who are on blood thinners who have AF and come in with recurrent GI bleed will be referred to our program. So, through outreach and efforts amongst ourselves as physicians and practitioners, we have been able to convey our services to a variety of folks in the hospital.

Elizabeth Schetina, BSN, RN: Actually, in our program, along with the other minimally invasive procedures that we do, we have a designated phone line and email where referrals can directly be sent, and that is monitored by staff on our team and is routed appropriately to the right department.

Bibhu D Mohanty, MD: The other thing I would mention is we have gone to great extent to really emphasize the role of our neurology colleagues in this structure. Sometimes, when you are trying to educate your colleagues or patients about procedural services that have good academic grounding, they still see you as a proceduralist. Sometimes that can dilute the message and hurt patient care in the long run. We have very intentionally and from our foundation taken that away and demonstrated that this is not from us, this is coming from a stroke prevention perspective. We very intentionally allow our stroke neurologists to do a lot of the talk. That way you have a less biased vision and source, and I think people are very receptive to that. We are not just talking about doing procedures, we are talking about helping patients prevent stroke, and we want them to be front and center when we are discussing this.

Elizabeth Schetina, BSN, RN: I have had several patients mention that they go back to their general cardiologist and have these discussions, and complete our shared decision-making process. We have gotten the feedback from not just the procedural physicians, but also from the general physicians who are familiar with their history and can make the best recommendations.

Bibhu D Mohanty, MD: I have gotten a lot of feedback from our general cardiology colleagues as well. In prior instances or settings, they would send patients and things would happen, but they would not hear back, or have to ask, “We did not send them for that purpose, why did this procedure happen?” We go to great lengths to make sure that that communication back to them is as secure as possible because ultimately, it is in their best interest and the patient’s best interest to make sure we are all communicating and doing what is right for that patient to prevent that future event.

Elizabeth Schetina, BSN, RN: I will also mention that being in Florida, we get a lot of patients that come from out of state, but they stay down here for months at a time, specifically during the winter. So, we are able to get all that information from other offices. Therefore, it is about communicating with all these different physicians and offices, so we have all the documentation that we need.

Bibhu D Mohanty, MD: I will speak briefly to some of our future collaborative work as well. One of the benefits of having a structure like this is that academic bodies, governing bodies, and industry partners, are all looking to help the same population of stroke patients. So, when they see a structure that is preset like this, they are all that much more apt to seek us out for clinical trials, novel device trials, and drug studies. Because of this, at this time, have over 10 ongoing studies with novel devices for LAAO, PFO closure, and rhythm monitoring. We have studies in cancer patients and transplant patients. All of this emanated from the fact that people see us as a collaborative entity. That lends itself to further collaboration amongst groups that you might think were disparate from what we do, but really, they are very interrelated. So, that has been a great benefit.

In the future, we hope to further elaborate this with groups that might not see themselves as linked to what we are doing. An example is cardiac surgery. We have a pathway for LAAO through cardiac surgery for patients who might not be candidates for transcatheter approaches. This is something that is laid out because they came to us and saw that we were doing this and asked if they could be part of it. It really opens up that collaborative arena when people start hearing about the structure and recognize what it is offering. I think that has been one of the joys of building this program, so much so that we need more staffing because it has grown so rapidly. But again, that is something to be proud of.

Elizabeth Schetina, BSN, RN: I think a lot of it is word of mouth of the patients too, because I have had a lot of patients come back and say that they have referred family and friends after going through their experience here. As our community outreach grows, we can definitely see how the volumes have increased. So yes, we are quite busy.

Bibhu D Mohanty, MD: We would like to thank EP Lab Digest for giving us this chance to share our program’s history and evolution, and we are very proud of what we have been able to accomplish in partnership with our neurovascular colleagues, EP colleagues, general practitioners, and all our physicians in this community who helped foster our efforts. Thank you for the opportunity to share with you today.

Elizabeth Schetina, BSN, RN: Thank you very much for having us. 

The transcripts were edited for clarity and length.

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