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Welcome to the Becker's Healthcare podcast. I'm Mariah
Taylor, assistant editor, and I'm thrilled to be
interviewing Justin Dunn, interventional cardiologist and regional director
of the Valve and Structural Heart Disease Center
at University Hospitals Harrington Heart and Vascular Institute.
Justin, thank you so much for joining me
today. I'm really excited to learn more about
how your system is decentralizing cardiac care. But
before we dive in, I'd love you to
introduce yourself and tell us a bit about
your background.
Well, thank you for having me. My name
is Justin Dunn. I'm an interventional cardiologist,
and I focus on,
structural heart disease.
And,
I have been here in practice,
for about just over ten years.
Amazing.
Now give me a little bit of an
overview of what decentralized
heart care looks like at your system, and
what were the motivations for expanding advanced heart
care beyond the main campus?
Well, you know,
larger health systems often have
difficulty
with some of their complex procedures,
especially with growth of programs,
like we have had here at university hospitals.
The programs often get congested, and patients have
a difficult time getting in,
to get their procedures done. We've had a
very successful structural heart program here at university
hospitals.
And, as a result of that,
we
have seen that, you know,
lab space and,
clinic space is becoming more and more congested.
And, you know, as our health system expands
out into
communities,
we have found that patients often,
want to get their procedures done closer to
home if possible.
And so we thought, well, you know, if
we set up the right infrastructure and and,
bring in the right people,
we should be able to provide these complex
procedures,
in our community hospitals closer to the patient's
homes.
And we can get them in faster and
get them treated faster,
and subsequently get them home faster.
So that was some of the motivation. We
felt this would increase access
to care for patients in our health system,
and it would bring
the complex care closer to their homes
so that families and patients didn't have to
travel so far,
to come for procedures and visit family members
and to come for appointments, etcetera.
Amazing.
And what are some of the benefits that
you've seen for patients, staffs, and the organization?
Well, this has been a huge success. I
mean, we started expanding out to the community
approximately six months ago,
and we have had outstanding success both from
an outcome standpoint
and, from a patient satisfaction standpoint.
Our patients now,
can go to the hospitals that they're comfortable
with, the ones that they're familiar with. They
go to the hospitals where they go to
see their other physicians, where they show up
in the ER,
all closer to home, and we can continue
to provide care for them even if there
are,
advanced complex procedures that they might need. We
can continue to provide that care closer to
home for them and not have them have
to travel far to our, to our main
hub campus,
which is often far away for some of
these patients.
And so we have seen,
that patients are
thrilled to be able to have this opportunity.
Their families are thrilled.
And,
we have structured the program in a way
that we set up the appropriate infrastructure so
that
we have,
guaranteed
essentially the same outcomes
at our regional
community hospitals,
as they would expect
and would find at our main campus hospital.
So number one, we've seen
excellent access for patients. We've seen patient satisfaction,
and we've seen, excellent outcomes. Same outcomes that
we would see if they came to a
main campus.
And number two, you know, we've seen,
growth in our program, significant growth. I mean,
even in six months, we've seen a 25%
increase in our in our volume,
just last year. So, and a lot of
it has to do with being able to
get patients in for these procedures. You know,
these patients who would have been waiting to
try to get in to a procedure down
at our main campus, which might have been
delayed due to space or timing or scheduling,
now can be treated much more quickly,
by by an advanced team that's experienced,
and with the same type of equipment that
they would get down at our main campus.
And we found that, overall, not only do
the patients benefit, but the organization as a
whole benefits
by, getting patients in faster, increased patient satisfaction,
increased volumes, and similar
outcomes.
Those are some really impressive results. And as
you might be aware, there's a few other
systems out there that are testing this kind
of decentralized
heart care. But for those that are considering
it and haven't started yet, what are some
of your best practices for building the quality
care in a community hospital?
Well, I think number one, you have to
put in the work upfront to make sure
that you have all the necessary parts in
place to guarantee
that your patient has
an excellent outcome. I mean, these patients,
expect to
have the best possible outcome when they come
in, especially for an elective procedure.
And when they come in, they don't want
to say, well, I have I'll have one
type of outcome at one facility and a
different type of outcome at a different facility.
We have to make sure that that's consistent
across the system. And so that includes things
like,
making sure that your cath lab equipment is,
appropriately stocked with the right equipment you need
for the procedures, the right equipment you need
for bailout in difficult situations.
You wanna make sure that your, equipment is
consistent across the system.
You wanna make sure your staff is trained
appropriately so that they have the experience necessary
to make sure that they feel comfortable
providing the same type of procedure across the
system and providing the same outcomes.
And, you know, we wanna make sure that
all the ancillary care is also trained. So
things like for for example, when we're talking
about AVR procedures or transcatheter aortic valve replacements,
which is kinda how we started growing this
program,
you need to have,
ultrasound techs, echo techs that understand
how to look at these valves and and
participate in these valve procedures. You need to
have ICU staff that understand what to look
for when patients come to the ICU after
these procedures.
You have to have anesthesia
understanding
what they might be expected to do in
a routine case or possibly in a case
that has some complexities or some differences outside
of what's routine.
So having all these things in place upfront
is critical before you start doing these procedures.
And I think if somebody
if a if a hospital wanted to endeavor
on this, all these parts need to be
in place,
from the beginning.
Otherwise,
you'll get into a situation where things might
go fine for a while, but then you
have, kind of an outlier case and you're
not prepared for how to manage that. So
I think it's critical to get things in
place upfront.
Excellent advice.
Now let's look a little bit into the
future. There's a lot of different elements going
on with any kind of heart care and
with all the different programs you're doing. So
what are your priorities in 2026?
Well, I think we started our,
growth of our structural heart program with transcatheter,
aortic valve replacement, the TAVR procedure, and also
left atrial appendage occlusions.
So both these procedures are are done at
our institution with conscious sedation. We're already we're
using equipment that was already existing in our
community hospital for the most part, so we
already had hybrid cath labs in our community
hospitals.
And so we started with programs that did
not,
require us to do a huge outpouring of
upfront resources, and we kinda said, okay. What
resources do we have available already that can
that can serve in the role of,
performing these procedures with the appropriate outcomes? So
we started with TAVR and left atrial appendage
occluders. We've had wild success with that here
at University Hospital. It's it's been a huge
success, and we've been really proud of it.
But I think we can we can grow
beyond this. I think, we can expand other
parts of structural heart disease. For example, mitral
valve interventions, tricuspid valve interventions,
things that require a little bit more
have a little bit more involvement from an
imaging specialist and and anesthesia.
But I think these, these are kind of
the next area of growth for us, and
I think that's coming very shortly here in
the future. So we have a lot planned,
and and I think this has been a
great example
of, how
facilities and organizations
that have the right people, that have the
right mentality, and that have the right patient
centered focus
toward these procedures.
I think when when the organization has buy
in to try to say, look, how do
we make these,
these procedures easier for our patient population and
grow to the patients? I think once you
have that in place, then you can grow
all kinds of programs. It's just a matter
of getting the resources in place to make
sure that it's safe and to perform at
these outside facilities and make sure that the
outcomes are as good or better.
Excellent advice. Well, thank you for being here
with me today and for providing all of
this wonderful, informative discussion.
And, hopefully, we'll be hearing more from you
and your program in the future. Thank you
so much. Appreciate you having me.