Medical education is integral to fulfilling the Sentara mission of improving health every day. For cardiology specialists at Sentara Heart, this means extending expertise and knowledge to internal medicine residents and students at Eastern Virginia Medical School (EVMS) in Norfolk, VA. EVMS shares a campus with Sentara Norfolk General Hospital (SNGH), which serves as the medical school’s primary teaching institution.
Every year, cardiology experts from Sentara Heart hospitals volunteer hundreds of hours of time to educate EVMS internal medicine residents and students about heart disease and treatments. Many serve as preceptors to residents and students, providing one-on-one guidance and instruction.
Sentara cardiologist John E. Brush Jr., M.D., serves as division chief of cardiology for internal medicine at EVMS and coordinates all Sentara volunteer cardiac education efforts. All internal medicine residents at EVMS complete a mandatory cardiology rotation at Sentara Leigh Hospital in Norfolk, VA.
Dr. Brush leads this rotation using his well-respected book, The Science of the Art of Medicine, as an instruction guide.The rotation focuses on both cardiology and medical reasoning, equipping residents with the logic and probability tools needed to make a diagnosis, order appropriate tests, develop a treatment plan and make a long-term prognosis.
Each month, a different cardiology expert from a Sentara hospital prepares and presents a lecture for EVMS internal medicine residents and students. Core topics for these monthly lectures range from congestive heart failure to atrial fibrillation and hypertension. SNGH also hosts weekly grand rounds featuring cardiology experts from world- renowned medical institutions, such as the Johns Hopkins University School of Medicine in Baltimore, MD, and McMaster University Michael G. DeGroote School of Medicine in Ontario, Canada.These livestreamed presentations can be viewed by other clinicians worldwide.
Sentara Heart also provides postgraduate training for EVMS advanced practice clinicians, such as physician assistants and nurse practitioners. When appropriate, Sentara Heart physicians collaborate with EVMS on research projects to improve the delivery of healthcare to cardiac patients.
Echocardiogram Sonographer Training
Before a Sentara cardiologist can make a diagnosis, our exceptionally skilled echocardiogram sonographers use their expertise in non-invasive technology to produce clear, readable images of a patient’s heart.
Approximately 85 sonographers (also known as echo technicians) work at the 12 Sentara hospital locations. All of the Sentara echocardiogram labs, including a few that are located within doctors’ offices, are accredited by the Intersocietal Accreditation Commission. Throughout the year, Sentara sonographers receive training on best practices to reduce variations in lab reporting and ensure consistent standards systemwide.
A new focus for our sonographers in 2016 was on cardio-oncology and cardiac strain imaging. Technicians participated in a hands-on workshop to learn more about the strain imaging function available on some ultrasound machines at various Sentara hospitals.This ultrasound test captures information that helps doctors identify early signs that a heart is under stress or starting to incur damage. Heart strain is a precursor to heart failure and congestive heart disease.
Checking for early signs of cardiac disease is especially important for patients with cancer undergoing chemotherapy and radiation because these treatments can weaken heart muscle. As part of a newly formed cardio oncology program, Sentara cardiologists work closely with oncologists to ensure cancer treatments aren’t damaging a patient’s heart. Information from echocardiograms with strain imaging enables cardiologists to more clearly see and identify subtle changes in heart function. If needed, a patient’s oncologist can alter treatment before too much damage occurs.
An education specialist conducts annual workshops. In 2017, Sentara sonographers will dissect cow and pig hearts to get an in-depth look at the heart’s structure and to gain a better understanding of how the chambers, valves and arteries interact.
Sonographers also participate in a monthly guest lecture series presented by various Sentara heart experts.The annual workshops and monthly lectures allow sonographers to earn required continuing medical education (CME) credits at the same hospital system where they work.
Recent Areas of Focus and Change Include:
High Reliability Organization:
In 2013, Sentara Heart made a commitment to change the organization’s culture to be more reflective of a High Reliability Organization (HRO). Sentara Heart’s cardiac nurses piloted this initiative.They recognized that Sentara already had all of the tools needed to initiate and sustain this change, most notably behavior-based safety habits, medical response teams, daily safety huddles, and patient-
The clinical staff worked diligently to promote the four pillars of an HRO culture: accountability, leadership, safety and patient-centric care. Staff then applied the HRO principles to three targeted safety components that greatly impact clinical care: out-of-unit codes, catheter- associated urinary tract infections, and inpatient falls with injuries.
By 2015, the staff noted remarkable results at Sentara Heart, and is looking to expand the HRO program to other Sentara hospital locations. HRO program results at Sentara Heart as of October 2015 reflect decreases in:
- Out-of-unit codes: 6 in 2015 vs. 20 in 2014
- Catheter-associated urinary tract infections: 6 in 2015 vs. 12 in 2014
- Inpatient falls with injury: 11 in 2015 vs. 16 in 2014
Many cardiac nurses are taking the next step into furthering their education with advanced certifications or degrees, including doctoral degrees, in various subspecialties. Sentara Heart continues to promote continuing education among all nurses in an effort to transform the care delivery model. Highly specialized cardiac nurses bring a significant amount of intellectual capital to the evidence-based care they provide every day.
Partners in Research:
Since 2011, Sentara Heart has encouraged front-line nurses to participate in research and quality improvement initiatives by creating a culture of inquiry and providing logistic support. Every Friday, researchers from the Sentara Cardiovascular Research Institute host a Cardiac Journal Club where nurses brainstorm possible research or quality improvement projects with experienced researchers.The number of nurse-driven quality improvement projects at Sentara Heart has increased steadily each year. In 2015, there were 32 Sentara Heart presentations, 22 involving cardiac nurses.
Exceptional Patient Care:
The formalized cardiac committees at Sentara Heart serve as a great platform for the cardiac nurses. While there are various types of cardiac nurses working in multiple settings, there are several standardized approaches to cardiac care that are constant among all sites. Consistency is key and remains a strong theme among the cardiac nurses. Each nurse understands the importance of providing the best care as cost efficiently as possible. It is for this reason that the cardiac team is always looking for collaboration for group purchasing.
The outcome of applying these principles to the care delivery model, and adhering to the Sentara Commitments to Cardiac Nursing Care, is reflected in our customer service scores.These scores reflect a rolling 12 months’ percentile ranking of 96 percent. On a scale of 10 (best hospital) to 0 (worst hospital), 86 percent of patients rate their overall care at Sentara at a 9 or 10.
The Sentara Heart cardiac nurse embodies the Sentara Philosophy of Nursing as evidenced by the treatment provided to patients suffering from heart conditions. Each patient requires a unique and individualized treatment approach. The Sentara Heart nurse delivers a hallmark standard of care that serves as a role model for other heart centers nationwide to emulate.