Cardiac Team models

[cheeseburgerandfry]

Looking for examples of how other groups with dedicated heart teams take call and all the other logistics.

Our hospital/CT surgeons are pushing us to create a dedicated heart team separate from the generalists. They want 4 first starts for the CT surgeons and 1 cath lab daily. One of the CT surgeons is new and will be ramping up a heart failure program with significant increases in numbers of ecmo and LVAD placement.

How many anesthesiologists would you recommend? How should we split call?

Anyone love/hate their models?

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[2buckchuck]

Looking for examples of how other groups with dedicated heart teams take call and all the other logistics.

Our hospital/CT surgeons are pushing us to create a dedicated heart team separate from the generalists. They want 4 first starts for the CT surgeons and 1 cath lab daily. One of the CT surgeons is new and will be ramping up a heart failure program with significant increases in numbers of ecmo and LVAD placement.

How many anesthesiologists would you recommend? How should we split call?

Anyone love/hate their models?

How many cardiac docs do you currently have?

Do you do cases directly or supervise?

Is that heart failure surgeon just new to your system or “new” new.

 

[Bertelman]

What cases are you covering in the Cath Lab? Imaging?

Sounds like you should start with around 8. One for each first start, one is post call, 1-2 on vacay.

By "split call", you mean how much general call vs. cardiac call the cardiac team takes?

 

[Pharmado]

Are you sitting the rooms personally or do you have CRNAs? Running 5 rooms in a medical direction model would ideally involve 2 docs, but you would need to stagger the starts. That path means a team of 4-5 cardiac docs is appropriate depending on how much cardiac each doc wants to do. If you are sitting your own cases you need 8+ docs and they each need to be willing to be doing cardiac 50% or more of the time.

 

[caligas]

You definitely need 8 as Bert said. Less than that and call is rough, vacation problematic, and attrition/illness very problematic. Hospital needs to be ready to cough up at least $5M to cover this department. Contract contingency for compensation for extra work when you inevitably run short staffed. In my experience things go better when cards anesthesia is part of a larger pool and float in and out of GA and hearts. Full time cardiac is a recipe for burnout.


Good luck.

 

[nimbus]

Looking for examples of how other groups with dedicated heart teams take call and all the other logistics.

Our hospital/CT surgeons are pushing us to create a dedicated heart team separate from the generalists. They want 4 first starts for the CT surgeons and 1 cath lab daily. One of the CT surgeons is new and will be ramping up a heart failure program with significant increases in numbers of ecmo and LVAD placement.

How many anesthesiologists would you recommend? How should we split call?

Anyone love/hate their models?

How many cases per year? Pump? Structural? You’d need a lot of cases to justify 4 first starts plus Cath lab.

 

[BlueRug]

You definitely need 8 as Bert said. Less than that and call is rough, vacation problematic, and attrition/illness very problematic. Hospital needs to be ready to cough up at least $5M to cover this department. Contract contingency for compensation for extra work when you inevitably run short staffed. In my experience things go better when cards anesthesia is part of a larger pool and float in and out of GA and hearts. Full time cardiac is a recipe for burnout.


Good luck.

I disagree.

Depending on the level of cases and volume, a dedicated cardiac team is essential/necessary.

Doing complex aortic work, redo-redo-redo valve/CABG, ecmo, transplants, MCS, etc isn’t well suited for part time cardiac folks. Those who put in the effort to get to that level are rarely content with doing much general OR. I’ve seen the shift from what you describe to dedicated teams, especially as MCS and ECMO seem to keep expanding. The surgeons are usually in full support as well, which is key.

If cardiac is instead outpatient normal EF CABGs or SAVRs on healthy bicuspids, then maybe I would agree with you.

 

[woopedazz]

We only have 2 rooms and I feel like 8 barely cuts it. 🫣 You guys are machines.

I don't think we've done an elective elective CABG in a long time though...