Members of the ACTIVE Unit, from left: Akshay Desai, MD; Michelle Young, NP; Gretchen Stern, PharmD;   Laura Burpee, NP;  Elaine Shea, RN;  Joanne Weintraub, NP;  and Irene Cooper, RN.

Members of the ACTIVE Unit, from left: Akshay Desai, MD; Michelle Young, NP; Gretchen Stern, PharmD;
Laura Burpee, NP; Elaine Shea, RN; Joanne Weintraub, NP; and Irene Cooper, RN.

One of the hallmarks of BWH’s Heart and Vascular Center is innovation. Three recent initiatives advance cardiac care and innovation.

Managing Advanced Heart Failure Patients 

Advanced heart disease specialists are providing a range of innovative, patient-centered approaches to reduce hospital admissions and improve quality of life for patients with chronic heart failure.

Despite tremendous progress in the development of targeted pharmacologic therapy, heart failure remains the leading cause of hospitalization in the Medicare-age population. Emerging evidence suggests that many hospital readmissions can be prevented through intensive outpatient management, decreasing the burdens of this disease for both patients and the health care system.

Congestion related to fluid accumulation throughout the body is a key driver of worsening symptoms and hospitalizations in heart failure patients. Typically, for patients who have congestion unresponsive to oral diuretic treatment, hospitalization is the only alternative. At BWH, the establishment of the ACTIVE Unit (Ambulatory Cardiac Triage, Intervention, and Education) provides planned, ongoing treatment of heart failure patients at high-risk for readmission. This unit offers extended ambulatory visits with a specialized nurse and pharmacist to review, reconcile and deliver the heart failure treatment regimen for ambulatory patients who might otherwise require hospital admission or rehospitalization.

“The ACTIVE Unit manages heart failure patients by providing convenient, comprehensive care, with the goal of preventing hospital admissions and emergency department visits,” said Michelle Young, APRN-BC, nurse practitioner in the Center for Advanced Heart Disease. “This approach also enables our team to get to know every patient and provide individualized care during these sessions.”

Patients with mild, congestive symptoms can receive advanced care from an interprofessional team of specialized heart failure nurse practitioners, registered nurses and pharmacists during a four-hour session. If needed, a dietitian, palliative care specialist and social worker can also visit the patient during their session.

Redesigning Care Delivery for Heart and Cardiovascular Patients

To enhance employee and patient satisfaction and improve efficiency and access to resources, the Watkins Cardiovascular Clinic began implementing a newly redesigned care model in 2016.

Instead of one unit, the new structure separates staff into four teams of eight to twelve general cardiologists, complemented by a nurse practitioner or physician assistant, registered nurse, practice assistant, medical assistant, pharmacist, pharmacy tech and a shared administrative assistant. As part of this change in structure, each member of the team has the opportunity to practice to the full extent of their license.

“Our interprofessional approach to patient-centered care allows for our patients and families to feel known by a dedicated care team. The structure also improves communication among team members throughout different phases of care, in the inpatient and ambulatory settings,” said Danika Medina, MPA, BSN, RN, NE-BC, CCTC, ambulatory nurse director for BWH Transplant Administration and the Center for Advanced Heart Disease.

One goal of the clinic redesign is to reduce new patient wait times. Pilot results from the first team showed a reduction in the wait time for a clinic appointment, an increase in access for new patients and a decrease in waiting times for patients who return for follow-up care.

Achieving Specialty Certification in Heart Failure Nursing

The heart failure nursing team, nestled under the umbrella of the Center for Advanced Heart Disease, set and achieved a collective goal last year to receive certification in heart failure nursing from the American Association of Heart Failure Nurses’ Certification Board. All three registered nurses and three nurse practitioners are now certified.

“Our heart failure nurses and nurse practitioners are expert clinicians in the complex care management of the heart failure patient,” said Medina. “They contribute to innovative care delivery via the ACTIVE Unit, and have developed and implemented clinical practice guidelines and nurse-driven clinical protocols with the goal of improving quality of care for the heart failure patient.”