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November 2007 Issue

Thanks to a preoperative evaluation at University Hospital, William Davis, pictured here with his wife Theresa, was “saved” from a potential heart attack. Doctors detected that Davis had a severely clogged artery.
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Bridging a Gap: Physician's Partnership Gives Patient Another Lease on Life

By Katie Pence
Published November 2007

William Davis, 60, says he tries to visit his son in the south every fall.

“It’s mostly a hunting trip for us,” says the West Union resident. “We look for squirrels, rabbits or wild hogs, but the older I get, the more I just like to the enjoy nature surrounding me.”

This year, Davis made the journey about a month after undergoing angioplasty at University Hospital (UH) to open severely clogged blood vessels in his heart.

“One of my major arteries was over 90 percent blocked,” Davis says. “I was a walking dead man, and I didn’t even know it.”

Even though Davis experienced intense chest pain and shortness of breath from time to time, his severe coronary artery disease was not discovered because of these symptoms.

Instead, Davis was diagnosed as he was preparing to undergo electroconvulsive therapy for depression.

“The anesthesiologist evaluated me and ran some tests,” Davis says. “Because of the results, he told me I couldn’t have the procedure. He said there was a very high risk that I might have a heart attack on the table.

“Then he sent me to Dr. Weintraub.”

Neal Weintraub, MD, head of the division of cardiovascular diseases, and Andy Friedrich, MD, of the department of anesthesiology, have teamed up with colleagues in the department of surgery to reduce the risk of heart problems occurring during and after procedures.

“We are very judicious and thoughtful in our approach to patient care and are aware of the need to communicate with anesthesiologists and surgeons in a timely manner,” Weintraub says. “We want to improve the health of patients, and in many cases, we also end up improving their quality of life.”

Davis’ preoperative evaluation was part of the collaboration between anesthesiology and cardiovascular diseases to find and treat heart problems before patients undergo surgery and other procedures requiring anesthesia.

As noted in recent guidelines issued by the American College of Cardiology and the American Heart Association, non-cardiac surgery is often the first opportunity for patients to receive evaluations for risk of heart disease.

“Unfortunately, one of the current realities of modern medicine is that there are far too many errors of omission, which is to say that doctors are underdiagnosing and undertreating medical problems far too often,” Friedrich says.

By checking for problems early, the team not only ensures quality care for the patient, they also save money by preventing last-minute cancellations.

“The preoperative evaluations are bridging a gap,” Friedrich says. “Once a patient is referred to a cardiologist, we can run tests and, based on the results, determine our next step.”

This also eliminates the problem of reserving operating space which could cost the hospital several thousands of dollars if a cancellation is made on the day of a surgery,” Friedrich adds.

Patients are usually seen days to weeks before their surgical procedure so they can receive appropriate treatment and the procedure can be rescheduled if necessary.

Physicians in the division of cardiovascular diseases make themselves available on a same-day basis following a patient’s evaluation by an anesthesiologist. They also coordinate testing with anesthesiology visits for patients who travel long distances.

“This standardized evaluation is a way for UH to improve quality of care,” Friedrich says.

Programs designed to reduce preventable errors are becoming more important. Beginning in October 2008, the Centers for Medicare and Medicaid Services will not reimburse hospitals for eight preventable hospital-acquired infections and medical errors.

“The list will grow,” Friedrich predicts. “Also, private insurers will more than likely follow suit. This is a way to create collaborative, evidence-based data showing that these evaluations are improving the way we treat patients.”

And the program is working.

According to a pilot study from February 2005, the areas of thoracic and vascular surgery had same-day cancellation rates between 6 and 9 percent. Since the evaluation program started, their combined rate has dropped to below 0.2 percent.

Currently, about 25 to 30 percent of patients are seen in the preoperative clinic before undergoing surgery. Clinic visits are standard for vascular, thoracic, orthopedic and urologic surgeries. Transplant, otolaryngology and gynecology will soon be added to the list.

Davis is living proof this type of evaluation is beneficial.

“One wrong move and I would have been a goner,” he says.

Now, Davis is getting stronger, and only 45 days after his angioplasty, he was strolling through the thick woodlands of Mississippi with his son.

“I can breathe better,” he says. “Occasionally, I’ll get a small pain, but it’s nothing like before.”

His original procedure has been rescheduled.

Davis’ wife, Theresa, says her husband only mentioned chest pain after the fact.

“He told the nurses that he would have chest pains for awhile and then they would stop,” she says. “The nurses asked, “‘Why didn’t you tell us?’”

But after Davis received treatment, Theresa noticed a difference in her husband.

“He seems more active,” she says. “The whole experience really scared us. Thank goodness they found the problem before he went into surgery. I want to keep him strong and well for a long time to come.” 

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