How to build a cardiovascular care team from the ground up

 

The heart team concept developed as part of the requirements for transcatheter aortic valve replacement (TAVR) clinical trials. These groups brought together a cardiac surgeon, interventional cardiology, nurse navigators, cardiac imager and other stakeholders to work together to formulate a treatment plan that best serves the patient's needs. Heart teams are now being used to treat patients for stroke, pulmonary embolism, heart failure and other conditions ... but there is more to creating a team than simply inviting people to meetings. 

At ACC.24, the American College of Cardiology (ACC) annual meeting, Ginger Biesbrock, DSC, PA-C, executive vice president of care transformation services at MedAxiom, shared her expertise on creating and optimizing high-functioning cardiovascular care teams during the business of cardiology sessions. Biesbrock highlighted the evolution of cardiovascular teams and their critical role in various specialized care areas.

"If you sit down on the front end, you can identify care objectives, and that then feeds into roles and responsibilities ... There are certain things that only a physician can do, there are certain things that an advanced practice provider (APP) can do, there are certain things that an RN can do," Biesbrock explained.

Developing a cohesive cardiovascular care team framework

Biesbrock emphasized the necessity of a structured approach to team development, which she outlined as a four-step process.  

   • Defining objectives of care: The first step involves clearly identifying the care objectives for a specific patient population. For instance, in structural heart disease, the objectives might include initial referral, diagnostic workup, shared decision-making, procedural care preparation and post-procedure follow-up.

   • Assigning roles and responsibilities: After defining the care objectives, it is crucial to determine the roles and responsibilities of each team member. This involves mapping tasks to appropriate license levels, ensuring that tasks requiring a physician are handled by one, while other tasks can be managed by physician assistants (PAs), nurse practitioners, registered nurses (RNs) or pharmacists.

   • Developing a longitudinal care delivery model: By mapping out the care delivery process longitudinally, a cohesive model can be established where each team member knows their role and responsibilities. This ensures a streamlined and coordinated approach to patient care, enhancing both efficiency and effectiveness.

   • Engaging and empowering team members: Encouraging team members to own their roles fosters a sense of agency and satisfaction. This ownership is crucial for the team’s overall performance and for the well-being of the team members.

"We have a diagnostic workup that needs to happen, pairing of procedural care and post-procedure follow up. Although the cardiologist could manage all of that, it's not in our best interest or our patient's best interest for that. The reason being, we need to also manage access and create teams that allow for capacity," Biesbrock explained.

Benefits of a well-structured heart team

A well-structured cardiovascular care team can also drive several key benefits, including:

   • Effectiveness and efficiency: Clearly defined roles and responsibilities ensure that each team member knows what is expected of them, reducing confusion and enhancing performance. This also allows for better management of patient capacity, addressing the challenge of limited time and resources.

   • Cost-effectiveness: Efficient team structures minimize the need for physicians to perform tasks that can be managed by other team members, optimizing resource use and reducing costs.

   • Team member well-being: A well-coordinated team environment provides job satisfaction and reduces burnout, contributing to overall team member well-being.

Measuring cardiovascular care team success

Biesbrock discussed the importance of involving stakeholders in the development of the care team, fostering ownership and trust. She noted that successful teams exhibit a culture where members have each other's backs and understand their contributions to the team's objectives. Additionally, well-defined goals and responsibilities help team members step into their roles confidently, enhancing team dynamics and performance.

She said the development of a high-functioning cardiovascular care team requires deliberate planning and a structured approach. But by defining care objectives, assigning appropriate roles, developing a coordinated care delivery model, and fostering team member engagement, healthcare providers can create effective, efficient, and satisfying care environments. She said this structured approach not only improves patient outcomes, but also enhances team performance and well-being, leading to a more sustainable and cost-effective healthcare model.

Dave Fornell is a digital editor with Cardiovascular Business and Radiology Business magazines. He has been covering healthcare for more than 16 years.

Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: dfornell@innovatehealthcare.com

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