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CARDIOLOGY: How to organize a successful heart and vascular service line in an academic medical center

Reorganization of cardiology-related services into a cohesive heart and vascular service line in 2005 at UMass Memorial Health Care is described in this lengthy article.  The service line was built by consolidating the previously separate divisions of cardiovascular medicine, cardiothoracic surgery, and endovascular surgery.  This article covers key success factors as well as major barriers and challenges.  The reorganized service line was found to have favorable outcomes financially and in other aspects over the study period from 2006 to 2011.

Special Note: There is an ORG CHART showing the relationship of the service line leadership on up to the hospital president.

Source:  Phillips, R.A., Cyr, J., Keaney, J.F., Jr., and others. (2015, Oct.). Creating and maintaining a successful service line in an academic medical center at the dawn of value-based care: Lessons learned from the heart and vascular service line at UMass Memorial Health Care. Academic Medicine, 90(10), 1340-1346.  Available for purchase here: http://journals.lww.com/academicmedicine/pages/articleviewer.aspx?year=2015&issue=10000&article=00020&type=abstract (Posted by AHA Resource Center (312) 422-2003), rc@aha.org


Top 30 Accountable Care Organizations – Update

SK&A has updated its ranking of the largest accountable care organizations based on the number of participating physicians. SK&A identified 657 ACOs as of September 2015, including Medicare Shared Savings Programs, commercial ACOs, Medicaid ACOs, and Pioneer ACOs.

Montiefiore ACO & United HealthCare, a commercial ACO, topped the list with 4,630 participating physicians and 1,151 facilities. Second on the list was a Medicaid ACO in Oregon, FamilyCare Inc., with 3,769 physicians and 1,372 facilities participating. The largest Pioneer ACO, Heritage California ACO, was ranked seventh, and Advocate Physician Partners Accountable Care Inc. was the largest MSS Program and ninth on the ranking.

Source: Top 30 accountable care organizations: SK&A market insight report. SK&A, Sept. 2015. http://www.skainfo.com/health_care_market_reports/ACO_Top30.pdf [Free registration may be required to view]

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

SPACE PLANNING: Imaging GSF per procedure room

Health facility space planners sometimes make use of benchmark ratios such as those given in this very short article to determine a preliminary space estimate based on the number of procedure rooms desired.  Here is an example: For CT scanners, 1,200 to 1,500 departmental gross square feet per procedure room.  The lower end of the range is for larger suites; the higher end for smaller suites.  Similar ratios are given for radiography/fluoroscopy, mammography, MRI, ultrasound, and nuclear medicine.  There is also a ratio given for outpatient multi-modality diagnostic imaging centers.

This information comes from Hayward & Associates, a health care facility planning consultancy that publishes the design manual SpaceMed.

Source: Estimating diagnostic imaging space based on the number of procedure rooms. (2015, Fall).  SpaceMed Newsletter. https://www.spacemed.com/newsletter/rule-83-imagingspace.pdf

Do ambulatory surgery centers affect hospital utilization?

Opening a freestanding ambulatory surgery center in a market where there previously had not been one decreased outpatient surgical volume at the local hospital by 7 percent, according to a large-scale study of Medicare beneficiaries.  The shift from hospital-based to ASC-based outpatient procedures was particularly pronounced for ophthalmology.  The researchers also analyzed the effect on quality of care and found no impact on either hospital admission within 30 days or on mortality rates due to the opening of an ambulatory surgery center.

Source: Hollenbeck, B.K., Dunn, R.L., Suskind, A.M., and others. (2015, Oct.). Ambulatory surgery centers and their intended effects on outpatient surgery. HSR. Health Services Research, 50(5), 1491-1507.  http://onlinelibrary.wiley.com/doi/10.1111/1475-6773.12278/abstract  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

NURSES: Average age of hospital RNs is about 43

The average age of RNs working in hospitals has held constant at about 43 years old for at least the past 10 years, according to one of my favorite sources of data on nurse staffing — the Survey of Hours Report — conducted and published by the Labor Management Institute.  Interestingly, this statistic does not vary much based on whether the hospital is a teaching hospital, a community hospital, or a rural hospital.  The findings are based on a survey taken each year, to which about 200 hospitals nationwide respond.

Most of this report is devoted to survey results related to RN to patient ratios for different types of nursing units, hours per patient day for different units, turnover, vacancy, time to hire, patient falls rates, medication error rates, and LOTS of other interesting statistics.

Source: 2014 PSS Survey of Hours Report.  Bloomington, Minn.: Labor Management Institute, p. 448.  [And earlier editions.]  http://lminstitute.com/products  Posted by AHA Resource Center (312) 422-2050 rc@aha.org

What happens in a government shutdown?

September 30 marks the end of the federal government’s fiscal year, which makes early fall one key time when political contention sometimes brings the threat of a government shutdown.  Sometimes it remains merely a threat, but there were, in fact, shutdowns in 1995 (21 days) and in 2013 (16 days).  I am writing this post on September 30, 2015, and the New York Times is reporting today that it looks like a shutdown will be averted this year.

However, agencies prepared contingency plans for a 2015 shutdown – and you can read them on the website of the Office of Management and Budget here:  https://www.whitehouse.gov/omb/contingency-plans

Modern Healthcare reported that a short shutdown would probably not have much impact on health care providers.  Medicare reimbursement comes from a trust fund separate from annual federal appropriations.  Veterans Affairs hospitals were expected to remain open.

A particular challenge for 2015 would be trying to implement the ICD-10 coding system at the time that a government shutdown would hit.


Herszenhorn, D.M. (2015, Sept. 30). Senate passes spending bill to avert government shutdown. The New York Times. http://www.nytimes.com/2015/10/01/us/politics/government-shutdown-congress.html?_r=0

Kessler, G. (2011, Feb. 25). Lessons from the great government shutdown of 1995-1996. The Washington Post. http://voices.washingtonpost.com/fact-checker/2011/02/lessons_from_the_great_governm.html

Kutscher, B. (2015, Sept. 28). Prolonged government shutdown would affect providers. Modern Healthcare, 45(39), 4.  http://www.modernhealthcare.com/article/20150926/MAGAZINE/309269941/prolonged-government-shutdown-would-affect-providers

Conn, J. (2015, Sept. 28). CMS preps for an upload and a shutdown. Modern Healthcare, 45(39), 4.  http://www.modernhealthcare.com/article/20150926/MAGAZINE/309269940

Mercia, D. (2013, Oct. 4). 995 and 2013: three differences between two shutdowns. CNN Politicshttp://www.cnn.com/2013/10/01/politics/different-government-shutdowns/

HOSPITAL DESIGN: Location of OR in relation to ED?

Some years ago, I was asked to find articles that mentioned where the emergency department was in relation to the surgical suite in hospitals.  A recent article on this topic (the one about Parkland below) caught my eye for that reason, and I decided to see what else might come up in a quick search of the literature.

Advice from Hayward & Associates (architects and space planners)

  • Emergency department entrance should be at grade level
  • These areas should be adjacent to the ED or directly accessible via elevator: Surgical suite, intensive care units, labor and delivery
  • The elevator should be oversized – large enough for stretcher, staff, and pieces of patient care equipment
  • If trauma service is provided – there must be a direct route from ED to surgical suite.  This can be a dedicated corridor if the departments are on the same level, or via elevator

CASE STUDY: Albert Einstein Medical Center (Philadelphia, PA) – 2009 article

  • Surgical suite is three floors above the ED
  • Cath lab is one floor above the ED

CASE STUDY: Carilion Roanoke Memorial Hospital (Roanoke, VA) – 2003 article

  • Cardiac cath labs and cardiac OR is four floors above ED and imaging departments

CASE STUDY: Emory University Hospital (Atlanta, GA) – 2014 article

  • Cath lab on 4th floor
  • Surgical suite on 3rd floor
  • ED on 1st floor

CASE STUDY: Florida Hospital (Orlando, FL) – 2011 article

  • Cath lab is 2 floors directly above the ED
  • Surgical suite is also 2 floors above the ED – but at some distance from the cath lab

CASE STUDY: Mercy Hospital (Springfield, MO) – 2012 article

  • Surgical suite is 2 floors above the ED
  • Cath lab is 3 floors above the ED
  • At the time this was written, they were anticipating a new heart institute project which would put the cath lab adjacent to the surgical suite.

CASE STUDY: Parkland Hospital (Dallas, TX) – 2015 article

  • New replacement hospital
  • ED designed for 180,000 visits per year
  • 154 treatment rooms in pods of 12 or 14
  • There are 4 trauma rooms – equipped as surgical suites – in the ED
  • The surgical suite is two floors above the ED
  • There are two trauma elevators – the largest dubbed the ‘megavator’

CASE STUDY: St. Agnes Medical Center (Fresno, CA) – 2015 article

  • Cardiothoracic services (3 cath lab suites and 4 dedicated operating rooms) are located 2 floors above the ED

CASE STUDY: University Health System (San Antonio, TX) – 2007 article

  • ED is on the sublevel with cath labs close by
  • Imaging is two floors up
  • Surgical suite is on the 11th floor
  • There are trauma elevators


Hayward, C. (2015). SpaceMed guide: A space planning guide for healthcare facilities. (3rd ed.). Ann Arbor, Mich.: HA Ventures, p. 1-12 to 1-13, and 2-15 to 2-16.

[About Albert Einstein]. Visco, J., and Irwin, G.H. (2009, Aug.). Albert Einstein Medical Center. Cath Lab Digest, 17(8). Retrieved from http://www.cathlabdigest.com/articles/Albert-Einstein-Medical-Center

[About Carilion]. Smith, C.D. (2003, Sept.). Carilion Roanoke Memorial Hospital. Cath Lab Digest11(9). Retrieved from http://www.cathlabdigest.com/articles/Carilion-Roanoke-Memorial-Hospital

[About Emory]. Sarpong, N. (2014, Dec.). Spotlight: Emory University Hospital cardiac cath lab. Cath Lab Digest, 22(12). Retrieved from http://www.cathlabdigest.com/article/Spotlight-Emory-University-Hospital-Cardiac-Cath-Lab

[About Florida]. Egolf, B. (2011, Sept.). Florida Hospital. Cath Lab Digest, 19(9). Retrieved from http://www.cathlabdigest.com/articles/Florida-Hospital

[About Mercy]. Hutchison, L.M., and Myears, D.W. (2012, Oct.). Spotlight interview: Mercy Springfield. Cath Lab Digest. 20(10). Retrieved from http://www.cathlabdigest.com/articles/Spotlight-Interview-%EF%BB%BFMercy-Springfield

[About Parkland]. Eagle, A. (2015, Sept.). Minutes count: Designs that improve ED performance. Health Facilities Management, 28(9), 16-21. Retrieved from http://www.hfmmagazine.com/display/HFM-news-article.dhtml?dcrPath=/templatedata/HF_Common/NewsArticle/data/HFM/Magazine/2015/Sept/hfm-emergency-department-designs-improving-emergency-department-design

[About St. Agnes]. (2015, Aug.). Spotlight: Saint Agnes Medical Center. Cath Lab Digest23(8). Retrieved from http://www.cathlabdigest.com/article/Spotlight-Saint-Agnes-Medical-Center

[About University Health System]. Espanto, F.D. (2007, June). University Health System. Cath Lab Digest. 15(6). Retrieved from http://www.cathlabdigest.com/articles/University-Health-System  Posted by AHA Resource Center (312) 422-2050, rc@aha.org


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