Officials at Mary Washington Hospital didn't necessarily have their heart set on the prestigious prize of being named one of the 50 Top Cardiovascular Hospitals in the country.
Instead, about nine years ago, they made a commitment to improve their cardiovascular program in general, to focus more on care related to the heart and blood vessels, said Eileen Dohmann, chief nursing officer and senior vice president of Mary Washington Healthcare, which owns the Fredericksburg hospital.
And for good reason. Heart disease kills 1 out of 4 people each year in the United States, and it's the leading cause of death for men and women.
Mary Washington officials felt like they were doing a pretty good job with cardiovascular cases, Dohmann said. But when they took a closer look at patients recovering from heart attacks, surgeries or procedures to improve blood flow or irregular rhythms, one statistic made their heart sink.
"Our readmission rate for heart failure was among the highest in the state," Dohmann said.
The industry expects about 20 percent of those hospitalized to return within 30 days. Mary Washington was seeing almost a third of its cardiovascular patients back at the emergency room with problems.
At the same time, officials recognized they could improve their cardiac surgery program, both in procedures offered and results produced. Mike Brown took over the new position of cardiac surgery program manager in 2011 and asked for advice from peers he met at hospital conferences focused on quality.
Mary Washington put together an interdisciplinary team, made up of people who wouldn't normally sit around the table together. Surgeons and cardiologists, along with people who administer anesthesia and those who read X-rays, started looking at the patient as a whole, not just through the lens of their specialties.
Mary Washington invested $4.6 million in a Cardiac Hybrid Room that opened in late 2016 and was designed for patients who need a heart valve replacement, but are too sick to have their chests cut open. The hybrid-room procedure is less invasive; surgeons guide an artificial valve through an artery, directly into the heart, to replace the damaged valve and restore blood flow.
Mary Washington started seeing improved outcomes, fewer patients were being readmitted, and Brown started answering questions instead of asking them.
These days, when he and Dohmann go to conferences, "people from big cardiac centers come to us and want to know how we achieve what we've done," Brown said.
'IT'S VERY ELITE'
Mary Washington Hospital recently celebrated its recognition as one of the 50 Top Cardiovascular Hospitals in the nation by IBM Watson Health. No other Virginia hospitals made the cut, and Mary Washington has never received the designation in the 20-year history of the Watson Health program.
"Nationally, it's very elite," Phillip Terrell, practice leader at IBM Watson Health, told a group of Mary Washington officials. "It's right to be proud; it really is a big achievement."
The designation actually puts Mary Washington in an even smaller group because it recognizes only 20 community hospitals. The rest are teaching hospitals, with and without cardiovascular residency programs.
IBM Watson strives to address pressing health challenges through data, analytics and artificial intelligence. (Think of the computer that kicked the butts of Ken Jennings and Brad Rutter on Jeopardy! in 2011.)
Through its 50 Top Cardiovascular listing—and the broader 100 Top Hospitals program—it provides benchmarks that can help all hospitals become better, according to its website. It recognizes facilities that have significantly higher survival rates with fewer complications as well as lower readmission rates and hospital stays.
The practices not only are better for patients' health and well-being, but they also save money. If all hospitals operated as those on IBM Watson Health's Top's 50 list, the actions would save 10,300 additional lives and more than $1.8 billion, the report states. In addition, another 2,800 patients would not have developed complications after surgery.
The cardiac surgery program at Mary Washington took a critical look at its practices and put in place changes that would become standard throughout the hospital.
The use of fewer blood transfusions was among them.
The accepted thinking used to be that as long as blood wasn't contaminated, it was good to go. But Dr. Alex Na, a cardiac surgeon who joined Mary Washington in 2011, pointed out that, "It's still somebody else's blood, and it causes an inflammatory reaction in the body."
Instead of routinely offering transfusions, the hospital became more conservative, using donated blood only when necessary, Brown said. The cardiac program also looked at removing a breathing tube as quickly as possible after surgery so patients aren't susceptible to pneumonia and explored ways to reduce the instance of atrial fibrillation, or irregular heartbeats.
Just as the team looked at the whole person, members also considered that successful surgery goes beyond survival rates. It means patients can live longer and get back to the lifestyle they once enjoyed, Na said.
That certainly has been the case with Mae Fink, an 84-year-old from Spotsylvania County who was the first patient in the hybrid room. She attended a recent event at Mary Washington to celebrate the Top 50 designation.
Before she had the TAVR, or transcatheter aortic valve replacement, she could barely take a few steps without stopping to catch her breath. Her aortic valve was clogged, and her body wasn't getting the oxygen it needed.
Within hours of surgery, she was talking—and walking around the unit. The night she was dismissed from Mary Washington, she went dancing at the senior living facility where she lives.
Fink is still feeling fine. As happy as she is about the Top 50 designation, she's in no rush to be a patient again.
"It's great to see everyone," she said, hugging or shaking hands with those in white coats. "Anytime there's an event out here, I'll gladly come, but otherwise, I don't want to be here."