SPECIal EXPaNDED ISSUE: HEaRT HOSPITal OPENING … · ... HEaRT HOSPITal OPENING ... Heart Hospital...

CardiovasCular updatefall

2008

Environment• Onededicatedentrancewithaconciergedeskforeasyaccessandattentiveservice.

• Calm,soothing,adaptablehotel-likeroomswithmountainviews.

Comprehensive Services, Programs, and Clinical Care• Cardiaccatheterizationlabs• Cardiothoracicandvascularoperatingsuites• Invasiveandnon-invasivecardiactesting• Comprehensivecardiovascularservicesincludingprevention,diagnostic,treatmentandrehabilitationinonelocation.

• Anexpertstaffwithspecialtrainingincaringforheartandvascularpatients.

• AccreditedChestPainCenter• HeartFailureClinic• Nuclearcardiology• Cardiacrehabilitation• Echocardiography• Laboratoryservices• New42-bedacutecareareafeaturing:13intensivecardiovascularcare,25coronarycare,andfourobservationbeds.

• Shortstayunitforobservationandpost-procedurerecovery.

SPECIal EXPaNDED ISSUE: HEaRT HOSPITal OPENING

TacomaGeneralOpensRegion’sFirstDedicatedHeartHospitalYearsofresearch,planninganddesigncometogetherwiththeNovember2008openingoftheTacomaGeneralHeartHospital,thefirstofitskindintheregion.Thestateoftheart“hospitalwithinahospital”islocatedintheLwingofTacomaGeneralHospital.Thehearthospitalisdedicatedexclusivelytothepreventionandtreatmentofcardiovasculardiseaseswhilethoughtfullymeetingtheneedsofpatientsandfamilies.Thehearthospitalwillhaveallofitsheartandvascularservicesunderoneroof,allowingforeasieraccessandfocusedpatientcare.

WHaT MakES US DIffERENT

TheTacomaGeneralHeartHospitalataGlanceTechnology• Themostup-to-datemedicaltechnologyincluding:cardiacroboticsurgery,minimallyinvasivesurgery,heartsupportdevices,state-of-theartelectrophysiologylab,endovascularsuiteforvascularandchestsurgeries,andcardiaccatheterizationlabs.

• EPICelectronichealthrecordsystem.• Digitalimagemanagementsystem.• Advanced64-SliceCardiacCTScanner.

Patient-focused CareTheTacomaGeneralHeartHospitalprovidesforpatientsfirst.Thecomfortofourpatientsandtheirfamilies,alongwithadvanceddiagnosis,treatment,andtherapy,arethemostimportantobjectivesofthehearthospital.Fromadmissionthroughdischargeandrehabilitationourcarefocusesonpersonalneeds,safety,quality,andhealthimprovement.

Clinical ResearchTheTacomaGeneralHeartHospitalisinvolvedinanumberofgroundbreakingclinicalresearchstudiestohelpadvancetheknowledgeofourstaffandthecareofourpatients.

AllenmoreHospital~GoodSamaritanHospital~MaryBridgeChildren’sHospital&HealthCenterTacomaGeneralHospital~GoodSamaritanClinics~MultiCareClinics

Numerousstudieshavelinkedtheenvironmenttoimprovementsinclinicaloutcomes.

Thehearthospital’snewlydesignedandconstructedcardiovascularintensivecareunitandcoronarycareunitincludethefollowingfeatures:• Anup-scaledesignandambiance.

• Naturallightandahealingenvironment.

• Threezonesofcareforthepatient,family,andclinician.

• Family-centereddesignwithsleepsofa.Self-sufficientheadwalls,overheadbooms,andsupplycartsineachroomallowcaregiverstobeclosertothepatient.

• Onefamilysleeproom,fourfamilywaitingareas,andtwoconsultation/physicianworkoffices.

• Negativeairflowtodecreaseinfectionriskwithtwodesignatedisolationroomswithanterooms.

CardiovasCular update

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PatientCareEnvironment

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Heart Hospital Entrance, lobby, and Concierge Desk(2nd Floor L Wing)Inthelobbyofthehearthospitalaconciergegreetsallofourpatients,families,andvisitors.Ifit’sinformation,registration,directions,orawheelchairourconciergewillbetheretoassist.

Imaging Services(3rd Floor L Wing)Imagingservicesprovidesspecializedcardiacproceduresthatincludecardiacnuclearimagingandthelatestcardiaccomputerizedtomographicangiography.


HeartHospitalTourCatheterization laboratory(7th Floor L Wing)Thehearthospitalhasfourstate-of-the-artcatheterizationlabstohelpphysiciansdiagnoseandtreatcardiovasculardisease.Someoftheservicesperformedinthecatheterizationlabsare:• Cardiaccatheterization• PTCA–percutaneoustransluminalcoronaryangioplasty(balloon)

• Heartandvascularstents

Electrophysiology laboratory(7th Floor L Wing)Thehearthospitalelectrophysiologylabincludeshighlyadvancedequipmentdesignedtotreatirregularheartrhythms.Someoftheservicesperformedintheelectrophysiologylabsinclude:• AICD(Implantablecardiodefibrillators)• Electrophysiologystudies,includingablation(surgicalremoval)

• Pacemakers

Preventive Cardiology, Diabetes Services and laboratory Services(4th Floor L Wing)Thepreventivecardiologydepartmentprovidesarangeofservicesincludingcardiacrehabilitation,cardiacstresstesting,holterandeventheartmonitoring,ambulatorybloodpressuremonitoring,andmen’sandwomen’sHeartAdvantagepreventionscreenings.

Diabetesservicesprovideoutpatientconsultationanddiabeteseducation.

Outpatientlaboratoryservices.

Chest Pain Unit and Cardiovascular Short Stay Unit(7th Floor L Wing)Thehearthospital’snationallyaccreditedchestpainunitisdesignedtoprovidefocusedcare,observation,andevaluationforpatientswithchestpain.

Thecardiovascularshortstayunitprovidesbedsforthosepatientsrecoveringfromacardiovascularprocedurethatrequiresastayoflessthan24hours.

Heart failure Clinic(7th Floor L Wing)Thehearthospital’sheartfailureclinicprovidesoutpatientcare,treatment,andsupportforthosepatientswithheartfailure.Theclinicstrivestohelpreducepatientreadmissionstothehospitalandtoimprovequalityoflife.

Cardiac, Thoracic and Vascular Operating Rooms(7th Floor L Wing)Thehearthospital’ssurgicaloperatingsuitesarestateoftheartandincludeuseofleadingedgeproceduressuchasroboticcardiacsurgeryandventricularassistdevices.Servicesinclude,butarenotlimitedto:• CABG(heartbypasssurgery)• Valvereplacement/repair• Aneurysmrepair• Othercardiothoracicsurgeries

Cardiovascular Intensive Care Unit and Coronary Care Unit(8th Floor L Wing)Thehearthospital’snewlyconstructedcardiovascularintensivecareunitandcoronarycareunitarelocatedonefloorabovethediagnosticandoperatingsuites,allowingforeasytransportationandcareofpatients.Theseunitsprovidethelatestmedicaltechnologywhileprovidingforacaringandcomfortableenvironmentforpatientsandfamilies.

Impella 2.5TheImpella2.5isanext-generationdevicethatjustrecentlyreceivedFDAclearance.WearethefirsthospitalinthePacificNorthwesttoutilizethisdevice,andhavecompletedseveralsuccessful

deploymentstodate.Thedeviceisinsertedthroughthefemoralarteryandpassedacrosstheaorticvalve,intotheleftventricle.Thedevicewilladdanadditional2.5L/minofbloodpumpedtothebodyfromtheleftventricle.TheImpella2.5isusedtosupporthigh-riskpatientsduringcathlabproceduresaswellasthosepatientswithcardiogenicshockandthosehavingtroubleweaningfromcardiopulmonarybypass.Supportwiththisassistdevicewillbelimitedtotheleftheart,andwilllastindurationfromhours,uptoaperiodof5days.

Thistemporaryartificialheartcanbeusedforeithertheright,leftorbothventriclesoftheheart.TheAbiomed5000isusedinthesickestpatientswithprofoundseverecardiogenicshock.Iftheheartisunabletorecoveradequatefunction,thenthepatientcanbe“bridgedtotransplantation”onthedevice.Thisdevicecansupportthefailingheartformonthsonend.

Wearealsolookingtothefuture,wherewehopetoprovideanalternativeforchronicheartfailurepatientswhoarefailingmaximummedicaltherapy,andarenotcandidatesforcardiactransplantation.Thisisreferredtoas“destinationtherapy”(DT),andutilizesanimplantableVADthatallowsthepatienttogohome.

At Tacoma General Heart Hospital we have the most advanced medical technology available for the treatment of heart disease.


AdvancedMedicalTechnology

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Ventricular assist Devices (VaDs)Aventricularassistdevice(VAD)isamechanicalpumpthathelpsaheartthatistooweaktopumpbloodeffectivelythroughthebody.

Abiomed AB 5000 HeartMate II


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Mitral Valve Repair through Cardiac Robotic SurgeryThemitralvalveisacomplexstructurethatcontrolsbloodflowthroughtheleftsideoftheheart.Whenopen,themitralvalveallowsbloodtoflowintotheheart’smainpumpingchamber,theleftventricle.Whentheleftventriclecontractstopushbloodthroughthebody,themitralvalveclosestopreventbloodfromflowingbacktowardthelungs.

Sometimesthemitralvalveisabnormalfrombirthorbecomesdamagedbyinfection.Moreoften,mitralvalvestructuresbecomedamagedwithageorfromcoronaryarterydisease.

Whateverthecause,anabnormalordamagedmitralvalvecannotcompletelysealtheheart’sleftventricle.Withanincompleteseal,bloodcanescapetheleftventricleandflowbackwardsthroughthemitralvalve.Thisconflictingforcecanmaketheheartworkharder,leadingtofurthermitralvalvedamageandotherpotentialcomplicationssuchasheartfailure.

Treatmentformitralvalvediseaseconsistsofeitherreplacingorrepairingthevalve.Mitralvalvereplacementisperformedsurgicallyusingeitheranartificialvalveoravalveobtainedfromapig.Duetothelesssuccessfuloutcomesofvalvereplacementitisusuallybettertorepairtheexistingvalve.Surgicalrepairinvolvesdelicatereconstructionofnativevalvetissuesinordertorestoreproperfunction.

Themostcommonapproachtorepairrequiresthesurgeontocutopenthebreastboneandspreadtheribstogaindirectaccesstotheheart.Cuttingthesternumandopeningtheribcage—thebody’snaturalprotectivestructurefortheheart—canprolonghealingtime,andincreasetheriskofinfection,seriouscomplicationsandevendeath.

TacomaGeneralHeartHospitaloffersanewapproachtomitralvalverepairthroughtheuseofthedaVinciSurgicalRoboticSystem.The,daVincimitralvalverepairoffersanumberofpotentialbenefits,including:• Lesspost-operativepain• Lessriskofinfection• Lessanesthesia• Lessbloodloss• Shorterhospitalstay• Fasterandmorecompleterecovery• Quickerreturntonormaldailyactivities

On-X Prosthetic Heart ValveTheOn-Xprostheticheartvalveisapurecarbonheartvalve.Thisvalveistheresultofnumerousinnovationsthatdistinguishitfromallotherprostheticvalves.Thedesignsolvesmanyoftheproblemsassociatedwithvalveprostheses.TheOn-Xvalveallowsgreaterflowwithreducedriskofthrombosisandhemolysis.TacomaGeneralHeartHospitalhasbeeninvolvedinanationalstudyontheOn-Xvalve,isthetopenrollerofpatientsintheUnitedStates,andistheonlyhospitalintheregionofferingthisprocedure.

Ultrafiltration Therapy TheTacomaGeneralHeartHospitalCoronaryCareUnithasimplementedanewtreatmentforfluidoverloadinheartfailurepatients.Todate,intravenousdiureticshavebeenthestandardofcaretotreatfluidoverload.AnewalternativetherapytoremoveexcessfluidistheAquadexUltrafiltrationSystem.Throughaspecialfilter

excessfluidisremovedfromtheblood.TheAquadexsystemcanremoveamaximumof1liter(1,000cc)offluideverytwohours.Thetherapyhasfewerclinicallysignificanteffectsonkidneyfunction,heartrate,bloodpressure,andelectrolytebalance.FindingsfromtheUNLOADstudyin2006demonstratedthathospitalizedpatientsreceivingultrafiltrationtherapyaspartoftheircarelostmoreweightandexperiencedgreaternetfluidlossthanpatientstreatedprimarilywithintravenousdiuretics.At90days,theultrafiltrationgrouphadsignificantlyfewerdaysinthehospital,re-hospitalizationsforheartfailure,unscheduledheartfailureofficevisitsandemergencyroomvisits.

Induced HypothermiaTacomaGeneralHeartHospitalhasimplementedinducedhypothermiaasatreatmentforcardiacarrestpatients.This“coolingtherapy”mimicstheconditionsofmildhypothermia.Severalclinicaltrialshaveshownthetreatmentmayhelppreventbraindamageanddeathafteracoma-inducingcardiacarrest.Theinducedhypothermicstatepreservesvitalorgansandtissuessothatwhenapatientregainsconsciousness,thechanceforanimprovedrecoveryisincreased.Potentialcandidatesforthecoolingprocedureincludepatientswhoaresufferingfromcardiacarrestandwhoareinacomaafterheartrateandbloodpressurehavebeenstabilized.Apatientischilledwithcoldsalineandexternalmeasurestocooltheircoretemperatureto34degreesCelsius.Theyremaincoldfor18-24hours;theyarethenre-warmedovereighthours.Someoftheeffectsofthistherapyincludedisruptionsinfluidbalance,electrolytesandbloodpressure,howeverthesecanallbemanagedsuccessfully.TacomaGeneralHeartHospitalhasdevelopedaprotocolthatiseasilyfollowedandwehavewitnessedgreatoutcomes.Weareexcitedaboutwhatthismeansforourpatientsandfamilies.

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Late 1950s–FirstcatheterizationlabinWashington;firstcardiaccathprocedureperformedinthebasementofMaryBridgeChildren’sHospital.Late 1950s–Firstheartsurgeryutilizingheart/lungmachineperformedatTacomaGeneralHospital.(FirstinthestateofWashington.)1981–Firstinstatetohaveahospital-basedoutpatientcardiacrehabilitationprogram.1982–TacomaGeneralHospitalperformsthefirstangioplastyinPierceCounty.1995–TacomaGeneralHospitalperformsthefirstcoronarystentimplantinPierceCounty.1995–TacomaGeneralCardiacCathLabbecomesoneofthefirsthospitalsinWashingtontobecome“film-less.”1996–TacomaGeneralCardiacCathLabisthefirstlabintheUnitedStatestosendapatientstudyoncompactdisctotheClevelandClinic.1996–SecondheartfailureclinicinWashingtonState,firstinPiercecountyandSouthwesternWashington.

2001–FirstHospitalinPierceCountytoofferbrachytherapy.2001–FirsthospitalinWesternWashingtontooffercardiaclabtest,c-reactiveprotein(cardiacinflammationmarker).2002–FirsthospitalinWesternWashingtontoofferlabtest(BNP)toaidinthedifferentialdiagnosisofheartfailure.2002–FirsthospitalinPierceCountytousetheangiojet,acardiacarteryclot-removingdevice.2003–Firsthospitalinthestatetousethenewdrugelutingstent.2003–NewtechnologyatTacomaGeneral:3-DCardiacMapping,BiventricularICDS,Bio-Z,andPFOClosures.2004–TacomaGeneral’sWomen’sHeartCenteropened(Women’sHeartAdvantagescreenings),CardiacrehabstudysitefortheHarvardLifestyleDemonstrationProject(Medicare).EPcryoablation,EPOinjections,ChestPainCenteropened.

2005–Performedfirstsurgicalleftventricularremodeling,Men’sHeartAdvantagescreeningprogram,AmbulatoryBloodPressureMonitoring,PlasmaPheresis,CardiacRehabsatellitestudysitefortheNationalInstitutesofHealthACTIONTrial(ExerciseandHeartFailurePatients).2006–HeartFailureHomeMonitoringprogramofferedandexpanded,LeftVentricularAssistDevices,CarotidStentProceduresperformed.2007–Firsthospitalincountytoinducehypothermiatherapyforcardiacarrestpatients.CardiacRehabilitationservicesexpandedtoGigHarbor.2008–ImpellaPerctuaneousVentricularAssistDeviceplacedincathlab(firstpatientplacementinthePacificNorthwest).FirstroboticassistedcardiacsurgeryatTacomaGeneralHospital.Ultrafiltrationtherapyforacuteheartfailurepatients.TacomaGeneralHeartHospitalopening.

Tacoma General Hospital and area physicians have a long history of leading the way for heart and vascular medicine in the Puget Sound region.


HistoryofHeartCareExcellence


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MedicalLeadership

Thomas k. Murphy, MDAugust16,1957–June26,1991

CardiacSurgeon

Gail B. Strait, MDFebruary9,1973–December26,1999

Cardiologist

Clarence l. anderson, MDSeptember20,1966–June30,1998

Cardiologist

John P. Nagle, MDJune21,1971–June18,2007

Cardiologist

Cordell H. Bahn, MDDecember14,1972–July1,1998

CardiacSurgeon

Eugene S. lapin, MDJuly31,1975–February1,2008

Cardiologist

“Honoring the past while we build for the future”OnNovember11,2008,MultiCareHealthSystemPresidentandCEODianeCecchettini,RN,willunveilaLeadershipLegacyWalltorecognizetheextraordinarycontributionofsixpastmedicalstaffmemberswhowereinstrumentalinthedevelopmentofcardiaccareandcardiacsurgeryatTacomaGeneralHospitalandinthecommunity.Thephysiciansbeinghonoredare:

Ms.Cecchettinistates,“It’simportantforustohonorthepastaswebuildthefuture.Thesephysicianswereourleadersandmentors.Theyunderstoodthefutureandrecognizedthepossibilitiesbeforetheybecameobvioustous.Wearedeeplyindebtedtoourphysicianleadersfortheirvision,theirleadershipandtheirdedicationtoimprovingthecareofheartpatientsinourcommunity.”ThiseventisbeingtimedtocoincidewiththeopeningoftheTacomaGeneralHeartHospitalandthenewcardiovascularintensivecareunitandcoronarycareunit.

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Christi McCarren, RN, MBaAdministrator,CardiovascularServices

linda Dean, RN, MSN, CCRNClinicalDirector,CardiovascularInpatientUnits

anita Wolfe, RN, BSN, MSM, CCRNClinicalDirector,CardiovascularDiagnostics

Pam kozu, RN, MNManager,CardiacOutpatientandDiabetesServices

Gwen frazier, RNManager,CardiovascularOperatingRooms

kristina Donahue, RN, BSNAssistantNurseManagerCardiovascularInpatientUnitsCCU

Susan Rose, RNAssistantNurseManager,CardiovascularInpatientUnits


ClinicalLeadershipAtTacomaGeneralHeartHospitalanexperiencedmanagementteamandclinicalspecialistsprovideexpertise,leadershipandvisionforthebestincardiovascularcare.

Tacoma General Heart Hospital leaders:

kathy Clark, RN, BSN, MSMAssistantNurseManagerCardiovascularInpatientUnitsCVICU

Tina Soete, RN, BSN, MSM, CCRNClinicalManager,CardiacCatheterizationLab

alison Swarens, RN, BSNSupervisor,ElectrophysiologyLab&HeartFailureClinic

Janet Snape, RNAssistantNurseManagerCardiovascularShortStayUnitCardiovascularAdmissionandRecovery

Glenn Bean, MS, faaCVPRClinicalCoordinator,PreventiveCardiology/SpecialProjects

Roger Campanelli, MSIMSystemAdministrator,ApolloDataSystem

kris Pulliam, RN, BSNCardiacSurgeryEducator/DataAbstractor

kathy Ueland, RN, BSN, CCRNHeartFailureEducator

Deb Whitney, RNHeartFailureNurseNavigator

Julie langer, RNDataAbstractor

larry Snyder, RN, CPVADCoordinator

lisa MarchInvasiveCardiovascularTechnologistProgramCoordinator


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These include:

Chest Pain Center AccreditationSociety of Chest Pain Centers (2008)TacomaGeneralHeartHospitalrecentlyreceivedreaccredidation.Accreditationfollowsarigorousclinicalreviewofpracticesandproceduresandasitesurvey.Fullaccreditationisawardedtothosehospitalsthatdemonstrateexcellencewithclinicalpracticeguidelinesandstandardsinthetreatmentofchestpain,unstableangina,andmyocardialinfarction(heartattack).NotableaccomplishmentswerethehospitalsCode“STEMI”quickheartattackcareanditsLowRiskChestPainProtocol.

Cardiac Rehabilitation Program CertificationAmerican Association of Cardiac and Pulmonary Rehabilitation (2008)TacomaGeneralHeartHospital’sCardiacRehabilitationservicehasreceivednationalrecertification.Inordertoreceivethisprestigiousdesignationaprogrammustmeetrigorousstandardsofcareandmeettheclinicalpracticeguidelinesforcardiacrehabilitation.


CommitmenttoQuality

Team Collaboration Award “Code STEMI”Volunteer Hospital Association (2006)Thecardiacservicesteamwonthisawardforitsgroundbreakingworkinheartattackcare.CodeSTEMIaimstoprovidefastheartattacktreatmenttominimizedamagetotheheartmuscle.

Award of Excellence in Healthcare QualityQualis Health (2006) “Code STEMI” Project

Blue Distinction Center for Cardiac CarePremera Blue Cross and Regence Blue Shield (2007)BlueDistinctionCentersforCardiacCarehasmetorexceededcriteriabasedonnationalguidelinesandhavebetteroveralloutcomesforpatients.

Designated Mentor Hospital for Acute Myocardial InfarctionInstitute for Healthcare Improvement (2006)

AtTacomaGeneralHeartHospitalwearecommittedtoquality.TheHeartHospitalparticipatesinmanynationalqualityinitiativesandaccreditationprograms.

Weusedatatocontinuouslyseekwaystoreducecomplicationsandusenewtechniquestodecreasepain,speedrecoveryandimproveoutcomes.

Thiscommitmenttoqualityhasresultedinnationalaccreditationandawardsthatattesttothequalityofcaredeliveredhere.

President’s Award for Clinical Quality (Code STEMI Project)MultiCare Health System (2006)

Finalist Gold Standard Award: Best Practices (Women’s Heart Center)Volunteer Hospital Association (2005)

Certificate of Achievement: Care of Patients with Acute MI, Critical Care and Heart FailureVolunteer Hospital Association/American Hospital Association (2005)

Three Star Rating for ElectrophysiologyUnited Health Care (2007)

Award for Clinical Poster Presentation: “Beyond Awareness: Helping Women Personalize Their Risk for Heart Disease”Preventive Cardiovascular Nurses Association (2008)

Team Collaboration Award: Heart Failure Transition ProgramVolunteer Hospital Association (2008)


InnovativeHeartCare

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Heart failureNearlyfivemillionpersonsintheUnitedStateshaveheartfailure.HeartfailureisthenumberonediagnosisofMedicarebeneficiaries,andsix-monthhospitalreadmissionratesforthispopulationarenearly44percent.Thisisacostlyandgrowingprobleminourhealthcaresystem.Researchhowever,showsthatreadmissionscanbereducedthroughbetterpatienteducationandself-care.ToaddressthisprobleminourregiontheTacomaGeneralHeartHospitalhaslaunchednew,innovativeprogramstofacilitatethepatientstransitionfromthehospitalandreducetheirneedforfuturehospitalizations.

Heart failure Transition ProgramANurseNavigatorpositionhasbeencreatedtoworkdirectlywithheartfailurepatients.Inadditiontobeingseenbyadedicatedheartfailureeducator,patientsareevaluatedbythe

NurseNavigator,whoassessesriskforreadmissionandidentifiespotentialbarriersthatmightaffectasuccessfultransition.Upondischarge,theNurseNavigatorwilleitherfollowupwiththepatientathomeorcallthepatientwithin24-48hours.Patientsremainintheprogramforfourtosixweeksandreceivephonecallsonaregularbasistoreinforceself-careeducationandearlysymptommanagement.Inaddition,remotemonitoringcapabilityisavailabletotrackearlyclinicalsignsofheartfailure.Thegoalsoftheprogramaretohelppatientsmanagetheirchronicillnessandtoseekoutpatienttreatmentearlierwhenneeded.

Heart failure Clinic & Support GroupTheHeartFailureClinicatTacomaGeneralHeartHospitalprovidesspecializedoutpatientcareforthosediagnosedwithClassIII&IVheartfailure.Thepurposeistohelppatientsbettermanagetheirhealthcare

needsandimprovetheirqualityoflife.Patientswhoarereferredundergoevaluationbyourmultidisciplinaryteamandatreatmentplanisdeveloped.Theclinicprovidesthefollowingservicesandeducation:• Patientandfamilyeducation• Physicalassessment• Labwork• Medicationadjustment• Symptommanagement• Heartandfluidmonitoring• IVmedicationadministration• Nutritionconsultation• Palliativecareconsultation

Onaverage,aheartfailurepatientmakessixvisitstotheclinic.Twiceamonthaneducationalsupportgroupisofferedtopatientsandfamilymembers.


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CommunityPartnershipsHeart failure Community Transition ProgramPacific Lutheran University School of Nursing (2008)ThisisauniquecollaborativeeffortbetweentheHeartFailureCommunityTransitionprogramandthePLUSchoolofNursing.Theprogramisdesignedtoprovideanopportunityfornursingstudentstogainexperiencewithheartfailurepatientsandinturnhelpprovidesupportforthisvulnerablepatientpopulation.Advanced-levelstudentsfollowupwithaheartfailurepatientupondischargefromhome.UnderthesupervisionoftheTGHeartFailureNurseNavigator.theyprovidephoneandhomevisitfollow-upcontactwiththepatient.Studentsfollowpatientsfortwoandhalfyears.Theprogram


ClinicalServiceChiefsAtTacomaGeneralHeartHospitalphysicianswhospecializeincardiovascularcareoverseeeachdepartment.TheseClinicalServiceChiefsprovideguidanceonpolicy,quality,technology,andclinicalcareofpatients.

Tacoma General Heart Hospital Clinical Service Chiefs:

allen Graeve, MDCardiothoracicSurgery

Needham Ward, MDCardiacRehabilitationHeartFailureClinic

Michael Rome, MDElectrophysiology

Val lev, MDCardiovascularInpatientUnits

kingson Momah, MDCardiacCathLab

Uma krishnan, MDWomen’sHeartCenter

Vinay Malhotra, MDEchocardiography

Tobias lee, MDChestPainUnit

focusesonself-careeducation,guidance,andsupport.Theultimategoalistopromoteself-managementandimprovecompliancewithtreatmentplans.

Go Red for Women CampaignAmerican Heart Association (Pierce County) (2008-2009)MultiCareandtheTacomaGeneralHeartHospitalhavepartneredwiththeAmericanHeartAssociationtopromote“GoRedForWomen,”anationalcampaigntoincreaseawarenessandpreventionofheartdiseaseinwomen.MultiCareisinvolvedinseveraleventsovertheyearwhichincludetheGoRedForWomenLuncheon,proclamationeventswithlocalcityandcountygovernments,nationalGo-Redday,andothercommunityawarenessevents.

Cardiac Rehabilitation Partnership with the YMCaYMCA Gig HarborCardiacrehabilitationservicesarenowofferedinGigHarborthankstoapartnershiptousetheYMCAfitnessfacilityintheMultiCareGigHarborMedicalPark.Cardiacrehabilitationincludesmedicallymonitoredexercisetherapy,education,andsupportforpatientswhohaveheartdisease.Thepart-timeprogramismadepossiblethroughtheuseofYMCAexerciseequipmentandthecardiacrehabstafffromtheTacomaGeneralHeartHospital.

Cardiovascular Update is published periodically for physicians and health care professionals by MultiCare Cardiovascular Services. For more information on our services please call 253.403.1109 or email [email protected]

ADMINISTRATOR,CARDIOVASCULARSERVICESChristi McCarrren RN, MBa

EDITORGlenn Bean MS, faaCVPR

MultiCareHeartCenter’sOutpatientServicesallENMORE HEaRT & lUNG CENTER

Allenmore Hospital1901SUnionAve.Tacoma,WA98405253.459.6633

CardiacStressTesting,PulmonaryFunctionTesting,EKG’s

COVINGTON HEaRT CENTER

MultiCare Covington Clinic17700SE272ndStreetCovington,WA98042253.372.7010

PhysicianConsultation,CardiacStressTesting,HolterMonitoring,AnticoagulationClinic,PulmonaryFunctionTesting,Echocardiography,StressEchocardiography,EKG’s

GOOD SaMaRITaN HOSPITal

40714thAve.SEPuyallup,WA98372253.697.4000

CardiacRehabilitation

TaCOMa GENERal HEaRT HOSPITal

315MartinLutherKing,Jr.WayTacoma,WA98405253.403.1109

CardiacRehabilitation,CardiacStressTesting,HolterMonitoring,AmbulatoryBPMonitoring,HeartAdvantagePreventionScreenings,Echocardiography,EKG’s


ClinicalResearchAtTacomaGeneralHeartHospitalourphysiciansandstaffparticipateinnationalresearchstudiesthathelpdevelopnewandbettertreatmentsforheartdisease,keepingtheTacomaGeneralHeartHospitalattheforefrontofthelatestbreakthroughsinmedicalknowledge.ThefollowingstudiesareenrollingpatientsattheHeartHospital.

Innocoll Cardiac Surgery Study: ThisstudyisbeingdonetodeterminewhethertheGentamicin-CollagenSpongereducespost-operativesternalwoundinfections.Theprincipleinvestigator(PI)isDr.AllenGraeve.

Einstein DVT/PE Study:ThisstudyisbeingdonetodeterminewhetheroralRivaroxabanisaseffectiveasSQLovenoxtransitionedtoWarfarininthetreatmentofDVTand/orPE.ThePIisDr.DavidChen.

Rocket-af Study:ThisstudycomparesRivaroxabantoWarfarinforthepreventionofstrokesinpatientswithatrialfibrillation.Rivaroxabanisaoncedailyoralagentthatdoesn’trequiremonitoringlikeWarfarin.ThePIisDr.JaimePugeda.

TIMI-50 TRa2P:ThisstudyisbeingdonetodeterminewhetherSCH530348reducestheincidenceofsubsequentheartattacks.ThePIisDr.TobyLee.

amgen Red-Hf:ThistrialisbeingdonetodeterminewhethercorrectingAnemiainheartfailurepatientswithDarbepoetinreducesmorbidityandmortality.ThePIisDr.NeedhamWard.

ascend-Hf:ThisstudyisbeingdonetodeterminewhetherNesiritidereducesmorbidityandmortalityinpatientstreatedforacuteexacerbationsofheartfailure.ThePIisDr.NeedhamWard.

PROaCT Trial:ThisstudyincludespatientswhohavereceivedtheOn-Xmechanicalheartvalve.Itisbeingdonetodeterminewhetherlowerlevelsofanticoagulation,includinglowerINRWarfarin,aswellasAspirin+Plavixonly,canbeusedtopreventthromboticeventsinpatientswhohavereceivedthisparticularmechanicalheartvalve.ThePIisDr.DennisNichols.

CHOICE Study:CarotidStentingForHighSurgical-RiskPatients;EvaluatingOutcomesThroughTheCollectionOfClinicalEvidence.Thisstudyincludespatientswithbothsymptomaticandasymptomaticcarotidarterystenosis.ThePIisDr.BrianKott.

CT Stat:CoronaryComputedTomographyforSystematicTriageofAcuteChestPainPatientstoTreatment.Thisstudyincludespatientsintheemergencyroomwithchestpain.ThePIisDr.VinayMalhotra.

SaTURN Trial:(To open soon)ThisstudywillincludepatientswithmoderatecoronaryarterydiseasetodeterminewhethermaximaldoseLipitorvs.maximaldoseCrestorismoreeffectiveintreatingcoronaryarterydisease.ThePIisDr.ValLev.

SaMMPRIS Trial:(To open soon)StentingandAggressiveManagementforPreventingRecurrentStrokeinIntracranialStenosis.ThisstudywillincludepatientswithintracranialstenosiswhohavehadTIAsorCVAs.ThePIsforthisstudyareDr.BrianKottandDr.JohnHuddlestone.

*(PI stands for Principal Investigator)

AllenmoreHospital~GoodSamaritanHospital~MaryBridgeChildren’sHospital&HealthCenterTacomaGeneralHospital~GoodSamaritanClinics~MultiCareClinics


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