HFSA 2021: Spectrum Health Heart Team Process
David Wohns, MD, MBA, FACC, FSCAI presents the heart team approach for complex coronary artery disease (CAD) and heart failure with reduced ejection fraction (HFrEF) developed at Spectrum Health. He discusses best practices and tools for heart team implementation. Dr. Wohns is the division chief of cardiology at Spectrum Health Medical Group. He gave this presentation virtually at the 2021 Heart Failure Society of America (HFSA) scientific meeting.
Dr. Wohns presents the heart team value proposition and the need for standardizing variability in patient care. He explains how the heart team approach involves multiple disciplines in helping to address issues such as criteria for ad hoc percutaneous coronary intervention (PCI), admission from the cath lab, pre-op testing and surgery consults, optimizing patients prior to surgery, and communication with patients, families, and nursing. He discusses challenges and outcomes and notes, “our patients and families have loved it, with free second, and third, and fourth, and fifth opinions.”
The heart team, he explains, has been shown to improve patient care, the quality and efficiency of decision-making, and confidence in decision-making, eliminating after-the-fact finger-pointing. The heart team approach was implemented at Spectrum Health in 2015 and, on average, 34 providers from multiple disciplines are present at the weekly heart team meeting. These include cardiologists (interventional, advanced heart failure, advanced imaging, noninvasive), cardiothoracic surgeons, cardiac anesthesia, and intensivists, as well as the heart team coordinator. The heart team coordinator compiles the list of patients for the weekly review and ensures that testing and images are available for viewing during the meeting.
The heart team reviews an average of 7-8 patients per week, collaboratively discussing each patient for about 5 to 7 minutes. The team then makes a consensus heart team recommendation that the presenting provider shares with the patient and family for their input before implementing the treatment plan. To date, the Spectrum heart team has reviewed more than 2,000 patients!
Dr. Wohns explains that outpatient office-based providers have loved the heart team, which has helped them understand the decision-making for their patients. In addition, the heart team has helped each specialty appreciate treatment decision subtleties, has provided team building, and Dr. Wohns reports, “quite frankly, it became fun.”
“As you think about a heart team implementation,” Dr. Wohns concludes, “I would encourage you to look at what problems you are trying to solve at your institution. Is it trust? Is it breaking down silos? Standard work? Efficiency? Unmet patient needs? What are you trying to solve as you grow or develop a heart team? And I would say, ‘if you build it, they will come.’”