Objectives. Describe a multidisciplinary team and it s utilization in the inpatient cardiovascular surgical patient

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2 None Endorsements

3 Objectives Describe a multidisciplinary team and it s utilization in the inpatient cardiovascular surgical patient Understand clinical and clinician benefits of a multidisciplinary team A general understanding of aortic stenosis and treatment options Identify the Heart Team of Southcoast Health, and their respective role and patient benefits Why I love my job

4 Introduction Southcoast Health s Cardiovascular Care Center is built upon a multidisciplinary team of providers who work collaboratively to treat our patients, eliminating the need for patients to travel out of our region for care. The strength of our cardiac program lies in our comprehensive approach as we put our patients at the forefront of our mission. Dr. Margaret Ferrell, Physician-in-Chief of Southcoast Health Cardiovascular Services.

5 Multidisciplinary Team Multidisciplinary care occurs when professionals from a range of disciplines with different but complementary skills, knowledge and experience work together to deliver comprehensive healthcare aimed at providing the best possible outcome for the physical and psychosocial needs of a patient and their careers. As patient needs may change with time, the composition of the team may also change to meet these needs. - Mitchell GK, Tieman JJ, Shelby-James TM. Multidisciplinary care planning and teamwork in primary care. Med J Aust 2008;188(8 Suppl):S61 4. Grade I-C recommendation - UpToDate Grade I: strong recommendation C: evidence comes from observational studies, unsystematic clinical experience, or from randomized, controlled trials

6 Multidisciplinary Team cont. As many as nine different specialties can be in contact with one single patient, identifying and caring for their individual needs Such as: Physical Therapy Occupational Therapy Nursing Registered Dietician Respiratory Therapy

7 Clinical and Clinician Outcomes Improved communication between different levels of healthcare workers Reduced length of stay Reduced cost of stay Increase quality of outcomes Optimizing healthcare workers' performance Increasing job satisfaction Surg Neurol Int Aug 28;5(Suppl 7):S doi: / ecollection 2014.

8 Aortic Stenosis and Surgical Options

9 Aortic Stenosis Aortic stenosis disease (AS) is a common native valve disease found in up to 7-10% of the elderly population. AS occurs when the heart valve essentially becomes like a stiff door, not allowing the valve to completely open, increasing not only the work of the heart which can lead to heart damage, but also lead to decreased blood flow to vital organs.

10 Surgical Aortic Valve Replacement Surgical aortic valve replacement (AVR) is the standard treatment for patients with symptomatic severe AS. However, despite the excellent results of conventional surgery, surgical risk is markedly increased in elderly patients with comorbidities. Additionally, several registries have demonstrated that about one-third of patients are considered too high-risk for conventional open heart surgery and remain untreated. AVR requires cardiopulmonary bypass machine

11 Transcatheter Aortic Valve Implantation Transcatheter aortic valve implantation (TAVI) otherwise known as TAVR (Transcatheter Aortic Valve Repair) was developed as an alternative to surgical AVR initially in this high-risk patient population. TAVR does not require cardiopulmonary bypass or sternotomy.

12 The Heart Team

13 Heart Team The Heart Team, as defined by the Centers for Medicare and Medicaid Services within the National Coverage Determination for transcatheter aortic valve replacement, embodies collaboration and dedication across medical specialties to offer optimal patientcentered care, with a requirement that the cardiovascular surgeon and interventional cardiologist jointly participate during the procedure.

14 Outcomes of Heart Team Optimization of patient selection Improved skill sets of clinicians due to collaboration Increased procedural success, and reduced hospital readmissions An additional goal is to deliver more patient-centered care, taking into account patient preferences and values through processes such as shared decision making.

15 Clinical Excellence Southcoast Health heart program has been ranked by Healthgrades as one of the Top 10% in the Nation for Overall Cardiac Service. Southcoast Heart Center has additionally received the following Healthgrades awards: America s 100 Best Cardiac Care (2016) Cardiac Care Excellence Award (2016) Coronary Bypass Surgery Five-Star Recipient (2016)

16 More Than Medicine

17 Questions