In the past at Atrium Health's Sanger Heart and Vascular Institute, as in many other hospitals, postoperative cardiac patients were discharged with a vague understanding of what recovery entails. Uncertainty can lead to preventable poor outcomes and readmissions for issues that could have been managed in the outpatient setting.

THE PROBLEM

Anxiety is common in patients preparing for cardiac surgery. Patients prefer to be home, but recovering from invasive surgery without expert guidance can be scary and dangerous.

Providers need up-to-date, reliable data to inform post-surgery decision-making, but collecting that data and turning it into insights can be a chore, said Dr. John Frederick, chief of cardiovascular surgery at Atrium Health's Sanger Heart and Vascular Institute.

"Collecting biometric data before remote monitoring meant nurse navigators had to rely on patients to manually record and report the information," he noted.

PROPOSAL

Health IT vendor Carium proposed a care experience platform to be added to Sanger Heart and Vascular's Perfect Care program that provides a complete ecosystem for virtual care.

"The care experience platform would ensure patients remain connected with their care teams, and that care teams remain connected with invaluable patient data to improve clinical decision-making," Frederick explained.

"A thoughtful change management strategy is critical to ensure a smooth and successful implementation, transition, adoption and advocacy of a new virtual care platform."

Dr. John Frederick, Atrium Health's Sanger Heart and Vascular Institute

"The platform would also help care teams map the recovery journey, establishing check-in dates and milestones everyone can work toward," he added.

The care experience platform, he said, promised to:

• Enable providers to spend less time on administrative tasks.
• Strengthen patient/provider relationships.
• Improve the patient experience.
• Create a steady flow of biometric data among patients and providers.
• Help rural patients and those lacking support networks maintain important connections with their care teams.

MEETING THE CHALLENGE

Patients download the Carium app and receive a digital health kit that includes a connected blood pressure cuff, weight scale, pulse oximeter and Google Fitbit to measure activity and sleep patterns.

As their care team builds stronger relationships with patients using the care experience platform, the biosensors collect actionable, real-time data that they use to inform ongoing evidence-based clinical decision-making.

"The program brings presurgery education, optimization and a strong connection between patients and their clinical nurse navigators that persists through discharge and beyond," Frederick explained. "This rapport doesn’t just make for a more empathetic and satisfying working environment – nurse navigators use important details about patients’ families, schedules and moods to personalize their treatment and bolster the patient experience.

"The platform automatically surfaces critical insights and signals thresholds, removing blind spots in the continuum of care, making it easier for the care team to know when interventions are required and when they’re not," he continued.

The provider/patient relationship is no longer limited by the hospital’s walls – people can heal from complex heart surgery at home while maintaining crucial virtual connections with the clinicians they depend on, he added.

"The clinical nurse navigators notice many patients take more active roles in their recovery, which helps outcomes and satisfaction," he noted. "They enjoy sharing their metrics and often use monitoring devices after the 90-day observation period."

RESULTS

Atrium Health’s Perfect Care program streamlines operations, benefiting patient outcomes and the bottom line. The initiative is driving impressive results for patients and the health system, Frederick reported. The organization is delivering better care at a lower cost and minimizing unnecessary trips to the hospital, he said.

"Thanks to the program, Sanger Heart & Vascular reduced 30-day readmissions by 40% and the average length of stay by a day," he said. "Clinical outcomes are equally impressive. The 30-day mortality rate for coronary artery bypass grafting is about 0.5% across the system, but that number is almost zero for patients in the virtual care program."

According to the Society for Thoracic Surgery, the national average is 2.5%.

Engagement among patients and care teams climbed, because patients knew help was always a call or text message away.

"Meanwhile, providers report improved patient relationships and more reliable access to timely, relevant patient data that surfaces insights when and where they’re needed," Frederick said. "Atrium Health has expanded the Carium care experience platform across its weight management, stroke, diabetes and hypertension programs, and is exploring broader implementation."

ADVICE FOR OTHERS

"Implementing virtual care technology can be a complex and daunting process – starting small and gradually expanding and optimizing the implementation can be a more effective approach," Frederick advised. "By starting with a smaller project, organizations can identify any issues and address them before implementing the technology on a larger scale.

"A thoughtful change management strategy is critical to ensure a smooth and successful implementation, transition, adoption and advocacy of a new virtual care platform," he continued. "Fear of change is real, especially when it affects processes, workflows and behaviors."

Elements of a strong change management strategy can include communication, collaboration, education and identification of the right “first followers,” who can confidently lead the way for colleagues and teams, he concluded.

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