2017 Cardiovascular Annual Report

BAYHEALTH CARDIOVASCULAR SERVICES 2017 ANNUAL REPORT

Taking patientcentered care

to heart.

BAYHEALTH.ORG/CARDIOVASCULAR

Dear Friends, I am pleased to share with you the 2017 Bayhealth Cardiovascular Service Line Annual Report.

I have had the pleasure of serving as the Vice President of Ancillary and Clinical Services for Bayhealth since 2012. In January 2017, the Cardiovascular Service Line was added to my scope of responsibilities as part of a long-term strategic initiative. In addition to the Cardiovascular Service Line, I also have accountability for the Neurosciences Service Line, Orthopaedic Service Line, and Oncology Service Line.

In addition, with the retirement of Louie Phillips, Greg Springer joined our team in October 2016 as the new senior director of operations for the Cardiovascular Service Line. Springer has more than 35 years of experience in cardiovascular care and leadership. He came to Bayhealth from The Christ Hospital system in Cincinnati, Ohio, where he was responsible for a dynamic Cardiovascular Service Line that included Congestive Heart Failure (CHF), Transcatheter Aortic Valve Replacement (TAVR), and Ventricular Assist Device (VAD) programs; eight outpatient diagnostic imaging centers; wound care; sleep centers; and accreditation in addition to the normal diagnostic and interventional programs. Springer maintains his certification in Nuclear Medicine and has a master’s degree in business administration.

While we have added new leadership with enhanced vision for the service line, the focus on quality of care, patient safety, and exceptional patient satisfaction remains unchanged.

One of the exciting areas of expansion in 2019 will be providing more comprehensive cardiac care at the new Bayhealth Hospital, Sussex Campus. We will have a state-of-the-art hybrid Cardiac Cath/Electrophysiology and Interventional Radiology suite to meet the growing needs of the Sussex County community. We will begin with basic procedures, and the goal is to expand to more complex cases in the future. In preparation for this service expansion, we have hired an additional interventional cardiologist and elevated our existing Cath Lab medical director to a system-wide role to ensure consistency in quality, process, and best practices between the two campuses.

Sincerely,

Brad D. Kirkes, MBA, MHA, OTR/L, CHT, FACHE Vice President of Ancillary and Clinical Services

OUR MISSION IS TO DELIVER WORLD-CLASS CARDIOVASCULAR AND THORACIC CARE HERE IN CENTRAL AND SOUTHERN DELAWARE.

Table of contents 4 5 6 7 8 10 12 13 14 15 BAYHEALTH 2017 ANNUAL REPORT

FISCAL YEAR 2017 QUALITY MEASURES

FISCAL YEAR 2017 MEDICAL LEADERSHIP

BAYHEALTH CARDIOVASCULAR SERVICE LINE TWO THUMBS UP FOR TAVR

AN INTERDISCIPLINARY APPROACH TO HEART HEALTH

LUNG CANCER PATIENT GRATEFUL TO SEE ANOTHER YEAR PHYSICIANS ASSIST WITH DESIGN OF NEW INTERVENTIONAL SUITE

CARING FOR PATIENTS AND THEN SOME

PHYSICIANS AND PRACTICES

VISIT BAYHEALTH.ORG/CARDIOVASCULAR FOR MORE INFORMATION OR CALL 1-866-BAY-DOCS (229-3627) IF YOU’RE IN NEED OF A CARDIOLOGIST.

Bayhealth 2017 Community Benefits COMMUNITY BENEFITS Financial Assistance (charity care at cost)

$7,744,251

Government-sponsored Healthcare

$57, 934, 628

Bad Debt (at cost)

$14, 118, 817

Total $38,680,483

COMMUNITY SERVICES ● Community Health Improvement Services

$2,892,135

● Health Professionals Education

$3,851,004

● Subsidized Health Services

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$22,493,439

● Research

$3,266,653

● Financial and In-Kind Contributions

$1,664,197

● Community-Building Activities

$4,432,125

● Community Benefit Operations

$80,930

Total

Grand Total (Benefits & Services)

$79,797,696 $118,478,179

Fiscal Year 2017 Quality Measures PRESS GANEY PATIENT SATISFACTION SCORES: INPATIENT CVSICU

PRESS GANEY OUTPATIENT SATISFACTION SCORES: ALL CARDIOVASCULAR SERVICES

100% N/D* 100% 100% 100%

99% 100% 99% 100% 99%

FIRST QUARTER SECOND QUARTER THIRD QUARTER FOURTH QUARTER AVERAGE OF ALL FOUR MONTHS

FIRST QUARTER SECOND QUARTER THIRD QUARTER FOURTH QUARTER AVERAGE OF ALL FOUR MONTHS

*No data for this quarter as scores could not be accessed from Press Ganey.

QUALITY MEASURES: OVERALL VOLUMES PER DEPARTMENT

10,970 1,979 57,174 485

CARDIOPULMONARY REHABILITATION ENCOUNTERS CARDIOVASCULAR AND ELECTROPHYSIOLOGY LAB CASES CARDIOLOGY STUDIES/TESTS CARDIOVASCULAR SURGICAL ASSOCIATES CASES

QUALITY MEASURE: STS OVERALL SCORE AND STAR QUALITY RATING

95.1% ✩✩✩ 94.9% ✩✩✩ 92.1% ✩✩✩

CABG QUALITY RATING AVR QUALITY RATING CABG + AVR QUALITY RATING

Source: The Society of Thoracic Surgeons June 30, 2018 Bayhealth voluntarily reports their surgical outcomes to the STS as part of the STS Public Reporting initiative in an effort to be transparent and accountable to our quality of surgical outcomes.

Roughly 80 percents of participants receive two out of three stars, putting Bayhealth on track with the majority of programs.

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Fiscal Year 2017 Medical Leadership The Bayhealth Cardiovascular Service Line is staffed with physicians and leadership committed to excellence in heart and vascular care, low readmission rates,

Gary Szydlowski, MD

Pedro Perez, MD

CHIEF OF BAYHEALTH CARDIOVASCULAR AND THORACIC SURGERY

MEDICAL DIRECTOR OF CARDIOLOGY AT BAYHEALTH MILFORD MEMORIAL

John Shuck, MD

John Mannion, MD

MEDICAL DIRECTOR OF THE CARDIOVASCULAR LAB

MEDICAL DIRECTOR OF THE CARDIAC SURGICAL INTENSIVE CARE UNIT

Raymond Miller, MD

Brian Walsh, DO

MEDICAL DIRECTOR OF ELECTROPHYSIOLOGY LAB

MEDICAL DIRECTOR OF PULMONARY REHABILITATION

Robert Scaffidi, MD DIRECTOR OF CARDIOLOGY AT BAYHEALTH KENT CAMPUS

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and high patient satisfaction scores. Here are our medical directors and service line leadership for Fiscal Year 2017.

Bayhealth Cardiovascular Service Line DEPARTMENTAL LEADERSHIP Greg Springer, MBA Senior Director of Operations (third from the right) Barbara Smith, MSN, RN, CNML, RCIS Cardiovascular and Electrophysiology Lab Manager (center)

Meghan Holland, RN, MSN, CCRN, CNML 2 North and Cardiovascular Surgical Intensive Care Unit Nurse Manager (second from the right) Diane Gonzales Administrative Assistant III (far left)

Cathy Mundorf, BS, RRT Cardiology Manager (far right)

CARDIAC DEPARTMENTS

Leslie McClements, BS, CCVTC, CMPE Senior Practice Manager, Cardiovascular and Thoracic Surgery Practice (second from the left)

Cardiopulmonary Rehabilitation

Paul LeBlanc, MS Cardiopulmonary Rehabilitation/Lifestyle Fitness Manager (third from the left)

Cardiovascular Services Cardiovascular and Thoracic Surgery Cardiac Diagnostic Centers Cardiac Catheterization and Electrophysiology Lab Cardiovascular Surgical Intensive Care Unit

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Two thumbs up for TAVR “I’m a tough guy. I worked in construction for more than 40 years. I can handle it.” That’s what Lincoln resident George DeCaro, 91, told his cardiologist when finally agreeing to have a transcatheter aortic valve replacement, also known as TAVR. DeCaro has been seeing Interventional Cardiologist Roberto Scaffidi, MD, of Bayhealth Cardiology Consultants, since suffering a heart attack 10 years ago. Nearly three years ago, Dr. Scaffidi began talking with DeCaro about having the TAVR procedure done.

TAVR is a minimally invasive surgical procedure used to address severe aortic stenosis and is an alternative to standard aortic valve replacement. This disease weakens the heart by causing it to work harder

to pump blood throughout the body, resulting in weakness, dizziness, and a lack of tolerance for exercise or ability to complete daily activities.

It took two years of conversations about the TAVR procedure before DeCaro finally agreed to move forward.

“I originally told Dr. Scaffidi that I wouldn’t have the surgery and that I preferred to die a natural death, but each month I was becoming weaker,” DeCaro said.

THIS HAS GIVEN ME A NEW LEASE ON LIFE. I FEEL LIKE I’M 21.

HAVING THE PROCEDURE IS ONE OF THE BEST THINGS I EVER DID. — GEORGE DECARO

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He had long suffered from the expected symptoms of aortic stenosis, but when he reached the point of having to hold onto the wall to walk to the bathroom at night, the time had come to have surgery. “I told him to do whatever he has to do. I was in perfect peace with it and had no fear,” DeCaro said.

When waking up from surgery, DeCaro felt so well, it was as if he hadn’t had the surgery. He even told Dr. Scaffidi that if it wasn’t for a minor pain, he’d have sworn the surgery was cancelled. Soon after waking up, DeCaro was walking around the hospital with the nursing staff. The next day when returning from his walk, he was met by Chief of Cardiovascular and Thoracic Surgery Gary Szydlowski, MD, who was the lead surgeon on the procedure along with Dr. Scaffidi as the lead cardiologist. “He asked me how I was doing. I said I loved it here, the nurses couldn’t be better, but there’s no place like home,” said DeCaro.

Later that day, his wife Loretta picked him up and took him home to Lincoln.

IT FEELS GREAT BECAUSE I KNEW WHAT HIS LIMITATIONS WERE BEFORE AND CAN SEE HOW MUCH BETTER HE FEELS IN SUCH A SHORT SPAN OF TIME. — ROBERTO SCAFFIDI, MD

Dr. Szydlowski said the procedure went flawlessly, noting that outside of DeCaro’s cardiac disease, he was in good health, was motivated, and had excellent heart function, making him a superb candidate for the procedure.

“Although TAVR is still an operation, for the proper patient, the risks are substantially less than the traditional open heart surgery. The recovery is very fast and patients are back to full activity in only two weeks,” Dr. Szydlowski said. “It is very gratifying for the entire TAVR team to see these patients do well. Patients are ecstatic about the improvement in their symptoms.”

The results of DeCaro’s TAVR procedure are exactly why Dr. Scaffidi encouraged the surgery. When asked how he feels post-surgery, DeCaro exclaimed he hasn’t felt this good in years. “This has given me a new lease on life. I feel like I’m 21. Having the procedure is one of the best things I ever did.” Knowing DeCaro is back to doing his daily activities such as working around the house and yard is what drives Dr. Scaffidi to work with heart patients. “It feels great because I knew what his limitations were before and can see how much better he feels in such a short span of time. He’s back to doing what he loves, including yard work, and I’m not worried whether or not he’s in pain.

And I know his wife feels better, too,” Dr. Scaffidi said.

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An interdisciplinary approach to heart health When Dover resident Leroy Bookhultz, 74, woke up on Valentine’s Day in 2017, he thought it was going to be a normal day. Little did he know he would suffer a heart attack that morning and go on to spend 18 days in the hospital.

Bookhultz had been suffering with a burning pain in his chest for a couple of weeks. Yet a stress test done on Feb. 11 showed everything looked fine.

Therefore, Bookhultz continued his normal activities of volunteering in central and southern Delaware.

Then in the early morning hours of Feb. 14 (around 4:30 a.m.), Bookhultz woke up coughing and having back pain. He called his neighbor, an EMT, at 9 a.m. As soon as Bookhultz opened the door, the neighbor said to call 911. He suffered a heart attack in the ambulance on the way to Bayhealth Hospital, Kent Campus.

The heart attack led to the acute rupture of the supporting mechanism of one of Bookhultz’s heart valves, causing the immediate and severe malfunction of the heart. “This resulted in heart failure and shock,” said Cardiothoracic Surgeon Gary Szydlowski, MD, who was one of several physicians that cared for Bookhultz during his stay.

Interventional Cardiologist Sanjeev B. Patel, MD, was the first physician Bookhultz saw after the heart attack and has continued to care for Bookhultz via follow-up appointments. “To be honest, he was very lucky. If he

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HE WAS IN FULLBLOWN CARDIAC SHOCK. HE SURVIVED BECAUSE OF HIS ABILITY TO GET TO THE HOSPITAL SO QUICKLY AND GREAT TEAMWORK. — SANJEEV B. PATEL, MD

had been home another hour or two when his valve ruptured, he wouldn’t have made it. He was in fullblown cardiac shock. Even if we do everything we can, there’s a 60 percent chance he won’t make it. He survived because of his ability to get to the hospital so quickly and great teamwork,” Dr. Patel said.

Following his stay in the hospital, Bookhultz spent time at Bayhealth Milford Memorial Inpatient Rehab, followed by stints with therapy and cardiac rehab.

“I’m doing very well. I can’t say that I don’t feel weak from time to time, but I’m doing well,” Bookhultz said.

“I wouldn’t be here if not for the great doctors and nurses. They’re dedicated to their patients and are there for them every minute of the day.”

Dr. Patel says it’s incredible to see Bookhultz recovering as well as he has. “To see him critically ill and going in the wrong direction, and to see him now getting better, that’s amazing. It’s nice to see a unique and complicated case with an excellent outcome. It’s the best of both worlds,” Dr. Patel said. His fellow physicians agree. “It feels very good to be involved in such a successful story. This is what sustains our drive,” said Dr. Szydlowski.

MISSION ACCOMPLISHMENTS Bayhealth Hospital, Kent Campus received two Mission: Lifeline® Bronze Quality Achievement awards for implementing specific quality improvement measures outlined by the American Heart Association for the treatment of patients who suffer severe heart attacks. One award is for the hospital’s work with STEMI (ST-elevation myocardial infarction) patients and the second is for its work with NSTEMI (non-ST-elevation myocardial infarction). A STEMI occurs when a coronary artery is completely blocked, whereas a NSTEMI is typically caused by a severely narrowed artery that isn’t completely blocked. To prevent death, it’s critical to restore blood flow as quickly as possible, either by mechanically opening the blocked vessel or by providing clot-busting medication. The goal of the Mission: Lifeline® program is to reduce the barriers to prompt treatment for heart attacks, beginning with the 911 call and continuing through treatment.

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Lung cancer patient grateful to see another year When Greenwood resident Beatrice Stutzman celebrated her 74th birthday on Dec. 1, 2016, she had a lot to be grateful for. Along with a happy and healthy family she had her health, which only a few months earlier appeared to be in trouble.

Roughly three years ago, Stutzman suffered from a nagging cough; however, it wasn’t something she was too terribly concerned with initially. “My cousin had stage four lung cancer and told me I better go to the doctor,” Stutzman said. When her primary care physician exhausted all efforts and couldn’t find anything definitive, Stutzman was referred to a pulmonologist and was eventually diagnosed with lung cancer. “Hearing the word cancer is devastating, no matter how positive a person is,” Stutzman said.

“It almost makes you feel violated.”

The next step in her cancer battle was a minimally invasive robotic procedure with Bayhealth Thoracic Surgeon Paul Fedalen, MD. Stutzman was thrilled to be a candidate for the robotic surgery, which uses the da Vinci Robotic Surgery System. During the procedure on Oct. 4, 2016, Dr. Fedalen performed a lobectomy by going through the side of Stutzman’s chest. Using cameras and the da Vinci system, Dr. Fedalen removed the lobe of the lung and the lymph nodes. In the past, Dr. Fedalen would’ve had to remove the lobe via a thoracotomy in which the rib is cracked; thanks to the minimally invasive procedure,

Stutzman spent just a few days in the CV/SICU at Bayhealth Hospital, Kent Campus and then continued her recovery at home.

Knowing he’s helped a patient beat cancer means everything, said Dr. Fedalen. “This is why I do this.

This is why the da Vinci Robotic Surgery System was developed specifically for cases such as this.”

Stutzman is grateful for the work of Dr. Fedalen and his staff. “He talked to me as if I was the only person in the world he needed to see all day,” Stutzman said.

“He saved my life. Because of him I get to be here so I’m here to say thank you. I had lung cancer and now I don’t. You can’t imagine how grateful I am to have beaten cancer. I know God worked through Dr. Fedalen to perform the surgery.”

YOU CAN’T IMAGINE HOW GRATEFUL I AM TO HAVE BEATEN CANCER. I KNOW GOD WORKED THROUGH DR. FEDALEN TO PERFORM THE SURGERY. — BEATRICE STUTZMAN

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Physicians assist with design of new interventional suite Bayhealth is preparing to open the first brand-new hospital Delaware has seen in decades — the Bayhealth Hospital, Sussex Campus. The six-story, $300 million facility in Sussex County is slated to welcome its first patient in 2019.

The new hospital and adjacent outpatient center will have many of the features common in new hospitals such as all private patient rooms, abundant natural light, and an expanded emergency department. In addition to the more spacious rooms and updated exterior, Bayhealth is positioning itself to be on the cutting edge of industry-wide advancements in healthcare technology.

One example of that effort is the addition of an interventional suite on the Sussex Campus. The new suite will be located on the second floor of the hospital, adjacent to the other six operating rooms.

This state-of-the-art suite will be even larger than a standard OR, allowing interventional teams access to the latest anesthesia and imaging equipment.

“This room could be used by multiple disciplines, including but not limited to vascular surgery, interventional cardiology, interventional radiology, and potentially interventional neurology,” said Bayhealth Vice President of Operations and Milford Administrator Mike Ashton.

“We are looking forward to offering our southern Delaware patients access to services we have not been able to provide in the past,” said Michael Amygdalos, MD. “It will bring significant upgrades to our imaging quality and computing power, along with a state-of-the-art monitoring system.”

Design plans call for the interventional suite to be roughly 900 square feet with an adjacent 250-squarefoot control room with the most current equipment.

“The design of the interventional suite has been a group effort between interventional cardiologists, radiologists, diagnostic imaging personnel, cardiac cath lab nurses, Cardiovascular Service Line leadership, and Surgical Services leadership,” said Bayhealth Vice President of Ancillary and Clinical Services Brad Kirkes.

“The new interventional suite represents a huge potential for growth in the southern region. It’s fun to be a part of ushering in that change,” said John Shuck, MD, Bayhealth Cath Lab medical director.

“Having this high-quality technology available will bring greater convenience to people in our local communities.”

Visit ImagineDE.com to stay current on all news related to the new health campus.

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Caring for patients and then some In addition to improving the health of the community, Bayhealth Cardiovascular Services team members also believe in giving back outside of the normal workday.

Throughout the year, the service line participates in fundraisers and educational events to raise money and awareness not only about heart disease but other diseases such breast cancer. Whether it’s the Bayhealth Cancer Institute’s Runway of Hope, the Southern Delaware Heart Walk, or Go Pink!, Cardiovascular Services is, and will continue to be, a support to all of Bayhealth’s patients.

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Physicians and practices Bayhealth is driven to provide the best care to our patients here at home. To accomplish this, we not only have specialty physicians at Bayhealth Cardiovascular and Thoracic Surgery and Bayhealth Cardiology Consultants, but we also work with physicians and practices within the community. Here’s a list of specialists we work with in central and southern Delaware.

BAYHEALTH CARDIOVASCULAR AND THORACIC SURGERY

BAYHEALTH CARDIOLOGY CONSULTANTS

540 S. Governors Ave., Dover 802 N. Dupont Highway, Milford

802 N. Dupont Highway, Milford

Paul Fedalen, MD Danielle Marelli, MD Gary Szydlowski, MD

BAYHEALTH CARDIOLOGY CONSULTANTS 110 Forrest Ave., Dover 314 S. Carter Road, Smyrna Harjinder S. Grewal, MD Raymond Miller, MD David Ramos, MD Roberto Scaffidi, MD John Shuck, MD

Bayhealth Kent Campus

Laeeq Ahmer, MD E. Mark Johnson, MD Pedro Perez, MD

AFFILIATED PHYSICIANS Vincent Abbrescia, DO Kristen Anderson, PA-C Stephen Blumberg, MD Khaled Eljazzar, MD Eranga Haththotuwa, MD Sanjeev Patel, MD Judith Rippert, DO Sydney Scott, PA-C Michael Shea, MD Gurmeet Singh, DO Nitin Verma, MD Call 1-866-BAY-DOCS (229-3627) if you’re in need of a cardiologist.

Bayhealth Milford Memorial

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BlueDistinction Center for Cardiac Care ®

Highmark Blue Cross Blue Shield Delaware has recognized Bayhealth Hospital, Kent Campus with a BlueDistinction® Center designation for delivering quality cardiac care, as part of the BlueDistinction Centers for Specialty Care® program. BlueDistinction Centers are nationally designated hospitals shown to deliver quality specialty care based on objective, transparent measures for patient safety and health outcomes that were developed with input from the medical community.

To receive a BlueDistinction Center for Cardiac Care designation, a hospital must demonstrate its expertise in delivering safe and effective cardiac care, focusing on cardiac valve surgery, coronary artery bypass graft (CABG), and percutaneous coronary interventions (PCI) episodes of care.

A hospital must also have earned national accreditation at the facility level. Bayhealth is proud to be recognized by Highmark BCBS Delaware for meeting the rigorous selection criteria for cardiac care set by the BlueDistinction Specialty Care program.

Cardiovascular disease is the leading cause of death in the United States, responsible for one out of every four deaths each year. Bayhealth is driven to provide the highest level of care to its cardiac patients and to look for innovative heart disease treatment options for the community.

Highmark Blue Cross Blue Shield Delaware is an independent licensee of the Blue Cross Blue Shield Association.

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