1 00:00:01,520 --> 00:00:04,080 Every year, Becker's annual meeting brings health care 2 00:00:04,080 --> 00:00:06,559 leaders together to unpack the most pressing issues 3 00:00:06,559 --> 00:00:07,620 facing the industry. 4 00:00:08,000 --> 00:00:10,820 And every year, those conversations shift in profound 5 00:00:10,880 --> 00:00:12,179 and unexpected ways. 6 00:00:12,559 --> 00:00:14,880 This April, more than 3,500 7 00:00:14,880 --> 00:00:17,024 health care executives will return to Chicago 8 00:00:17,324 --> 00:00:19,265 for Becker's sixteenth annual meeting. 9 00:00:19,725 --> 00:00:21,005 795 10 00:00:21,005 --> 00:00:23,804 elite speakers will offer new lessons, new case 11 00:00:23,804 --> 00:00:26,385 studies, and predictions about what comes next. 12 00:00:26,685 --> 00:00:28,945 Join us April 13 through the sixteenth. 13 00:00:29,324 --> 00:00:31,265 For the agenda and event details, 14 00:00:31,609 --> 00:00:33,770 visit beckershospitalreview.com 15 00:00:33,770 --> 00:00:35,609 and click on the events tab in the 16 00:00:35,609 --> 00:00:36,429 upper right. 17 00:00:37,690 --> 00:00:40,729 Welcome to the Becker's Healthcare podcast. I'm Mariah 18 00:00:40,729 --> 00:00:42,969 Taylor, assistant editor, and I'm thrilled to be 19 00:00:42,969 --> 00:00:47,195 interviewing Justin Dunn, interventional cardiologist and regional director 20 00:00:47,195 --> 00:00:49,674 of the Valve and Structural Heart Disease Center 21 00:00:49,674 --> 00:00:52,894 at University Hospitals Harrington Heart and Vascular Institute. 22 00:00:53,674 --> 00:00:56,074 Justin, thank you so much for joining me 23 00:00:56,074 --> 00:00:58,049 today. I'm really excited to learn more about 24 00:00:58,049 --> 00:01:00,770 how your system is decentralizing cardiac care. But 25 00:01:00,770 --> 00:01:02,609 before we dive in, I'd love you to 26 00:01:02,609 --> 00:01:04,209 introduce yourself and tell us a bit about 27 00:01:04,209 --> 00:01:04,869 your background. 28 00:01:05,329 --> 00:01:07,269 Well, thank you for having me. My name 29 00:01:07,569 --> 00:01:10,069 is Justin Dunn. I'm an interventional cardiologist, 30 00:01:11,084 --> 00:01:12,625 and I focus on, 31 00:01:13,084 --> 00:01:14,385 structural heart disease. 32 00:01:15,645 --> 00:01:16,045 And, 33 00:01:16,844 --> 00:01:19,185 I have been here in practice, 34 00:01:19,885 --> 00:01:22,064 for about just over ten years. 35 00:01:23,180 --> 00:01:23,680 Amazing. 36 00:01:24,540 --> 00:01:26,299 Now give me a little bit of an 37 00:01:26,299 --> 00:01:27,840 overview of what decentralized 38 00:01:28,219 --> 00:01:30,379 heart care looks like at your system, and 39 00:01:30,379 --> 00:01:33,420 what were the motivations for expanding advanced heart 40 00:01:33,420 --> 00:01:34,799 care beyond the main campus? 41 00:01:35,844 --> 00:01:37,305 Well, you know, 42 00:01:37,924 --> 00:01:39,784 larger health systems often have 43 00:01:40,245 --> 00:01:40,745 difficulty 44 00:01:41,125 --> 00:01:43,305 with some of their complex procedures, 45 00:01:44,325 --> 00:01:46,025 especially with growth of programs, 46 00:01:46,405 --> 00:01:48,344 like we have had here at university hospitals. 47 00:01:49,159 --> 00:01:52,200 The programs often get congested, and patients have 48 00:01:52,200 --> 00:01:53,819 a difficult time getting in, 49 00:01:54,200 --> 00:01:55,959 to get their procedures done. We've had a 50 00:01:55,959 --> 00:01:58,599 very successful structural heart program here at university 51 00:01:58,599 --> 00:01:59,099 hospitals. 52 00:01:59,719 --> 00:02:01,500 And, as a result of that, 53 00:02:01,984 --> 00:02:02,484 we 54 00:02:02,784 --> 00:02:04,645 have seen that, you know, 55 00:02:05,504 --> 00:02:06,805 lab space and, 56 00:02:07,584 --> 00:02:09,925 clinic space is becoming more and more congested. 57 00:02:10,465 --> 00:02:12,784 And, you know, as our health system expands 58 00:02:12,784 --> 00:02:13,525 out into 59 00:02:13,919 --> 00:02:14,419 communities, 60 00:02:14,879 --> 00:02:16,500 we have found that patients often, 61 00:02:17,199 --> 00:02:19,519 want to get their procedures done closer to 62 00:02:19,519 --> 00:02:20,500 home if possible. 63 00:02:20,879 --> 00:02:22,560 And so we thought, well, you know, if 64 00:02:22,560 --> 00:02:24,479 we set up the right infrastructure and and, 65 00:02:24,799 --> 00:02:26,019 bring in the right people, 66 00:02:26,319 --> 00:02:28,560 we should be able to provide these complex 67 00:02:28,560 --> 00:02:29,060 procedures, 68 00:02:29,895 --> 00:02:31,974 in our community hospitals closer to the patient's 69 00:02:31,974 --> 00:02:32,474 homes. 70 00:02:33,014 --> 00:02:35,175 And we can get them in faster and 71 00:02:35,175 --> 00:02:36,314 get them treated faster, 72 00:02:36,775 --> 00:02:38,555 and subsequently get them home faster. 73 00:02:38,935 --> 00:02:40,534 So that was some of the motivation. We 74 00:02:40,534 --> 00:02:42,715 felt this would increase access 75 00:02:43,129 --> 00:02:45,469 to care for patients in our health system, 76 00:02:45,530 --> 00:02:46,510 and it would bring 77 00:02:47,129 --> 00:02:49,629 the complex care closer to their homes 78 00:02:50,010 --> 00:02:52,889 so that families and patients didn't have to 79 00:02:52,889 --> 00:02:54,030 travel so far, 80 00:02:54,569 --> 00:02:56,650 to come for procedures and visit family members 81 00:02:56,650 --> 00:02:58,110 and to come for appointments, etcetera. 82 00:02:59,185 --> 00:02:59,685 Amazing. 83 00:03:00,224 --> 00:03:01,905 And what are some of the benefits that 84 00:03:01,905 --> 00:03:04,405 you've seen for patients, staffs, and the organization? 85 00:03:05,264 --> 00:03:06,625 Well, this has been a huge success. I 86 00:03:06,625 --> 00:03:08,884 mean, we started expanding out to the community 87 00:03:08,944 --> 00:03:10,485 approximately six months ago, 88 00:03:10,944 --> 00:03:13,889 and we have had outstanding success both from 89 00:03:13,889 --> 00:03:15,030 an outcome standpoint 90 00:03:15,569 --> 00:03:17,909 and, from a patient satisfaction standpoint. 91 00:03:19,010 --> 00:03:20,230 Our patients now, 92 00:03:20,930 --> 00:03:22,689 can go to the hospitals that they're comfortable 93 00:03:22,689 --> 00:03:24,770 with, the ones that they're familiar with. They 94 00:03:24,770 --> 00:03:26,844 go to the hospitals where they go to 95 00:03:26,844 --> 00:03:28,844 see their other physicians, where they show up 96 00:03:28,844 --> 00:03:29,665 in the ER, 97 00:03:30,125 --> 00:03:32,045 all closer to home, and we can continue 98 00:03:32,045 --> 00:03:34,045 to provide care for them even if there 99 00:03:34,045 --> 00:03:34,545 are, 100 00:03:35,485 --> 00:03:38,125 advanced complex procedures that they might need. We 101 00:03:38,125 --> 00:03:39,805 can continue to provide that care closer to 102 00:03:39,805 --> 00:03:41,085 home for them and not have them have 103 00:03:41,085 --> 00:03:43,889 to travel far to our, to our main 104 00:03:43,889 --> 00:03:44,790 hub campus, 105 00:03:45,409 --> 00:03:47,170 which is often far away for some of 106 00:03:47,170 --> 00:03:47,830 these patients. 107 00:03:48,610 --> 00:03:50,050 And so we have seen, 108 00:03:51,250 --> 00:03:52,629 that patients are 109 00:03:52,930 --> 00:03:55,030 thrilled to be able to have this opportunity. 110 00:03:55,250 --> 00:03:56,550 Their families are thrilled. 111 00:03:57,125 --> 00:03:57,625 And, 112 00:03:58,564 --> 00:04:00,324 we have structured the program in a way 113 00:04:00,324 --> 00:04:03,284 that we set up the appropriate infrastructure so 114 00:04:03,284 --> 00:04:03,784 that 115 00:04:04,085 --> 00:04:04,724 we have, 116 00:04:05,125 --> 00:04:05,625 guaranteed 117 00:04:05,925 --> 00:04:07,544 essentially the same outcomes 118 00:04:08,004 --> 00:04:09,224 at our regional 119 00:04:09,900 --> 00:04:10,800 community hospitals, 120 00:04:11,659 --> 00:04:12,719 as they would expect 121 00:04:13,099 --> 00:04:15,439 and would find at our main campus hospital. 122 00:04:15,900 --> 00:04:17,839 So number one, we've seen 123 00:04:18,620 --> 00:04:21,600 excellent access for patients. We've seen patient satisfaction, 124 00:04:21,660 --> 00:04:25,154 and we've seen, excellent outcomes. Same outcomes that 125 00:04:25,154 --> 00:04:26,435 we would see if they came to a 126 00:04:26,435 --> 00:04:27,095 main campus. 127 00:04:27,475 --> 00:04:29,555 And number two, you know, we've seen, 128 00:04:29,875 --> 00:04:31,954 growth in our program, significant growth. I mean, 129 00:04:31,954 --> 00:04:33,954 even in six months, we've seen a 25% 130 00:04:33,954 --> 00:04:35,415 increase in our in our volume, 131 00:04:36,435 --> 00:04:38,449 just last year. So, and a lot of 132 00:04:38,449 --> 00:04:39,490 it has to do with being able to 133 00:04:39,490 --> 00:04:41,569 get patients in for these procedures. You know, 134 00:04:41,569 --> 00:04:42,930 these patients who would have been waiting to 135 00:04:42,930 --> 00:04:44,850 try to get in to a procedure down 136 00:04:44,850 --> 00:04:47,090 at our main campus, which might have been 137 00:04:47,090 --> 00:04:49,830 delayed due to space or timing or scheduling, 138 00:04:50,930 --> 00:04:52,790 now can be treated much more quickly, 139 00:04:53,514 --> 00:04:56,095 by by an advanced team that's experienced, 140 00:04:56,954 --> 00:04:58,794 and with the same type of equipment that 141 00:04:58,794 --> 00:05:00,334 they would get down at our main campus. 142 00:05:01,274 --> 00:05:04,555 And we found that, overall, not only do 143 00:05:04,555 --> 00:05:07,035 the patients benefit, but the organization as a 144 00:05:07,035 --> 00:05:07,854 whole benefits 145 00:05:08,339 --> 00:05:11,399 by, getting patients in faster, increased patient satisfaction, 146 00:05:11,540 --> 00:05:13,480 increased volumes, and similar 147 00:05:13,939 --> 00:05:14,439 outcomes. 148 00:05:15,220 --> 00:05:17,620 Those are some really impressive results. And as 149 00:05:17,620 --> 00:05:19,620 you might be aware, there's a few other 150 00:05:19,620 --> 00:05:22,004 systems out there that are testing this kind 151 00:05:22,004 --> 00:05:22,665 of decentralized 152 00:05:22,965 --> 00:05:25,545 heart care. But for those that are considering 153 00:05:25,605 --> 00:05:28,085 it and haven't started yet, what are some 154 00:05:28,085 --> 00:05:30,985 of your best practices for building the quality 155 00:05:31,045 --> 00:05:32,665 care in a community hospital? 156 00:05:33,620 --> 00:05:35,480 Well, I think number one, you have to 157 00:05:35,699 --> 00:05:37,779 put in the work upfront to make sure 158 00:05:37,779 --> 00:05:40,180 that you have all the necessary parts in 159 00:05:40,180 --> 00:05:41,319 place to guarantee 160 00:05:41,699 --> 00:05:42,919 that your patient has 161 00:05:43,220 --> 00:05:45,399 an excellent outcome. I mean, these patients, 162 00:05:46,419 --> 00:05:47,480 expect to 163 00:05:47,845 --> 00:05:49,524 have the best possible outcome when they come 164 00:05:49,524 --> 00:05:51,305 in, especially for an elective procedure. 165 00:05:52,485 --> 00:05:54,485 And when they come in, they don't want 166 00:05:54,485 --> 00:05:56,324 to say, well, I have I'll have one 167 00:05:56,324 --> 00:05:58,245 type of outcome at one facility and a 168 00:05:58,245 --> 00:06:00,264 different type of outcome at a different facility. 169 00:06:00,404 --> 00:06:02,004 We have to make sure that that's consistent 170 00:06:02,004 --> 00:06:04,419 across the system. And so that includes things 171 00:06:04,419 --> 00:06:04,819 like, 172 00:06:05,540 --> 00:06:08,740 making sure that your cath lab equipment is, 173 00:06:09,379 --> 00:06:11,620 appropriately stocked with the right equipment you need 174 00:06:11,620 --> 00:06:13,379 for the procedures, the right equipment you need 175 00:06:13,379 --> 00:06:15,399 for bailout in difficult situations. 176 00:06:15,754 --> 00:06:17,995 You wanna make sure that your, equipment is 177 00:06:17,995 --> 00:06:19,294 consistent across the system. 178 00:06:19,595 --> 00:06:22,154 You wanna make sure your staff is trained 179 00:06:22,154 --> 00:06:24,954 appropriately so that they have the experience necessary 180 00:06:24,954 --> 00:06:26,334 to make sure that they feel comfortable 181 00:06:26,714 --> 00:06:28,555 providing the same type of procedure across the 182 00:06:28,555 --> 00:06:30,254 system and providing the same outcomes. 183 00:06:30,930 --> 00:06:32,290 And, you know, we wanna make sure that 184 00:06:32,290 --> 00:06:35,170 all the ancillary care is also trained. So 185 00:06:35,170 --> 00:06:37,250 things like for for example, when we're talking 186 00:06:37,250 --> 00:06:40,370 about AVR procedures or transcatheter aortic valve replacements, 187 00:06:40,370 --> 00:06:42,209 which is kinda how we started growing this 188 00:06:42,209 --> 00:06:42,709 program, 189 00:06:43,410 --> 00:06:44,050 you need to have, 190 00:06:44,805 --> 00:06:47,064 ultrasound techs, echo techs that understand 191 00:06:47,605 --> 00:06:49,524 how to look at these valves and and 192 00:06:49,524 --> 00:06:51,365 participate in these valve procedures. You need to 193 00:06:51,365 --> 00:06:53,605 have ICU staff that understand what to look 194 00:06:53,605 --> 00:06:55,365 for when patients come to the ICU after 195 00:06:55,365 --> 00:06:56,024 these procedures. 196 00:06:56,725 --> 00:06:57,944 You have to have anesthesia 197 00:06:58,589 --> 00:06:59,089 understanding 198 00:06:59,709 --> 00:07:01,709 what they might be expected to do in 199 00:07:01,709 --> 00:07:03,649 a routine case or possibly in a case 200 00:07:03,870 --> 00:07:06,670 that has some complexities or some differences outside 201 00:07:06,670 --> 00:07:07,569 of what's routine. 202 00:07:07,949 --> 00:07:09,790 So having all these things in place upfront 203 00:07:09,790 --> 00:07:12,050 is critical before you start doing these procedures. 204 00:07:13,685 --> 00:07:15,064 And I think if somebody 205 00:07:15,444 --> 00:07:17,444 if a if a hospital wanted to endeavor 206 00:07:17,444 --> 00:07:19,524 on this, all these parts need to be 207 00:07:19,524 --> 00:07:20,264 in place, 208 00:07:20,644 --> 00:07:21,464 from the beginning. 209 00:07:22,164 --> 00:07:22,664 Otherwise, 210 00:07:23,444 --> 00:07:25,770 you'll get into a situation where things might 211 00:07:25,770 --> 00:07:27,449 go fine for a while, but then you 212 00:07:27,449 --> 00:07:29,770 have, kind of an outlier case and you're 213 00:07:29,770 --> 00:07:32,250 not prepared for how to manage that. So 214 00:07:32,250 --> 00:07:33,689 I think it's critical to get things in 215 00:07:33,689 --> 00:07:34,509 place upfront. 216 00:07:35,370 --> 00:07:36,430 Excellent advice. 217 00:07:36,810 --> 00:07:38,410 Now let's look a little bit into the 218 00:07:38,410 --> 00:07:40,730 future. There's a lot of different elements going 219 00:07:40,730 --> 00:07:42,425 on with any kind of heart care and 220 00:07:42,425 --> 00:07:44,504 with all the different programs you're doing. So 221 00:07:44,504 --> 00:07:47,004 what are your priorities in 2026? 222 00:07:48,024 --> 00:07:50,185 Well, I think we started our, 223 00:07:50,745 --> 00:07:52,845 growth of our structural heart program with transcatheter, 224 00:07:53,384 --> 00:07:55,865 aortic valve replacement, the TAVR procedure, and also 225 00:07:55,865 --> 00:07:57,120 left atrial appendage occlusions. 226 00:07:57,600 --> 00:08:00,319 So both these procedures are are done at 227 00:08:00,319 --> 00:08:02,800 our institution with conscious sedation. We're already we're 228 00:08:02,800 --> 00:08:04,639 using equipment that was already existing in our 229 00:08:04,639 --> 00:08:06,560 community hospital for the most part, so we 230 00:08:06,560 --> 00:08:09,040 already had hybrid cath labs in our community 231 00:08:09,040 --> 00:08:09,540 hospitals. 232 00:08:10,000 --> 00:08:13,314 And so we started with programs that did 233 00:08:13,314 --> 00:08:13,814 not, 234 00:08:14,194 --> 00:08:17,074 require us to do a huge outpouring of 235 00:08:17,074 --> 00:08:19,314 upfront resources, and we kinda said, okay. What 236 00:08:19,314 --> 00:08:21,955 resources do we have available already that can 237 00:08:21,955 --> 00:08:24,055 that can serve in the role of, 238 00:08:24,754 --> 00:08:27,839 performing these procedures with the appropriate outcomes? So 239 00:08:28,000 --> 00:08:29,680 we started with TAVR and left atrial appendage 240 00:08:29,680 --> 00:08:31,600 occluders. We've had wild success with that here 241 00:08:31,600 --> 00:08:33,440 at University Hospital. It's it's been a huge 242 00:08:33,440 --> 00:08:35,379 success, and we've been really proud of it. 243 00:08:35,440 --> 00:08:36,960 But I think we can we can grow 244 00:08:36,960 --> 00:08:39,200 beyond this. I think, we can expand other 245 00:08:39,200 --> 00:08:41,804 parts of structural heart disease. For example, mitral 246 00:08:41,804 --> 00:08:43,824 valve interventions, tricuspid valve interventions, 247 00:08:44,125 --> 00:08:45,824 things that require a little bit more 248 00:08:46,204 --> 00:08:47,804 have a little bit more involvement from an 249 00:08:47,804 --> 00:08:49,904 imaging specialist and and anesthesia. 250 00:08:50,924 --> 00:08:52,845 But I think these, these are kind of 251 00:08:52,845 --> 00:08:54,125 the next area of growth for us, and 252 00:08:54,125 --> 00:08:55,804 I think that's coming very shortly here in 253 00:08:55,804 --> 00:08:57,350 the future. So we have a lot planned, 254 00:08:57,350 --> 00:08:58,870 and and I think this has been a 255 00:08:58,870 --> 00:08:59,610 great example 256 00:09:00,870 --> 00:09:01,769 of, how 257 00:09:02,870 --> 00:09:04,089 facilities and organizations 258 00:09:04,549 --> 00:09:06,230 that have the right people, that have the 259 00:09:06,230 --> 00:09:09,049 right mentality, and that have the right patient 260 00:09:09,644 --> 00:09:10,945 centered focus 261 00:09:11,325 --> 00:09:12,465 toward these procedures. 262 00:09:13,085 --> 00:09:15,325 I think when when the organization has buy 263 00:09:15,325 --> 00:09:16,524 in to try to say, look, how do 264 00:09:16,524 --> 00:09:17,425 we make these, 265 00:09:18,205 --> 00:09:20,605 these procedures easier for our patient population and 266 00:09:20,605 --> 00:09:22,529 grow to the patients? I think once you 267 00:09:22,529 --> 00:09:24,450 have that in place, then you can grow 268 00:09:24,450 --> 00:09:25,809 all kinds of programs. It's just a matter 269 00:09:25,809 --> 00:09:28,210 of getting the resources in place to make 270 00:09:28,210 --> 00:09:30,690 sure that it's safe and to perform at 271 00:09:30,690 --> 00:09:33,009 these outside facilities and make sure that the 272 00:09:33,009 --> 00:09:35,190 outcomes are as good or better. 273 00:09:36,014 --> 00:09:38,575 Excellent advice. Well, thank you for being here 274 00:09:38,575 --> 00:09:40,414 with me today and for providing all of 275 00:09:40,414 --> 00:09:42,434 this wonderful, informative discussion. 276 00:09:43,134 --> 00:09:45,054 And, hopefully, we'll be hearing more from you 277 00:09:45,054 --> 00:09:47,054 and your program in the future. Thank you 278 00:09:47,054 --> 00:09:48,478 so much. Appreciate you having me.