Pittsburgh's McGinnis Institute coordinates care

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Outpatient visits to the Gerald McGinnis Cardiovascular Institute are as convenient as one-stop shopping, with doctors and other health professionals all in one place at Allegheny General Hospital.

In-hospital patients, meanwhile, benefit from a system in which all the caregivers gather daily after visiting their patients to brief each other on the patients' conditions, thus preventing overlap or omissions in care. The attending physician or a physician assistant then returns to see the patients and tell them what was reported during the briefings.

"We champion multidiscipline, patient-focused care," said Dr. Srinivas Murali, director of cardiology at Allegheny General.

So does the administration of West Penn Allegheny Health System, which includes Allegheny General and other hospitals.

A patient- and family-centered care system is in place in the maternity department at Western Pennsylvania Hospital in Bloomfield, a spokeswoman said. At its Ed Dardanell Heart & Vascular Center at West Penn Hospital-Forbes Regional Campus, patients are being debriefed on their experiences, good and bad, at focus groups.

"We're actually doing innovative things at Forbes Dardanell Center that allow the patient-and-family experience," said Diane Frndak, vice president of organizational excellence for the health system. "We have a grant from Highmark Foundation to do more creative problem-solving and process redesign using the entire team that cares for the patient."

The entire-team approach is well-established for both outpatients and inpatients at Allegheny General's McGinnis Institute.

For the former, it starts when they pull into the huge driveway outside the main entrance of the 7,000-square-foot first-floor complex and their cars are parked by a valet. "Most of our patients come from outside of Allegheny County," Dr. Murali said. "They're not used to the traffic and the congestion."

From there, the outpatient can go to a series of visits with doctors and professionals connected to his condition and have all needed tests and blood work done within the McGinnis complex.

"How we are different [is] frequently a patient may have to make an appointment to see a doctor and then [that doctor] says the patient should see another specialist, and the patient ends up needing to make another appointment. We try to have as many [doctors and professionals] in one place as we can. It really benefits the patient," he said.

Besides seeing doctors and having tests, the outpatients can talk to a pharmacist who might suggest substituting less-expensive generic equivalent drugs for brand-name pharmaceuticals; nurses who educate them on such topics as nutrition and the signs and symptoms of heart disease; a psychiatrist; and/or a social service specialist.

"At the end of the visit we have enough information to make informed decisions on the patient's care," Dr. Murali said.

The same holds true with the team-approach rounds done for inpatients. Each caregiver involved in a case visits the patient, and then all caregivers get together to share information.

Consider, for example, the group that met Dec. 22 to discuss the conditions of all the heart failure patients currently hospitalized. Present were Dr. Murali, trainees and/or fellows; a physician assistant, a nurse manager who does palliative and hospice care, a social worker, a case manager and a dietitian.

"One big challenge is the communication among health professionals involved in the care of a patient," Dr. Murali said. "[Here] the kidney specialist talks to the cardiologist."

During this meeting, the group, using a laptop computer, looked at up-to-date reports and test results, including X-rays. A nurse talked about a patient who had returned to the hospital with open sores. The group discussed the condition of a heart transplant patient who was not recovering as quickly as he should have been.

A similar meeting was held later to discuss transplant patients, both pre-op and post-op. Those present include Dr. Murali, transplant surgeon Dr. David Dean, a clinical pharmacist, the transplant coordinator, and a cardiac rehabilitation specialist.

After the rounds, Dr. Murali visited mechanical heart recipient Deborah Rankin of Penn Hills, who was getting ready to go home after treatment for a gastrointestinal bleed. She got the artificial heart Feb. 19 and had since been placed on the transplant list.

Ms. Rankin couldn't say enough good things about her patient-centered care in the McGinnis Institute.

"From Day 1 everyone has been wonderful, from the kitchen on up," she said. "I've had the best of care; they keep me in the loop. I ask questions; they explain. They've been very accommodating."

Pohla Smith can be reached at psmith@post-gazette.com or 412-263-1228.


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