Peripheral vascular disease (PVD) care has become a hot topic in hospital and medical circles over past few years. The attention topic has been receiving is analogous to famous line in movie, The Graduate when star was given advice to go to work in “plastics” to ensure career success. As with “plastics,” PVD care has not taken off as expected. A number of factors have influenced development—or lack of development—with greatest being PVD’s “big sister,” coronary artery disease, claiming most of healthcare attention, to say nothing about its appetite for resources.

Should your hospital or health system focus on and commit resources to enhance PVD services? What is market opportunity? What is revenue potential? What does a “best” program look like? Spending time doing research and working through these questions will take guesswork out of identifying emerging opportunity for peripheral vascular care for your organization.

What is PVD?

PVD is a condition in which arteries that carry blood throughout body become narrowed or clogged. This interferes with normal flow of blood and can cause pain and physical limitations. Conditions affecting arteries of heart are considered Coronary Artery Disease (CAD).

One of most significant risk factors for PVD is age. The older population is projected to double over next 30 years, reaching 70 million by 2030. A national study: PAD Awareness, Risk and Treatment—New Resources for Survival (PARTNERS published in Journal of American Medical Association (JAMA September 19, 2001) found that PVD is seriously under-diagnosed and under-treated. The American Heart Association and Harvard Health estimate: •300,000 PVD cases are diagnosed each year. •Eight to 10 million Americans are affected. •PVD is two to five times more common in men. •PVD patients have a six-fold higher death rate from cardiovascular disease. •PVD patients have a 15 percent chance of dying within five years when symptomatic. •PVD patients have a 50 percent chance of dying within 10 years from PVD.

Who Treats PVD?

Treatment for PVD can follow three main pathways:

•Noninvasive disease management that includes risk-factor reduction, medications to relieve symptoms and increase exercise tolerance and gene-based therapy. •Surgical intervention that is safe and effective for many patients in whom less invasive procedures are not adequate. •Catheter-based treatments that have an important and increasing role in treatment of PVD.

Primary Care Physicians are often first provider to identify problem. Cardiologists may identify PVD during cardiac catheterization procedures.

The more complicated issue related to PVD is which specialist should provide treatment. Traditionally, interventional radiologists and vascular surgeons have treated patients with advanced stage PVD. With introduction of catheter-based interventions, cardiologists are treating PVD in catheterization lab. This shift has set stage for cultural and political “turf wars” that need to be addressed and resolved if a hospital is to have a full service, integrated program.

Features and Benefits

The One Stop Post Op™ concept of post-operative open-heart surgery care provides patient focused care across continium, from pre and immediate post-op period until discharge. The level of patient care changes, equipment changes, but patient remains in same room receiving care from same nursing staff. While this is not a new concept to health care, it is relatively new to post-operative open heart surgery recovery. In traditional open heart surgery recovery models patient is transferred from an Intensive Care Unit to an intermediate care unit and possibly to a non-monitored bed prior to discharge. The traditional process moves patient to care source instead of applying a patient responsive approach that delivers services directly to hospital’s customer.

The One Stop Post Op™ model reduces care costs by eliminating inefficiencies associated with transfers. Streamlining care delivery affects length of stay as consistent caregivers, familiar with patients and medical conditions that can occur following OHS surgery, recognize and immediately address complications. The nurses in “one-stop CVU units” are clinical specialists in pre and postoperative open-heart surgery care, experts in early recognition of clinical complications and can provide rapid intervention, optimizing clinical pathway variance monitoring and management. In addition, One Stop Post OP™ nursing and ancillary staff address patient discharge issues of homecare, family support and skilled facility placement, eliminating a fragmented planning process that can frequently occur when patients are transferred to several post operative care units.

Physicians, nurses and ancillary staff have opportunity to bond as a continuous quality improvement team that can experience success of discharging patients who have recovered from their OHS surgery. This is “real time” quality feedback. Satisfaction is not limited to patients and families; physician, staff and ancillary personnel appreciate this innovative approach to care. The One Stop Post Op™ model provides an environment that facilitates staff empowerment and ownership with all caregivers focusing on entire recovery process.

Key Points

Excellent satisfaction: Patients, Nurses, Physicians The One Stop Post Op ™ cardiovascular recovery unit has documented results that patient satisfaction can be improved with this innovative care delivery model. Nursing retention was higher and was attributed to increased job satisfaction while working in a unit that implemented this model. Physician survey scores reported excellent grades for patient care and nurse response.