Outcomes

Coronary Artery Bypass Grafting (CABG) Outcomes

Our goal at Lexington Medical Center is to offer the best cardiovascular services available to patients today. With the region’s only Duke Health-affiliated Heart Center, LMC patients can expect to not only receive fast treatment, but the most advanced treatments and protocols medicine has to offer. Our affiliation with Duke has allowed us to develop a strong cardiovascular program by ensuring we align with the latest practice guidelines, assist with staff education, and providing support with each new heart procedure started at LMC. The entire LMC Cardiovascular Team is truly dedicated to ensuring our patients are provided exceptional, quality care.

On March 28, 2012, Lexington Medical Center performed our first open heart surgery. Now, over 7 years later, our Cardiovascular Surgical Team has performed well over 2500 cardiovascular procedures. Through the Cardiovascular Services Committee, a multidisciplinary team of healthcare professionals reviews quality measures and participates in strategic planning for the organization’s cardiac services. We monitor 100% of our cardiac surgery patients, benchmarking ourselves nationally and responding to any opportunities for improvement and growth.

LMC is a participant in the Society for Thoracic Surgeons (STS) Registry for Adult Cardiac Surgery. The STS rating system is one of the most sophisticated and highly regarded overall measures of quality in health care, rating the benchmarked outcomes of cardiothoracic surgery programs across the United States and Canada.

STS ranked LMC in the highest quality tier for 2018 after surveying more than 1,000 participating programs and awarded LMC's cardiovascular program an overall three-star rating for heart surgery. The latest analysis of data for coronary artery bypass grafting procedures covered a one-year period, from January 1 to December 31, 2018. Historically, 10 to 12 percent of heart programs in the United States and Canada achieved this prestigious designation, which recognizes quality patient and clinical outcome excellence.


The Society of Thoracic Surgeons (STS)
National Adult Cardiac Surgery Database
Isolated CABG Case Volume

The Society of Thoracic Surgeons (STS)
National Adult Cardiac Surgery Database
CABG Intra-operative/Post-operative Blood Products Used
(Lower Percentages are Better)

Perioperative bleeding requiring the need for blood transfusion is common during cardiac operations, especially those that require cardiopulmonary bypass. Interventions aimed at decreasing the need for blood products improves patient’s short and long-term outcomes. By following evidenced-based practice, LMC has consistently maintained lower than average usage of blood products.

The Society of Thoracic Surgeons (STS)
National Adult Cardiac Surgery Database
Discharged to Home Following CABG Procedures
(Higher Percentages are Better)

After a coronary artery bypass graft procedure (CABG), many patients across the nation need to be discharged to a transitional care/rehab facility or a nursing home for additional care. At LMC, the majority of our patients are able to be discharged to their homes.

TAVR (Transcatheter Aortic Valve Replacement)

In May of 2014, LMC began to offer Transcatheter aortic valve replacement, known as TAVR, as a less invasive treatment option for patients with aortic stenosis who are at risk for open heart surgery. This state-of-the-art cardiovascular technology allows doctors to replace the aortic valve through a small incision in the groin or chest. During the procedure, a new valve is positioned inside the old, diseased valve while the heart is still beating. The new valve then functions immediately. Patients experience less pain than traditional open heart surgery patients and can have a significantly shorter recovery time.

LMC participates in the Society for Thoracic Surgeons (STS) and American College of Cardiology (ACC)’s national Transcatheter Valve Therapy (TVT) Registry. LMC continues to excel with outstanding patient outcomes compared to other TAVR programs across the nation.

STS/ACC TVT Registry
Volume of Transcatheter Aortic Valve Replacement (TAVR) Procedures

STS/ACC TVT Registry
Length of Stay
(Lower Numbers are Better)

It has been a goal of LMC’s TAVR program to enable our patients to return home as quickly as possible after their procedure. LMC performs better than the National Average in achieving this positive outcome.

STS/ACC TVT Registry
Discharged to Home
(Higher Percentages are Better)

After the TAVR procedure is completed, many patients across the nation have to be discharged to a rehab facility or a nursing home for additional care. At LMC, the majority of our patients are able to be discharged to their home.

WATCHMAN ™

Lexington Medical Center's heart program continues to grow. The Left Atrial Appendage Occlusion (LAAO) device, WATCHMAN, debuted in March 2017. This innovative one-time procedure is minimally invasive, performed in the Cath Lab, and lasts about an hour. Most patients are discharged home the following day. WATCHMAN has proven to reduce the risk of stroke by preventing blood clots that form during non-valvular atrial fibrillation. This device also eliminates the need for long-term anticoagulation in patients who are at risk for bleeding complications.

MitraClip ®

Beginning in October 2018, LMC continued to expand its cardiovascular services to offer the MitraClip procedure. MitraClip is a less invasive procedure used to treat mitral regurgitation for those patients who are not candidates for surgery. The MitraClip device is a small clip that is attached to your mitral valve. It treats mitral regurgitation by allowing the mitral valve to close more completely, helping to restore normal blood flow through the heart. This procedure is usually performed in the Cath Lab and patients are typically able to be discharged home from the hospital within 2 to 3 days after the procedure. Patients often experience improvement in symptoms and quality of life soon after the procedure is completed.

Implantable Cardioverter Defibrillator (ICD)

Did you know that you may be at risk for sudden cardiac death if you have had a myocardial infarction (MI), ventricular arrhythmias, long QT syndrome, Brugada syndrome, congenital heart disease, or you have survived sudden cardiac arrest?

Patients have been evaluated and treated, by the knowledgeable staff Lexington Medical Center (LMC), since 2010 with the implantation of Implantable Cardioverter Defibrillators (ICDs). What is an ICD? An Implantable Cardioverter Defibrillator (ICD) is a battery-operated pulse-generator that is placed in a pocket on the chest or in the abdomen. There are different types of ICDs, but all have leads that connect the heart to the generator which can gather and send electric signals. When the heart rate is too slow (bradycardia) the ICD can send tiny signals that increase the heart rate. If the heart rate becomes too fast the ICD can send an electric impulse to “shock” the heart, correcting the abnormal rhythm.

ICDs can be implanted through a minimally invasive procedure in the Cardiac Cath lab, Electrophysiology (EP) lab, or through open heart surgery in the Operating Room (OR). ICDs assists patients in the management of ventricular arrhythmias which place the patient at risk for sudden cardiac arrest.

Lexington Medical Center participates in the American College of Cardiology’s (ACC) national ICD Registry which validates Lexington Medical Center’s excellent patient outcomes compared to facilities across the nation.

ACC / NCDR: ICD Volumes
2016 – 2018

Acute Myocardial Infarction (AMI) (also known as Heart Attack)
ST elevated MI (STEMI) and Non-ST elevated MI (NSTEMI)

The American College of Cardiology (ACC) and the American Heart Association (AHA) publish guidelines and recommended standards of care for the recognition and treatment of patients experiencing a myocardial infarction or heart attack. A "STEMI" or “ST elevated myocardial infarction” occurs when a coronary artery is acutely blocked off by a thrombus or clot. This blockage can cause the heart muscle supplied by the artery to die. Evidence of the blockage can be seen on an ECG and early recognition enables our team to react swiftly minimizing cardiac damage. A "NSTEMI" or “non-ST elevated myocardial infarction” is a type of heart attack that evolves over a period of time and is the result of gradual damage to the heart. A NSTEMI is usually caused by the build-up and disruption of plaque that can severely narrow a coronary artery. The artery is not completely blocked.  While a NSTEMI may not be as time sensitive as a STEMI, it is still a heart attack and results in damage or death of the heart muscle.

Minutes matter during a heart attack since the heart muscle is damaged from lack of blood and oxygen. "Time is muscle!" Anyone experiencing the signs and symptoms of a heart attack should contact 911 immediately.

Lexington Medical Center's (LMC) Cardiovascular Action Team reviews and analyzes data and processes to identify and facilitate opportunities for improvement in the quality of care we provide our patients, families, and community. As a Duke Medical Center Affiliate, we benchmark our efforts against the best healthcare centers in the nation. Our attention to quality has led to recognition from the American Heart Association with the Gold Performance Achievement Award for our patient outcomes related to STEMI Care and the Silver Performance Achievement Award for our patient outcomes related to NSTEMI care.

The National Cardiovascular Data Registry (NCDR) for Chest Pain – MI has also recognized LMC with the 2019 Silver Performance Achievement Award for our demonstration of consistent quality care and adherence to guideline recommendations.

Early recognition and notification of appropriate staff facilitates the timely response needed to ensure the best possible outcome is achieved. Prompt arrival to the catheterization lab and intervention within 90 minutes of identification minimizes the damage to the heart muscle.

NCDR: Chest Pain - MI
Proportion of STEMI Patients receiving Percutaneous Coronary Intervention (PCI) within 90 Minutes
(Higher is Better)

An Electrocardiogram (ECG) is key to early identification and intervention. The heart's electrical conduction is depicted on the ECG. The ECG is interpreted and appropriate treatment is ordered by our certified staff. When a patient arrives by private vehicle with acute coronary symptoms (ACS) our Emergency Department staff obtains an ECG within 10 minutes to facilitate the identification and treatment of blockages relieving chest pain and preventing further damage to the heart.

NCDR: Chest Pain - MI
Percentage of patients with Acute Myocardial Infarction (AMI) who received an ECG within 10 minutes of arrival in the Emergency Department
(Higher is Better)

One proven way to ensure the best outcomes for heart attack patients is to help them reduce their risk factors for additional cardiac events. Tobacco use is a major risk factor for heart disease. By educating heart attack patients to stop smoking, Lexington Medical Center is helping to reduce the patient’s risk of further cardiac events.

NCDR: Chest Pain - MI
Adult Smoking Cessation Counseling
(Higher is Better)

Not all heart attack patients require coronary intervention. When this occurs, physicians optimize the patient’s medicines without adding the risks of an invasive procedure. Making sure that medically treated heart attack patients are discharged on appropriate medications is essential to improving the patient’s outcome.

NCDR: Chest Pain - MI
Patients who Receive Appropriate Anti-Platelet Medication at Discharge for Medically Treated Heart Attacks
(Higher is Better)

Heart Failure (HF) Readmissions

According to the American Heart Association, 5.7 million Americans are living with heart failure. An additional 670,000 new cases are diagnosed annually, up from 500,000 a few years ago. With the aging of the population, Heart Failure is poised to reach epidemic proportions in coming years. Heart Failure readmissions (taking patient away from home) remain a continuous challenge in the care of the Heart Failure patient. Although gains have been made over the past five years, still more than 20% of patients are readmitted within 30 days.

One of Lexington Medical Center’s goals is preparing our HF patients for a safe transition home with the desired outcome of preventing the need for readmission. Some strategies to meet this goal are: providing a dedicated Social Worker to work with HF patients and family members, increasing referrals to Home Health Services, providing digital scales to patients on admission for use while hospitalized and to take home for easy daily weight monitoring, scheduling early follow-up appointments, follow-up phone calls within 72 hours of discharge, and identifying and connecting patients with a primary care physician. Lexington Medical Center has received a grant from the Lexington Medical Center Foundation for four consecutive years to purchase digital scales for our HF patients who do not own a scale.

Since 2014, Lexington Medical Center has received an annual grant from our Lexington Medical Center Foundation to provide 20 hours of non-medical in-home assistance to individuals with a known diagnosis of heart failure and other chronic diagnoses who are at high risk for readmission for up to 30 days after discharge from an acute care hospital stay. Starting in July 2017, this program was funded by the Duke Endowment and will be continued through June 2020. Lexington Medical Center has contracted with a non-medical home care agency to provide this transitional support. Patients must meet all eligibility requirements to qualify for this service. This program is used in conjunction with all other discharge planning activities that are applicable to the individual patient’s needs, including home health services, durable medical equipment, pharmaceutical assistance programs, and referral to other community programs.

In the spring of 2019, a Patient Care Navigator position was created specifically to help patients with heart failure navigate their transition from hospital to home. The Patient Care Navigator calls high risk patients between 24-72 hours after discharge. During this phone call, the Patient Care Navigator reviews the patient’s plan of care and medication list, addresses any symptoms the patient may be having as well as ensures the patient received any equipment or other in-home assistance that was ordered at discharge. Additionally, the Patient Care Navigator is responsible for scheduling all follow up appointments that were ordered at discharge. National guidelines from the American Heart Association state that patients should see their Primary Care Physician or their Cardiologist within seven days of discharge and LMC’s Patient Care Navigator is helping to make sure that happens. Overall, the Patient Care Navigator serves as a central hub for patients with heart failure so when they leave the hospital, they know who to call if they need help.

Sepsis Management

Sepsis is a medical emergency that is caused by a reaction to an infection. The infection overwhelms the body’s immune system and chemicals are released into the bloodstream causing inflammation of the entire body. Sepsis can be unpredictable and progress rapidly. Often times, the symptoms can be mistaken for other conditions, making it more difficult to diagnose. If not treated, it can lead to organ failure and death. Mortality can be as high as 40% in patients that develop sepsis and it is one of the leading causes of death in the United States.

A National Surviving Sepsis Campaign recommends early recognition and early treatment to improve patient outcomes. Experts recommend ‘bundles’ of care to simplify the complex treatment of these patients.

LMC has adopted a multi disciplinary team approach for recognition and timely treatment of these patients. Early appropriate treatment has been shown to decrease incidence of organ failure and death. The electronic health record is used to identify patients with potential sepsis quickly in the Emergency Department and to screen for triggers of deterioration that may indicate that a patient is developing sepsis after arrival. LMC is committed to improving outcomes in this patient population.

Severe Sepsis/Septic Shock
Management Bundle Compliance Comparison Data
(Higher Percentage is Better)

Catheter-Associated Urinary Tract Infections (CAUTI)

What is a urinary catheter?

A urinary catheter is a thin tube placed in the bladder to drain urine. Urine drains through the tube into a bag that collects the urine. A urinary catheter may be used if you are unable to urinate on your own; to measure the amount of urine you make, for example during intensive care; during and after some types of surgery and during some tests of the kidneys and bladder. People with urinary catheters have a much higher chance of getting a urinary tract infection than people who don’t have a catheter.

How do patients get a catheter-associated urinary tract infection (CAUTI)?

If germs enter the urinary tract, they may cause an infection. Many of the germs that cause a catheter-associated urinary tract infection are common germs that can enter the urinary tract when the catheter is being put in or while the catheter remains in the bladder.

What are some of the things that healthcare providers at Lexington Medical Center are doing to prevent CAUTI?

• Other methods to drain urine are sometimes used, such as external catheters in males and females and putting a temporary catheter in to drain the urine and removing it right away.
• Catheters are put in only when necessary and they are removed as soon as possible.
• Only properly trained persons insert catheters using sterile technique.
• The skin in the area where the catheter will be inserted is cleaned before inserting the catheter.
• Bladder scanners are used to assess the amount of urine in a patient’s bladder to avoid unnecessary urinary catheterization.
• Healthcare providers clean their hands by washing with soap and water or using alcohol-based hand rub before and after touching your catheter.
• Healthcare providers avoid disconnecting the catheter and drain tube. This helps to prevent germs from getting into the catheter tube.
• The catheter is secured to the leg to prevent pulling on the catheter.
• Specialized cleansing wipes are used to perform daily catheter care while catheters are in place.

Lexington Medical Center closely monitors patients with urinary catheters. Interdisciplinary health care teams carefully evaluate clinical practice issues and infection outcome data. Lexington Medical Center reports CAUTI data to the National Healthcare Safety Network (NHSN), a Clinical Registry of the Centers for Disease Control. This data is shared with health consumers through the Center for Medicare and Medicaid Services Quality website.

Catheter-Associated Urinary Tract Infections
(Lower is Better)

Central Line-Associated Bloodstream Infections (CLABSIs)

Central line-associated bloodstream infections (CLABSIs) result in thousands of deaths each year and billions of dollars in added costs to the U.S. healthcare system. LMC is committed to reducing our central line infections through a variety of mechanisms.

What is a central line?

A central line (also known as a central venous catheter) is a catheter (tube) that doctors often place in a large vein in the neck, chest, or groin to give medication or fluids or to collect blood for medical tests. Intravenous catheters (also known as IVs) are used frequently to give medicine or fluids into a vein near the skin’s surface (usually on the arm or hand), for short periods of time.

What is a central line-associated bloodstream infection?

A central line-associated bloodstream infection (CLABSI) is a serious infection that occurs when germs (usually bacteria or virus) enter the bloodstream through the central line. Patients who get a CLABSI have a fever, and might also have red skin and soreness around the central line. If this happens, healthcare providers can do tests to learn if there is an infection present.

What are some of the things that healthcare providers at Lexington Medical Center are doing to prevent CLABSI?

• Lexington Medical Center follows CDC (Centers for Disease Control) recommended central line insertion and maintenance practices to prevent infection when the central line is placed, including: perform hand hygiene, apply appropriate skin antiseptic, ensure that the skin prep agent has completely dried before inserting the central line.
• We have several types of central line catheters coated with antimicrobial infection protection available.
• We use maximal sterile barrier precautions during insertion (sterile gloves, sterile gown, cap, mask and large sterile drape).
• Once the central line is in place our staff follows recommended CDC central line maintenance practices.
• We bathe all central line patients with antiseptic impregnated cloths to further reduce risk of infection.
• We remove a central line as soon as it is no longer needed.

Lexington Medical Center closely monitors patients with central lines. Interdisciplinary health care teams carefully evaluate clinical practice issues and infection outcome data. We report CLABSI data to the National Healthcare Safety Network (NHSN), a secure Centers for Disease Control managed data reporting system. This data is shared with health consumers through the SD DHEC Hospital Acquired Infection Website as well as the Center for Medicare and Medicaid Services Quality website.

Central Line-Associated Bloodstream Infections
(Lower is Better)

Newborn Hearing Screens

Hearing loss occurs in approximately 2-4 out of 1,000 babies. Since babies start developing speech and language from birth, hearing is very important. Early detection of hearing loss results in effective treatment and interventions.

South Carolina newborns receive a hearing test prior to discharge from the hospital. Lexington Medical Center has developed a process to screen infants according to the recommendations from the American Academy of Pediatrics. The goal is to maintain a 95% or better screening rate. We successfully screen over 99% of our newborns each year.

Newborn Metabolic Screenings

South Carolina newborns receive metabolic screenings to detect conditions that can lead to death or disability. Lexington Medical Center has participated in On Time, Every Time, a collaborative initiative with DHEC and the SCHA since February 2014 to improve the birth outcomes in our state by strengthening the newborn screening program and improving the collection of the newborn screens and their delivery to the DHEC State Lab for processing.

Goal: Collection is to be between 24-48 hours of age for the infant. All specimens to be sent to DHEC Bureau of Laboratories within 24 hours of collection.

Initiative: On Time, Every Time. The goal is 100% for < 24 hours.

Newborn Metabolic Screenings
(Higher Percentage is Better)

Total Joint Program

Our Total Joint Program provides a patient centered experience that focuses on patient and family preparation and education to ensure our patient’s safety and a speedy recovery. We are dedicated to always providing the best care experience, which includes a comprehensive program that covers the patient's care from start to finish. We combine innovative surgical techniques and after surgery rehabilitation with skilled, compassionate care. Lexington Medical Center values a team approach whereby all disciplines involved work together to always provide the best possible experience for all patients.

Total Knee Readmission
(Lower Percentage is Better)

Discharge Disposition After Knee Replacement

Total Knee and Hip Replacement
Day After Surgery Average Pain Level
(Scale 0-10)

Hospital Acquired Potentially-Preventable Venous Thromboembolism (VTE)

Preventable VTE is defined as a diagnosed deep vein thrombosis (DVT) or pulmonary emboli (PE) which occurred in a setting in which prophylactic treatment that could have potentially prevented it from occurring was not contraindicated. DVT occurs in the arms or legs while PE is a blood clot in the lung.

This measure assesses the number of patients diagnosed with confirmed VTE during hospitalization (not present on admission) who did not receive VTE prevention between hospital admission and the day before the VTE diagnostic testing order date. This information is publicly reported on the Centers for Medicare and Medicaid Services (CMS) website. Lexington Medical Center patients are assessed on admission and post-operatively. Physician Order sets include VTE preventive measures.

VTE-6 Hospital Acquired
Potentially-Preventable Venous Thromboembolism (VTE)
(Lower % is Better)

Stroke Care Quality Initiatives

Stroke is the fifth leading cause of death in the nation and the leading cause of disability. Recognizing the signs of stroke and calling 911 are the first steps to improving patient outcomes. Our Acute Stroke Team in the Emergency Department rapidly identifies potential stroke patients eligible for thrombolytics (a clot-busting drug that reduces disability) and facilitates timely treatment. Research shows only a small percentage of stroke patients arrive in time for thrombolytics. Treatment within 60 minutes of identification of stroke symptoms can reduce disability.

As a Primary Stroke Center, Lexington Medical Center (LMC) utilizes evidence based orders and protocols to improve patient outcomes. Best practice guidelines recommend specific medications to reduce risk for, or recurrence of stroke; as well as to reduce disability, complications, and/or death related to stroke. Blood clots that flow to the brain from the heart or arteries are often the source of a stoke. Blood clots can develop inside the blood vessels of people with cardiovascular disease (blockages in the arteries). Blood clots are also likely to form inside the heart of individuals with a common irregular heart rhythm called Atrial fibrillation (AFib). Both of these conditions significantly increases risk of stroke. Effective strategies to reduce complications of stroke and prevent recurrence of stroke are prescribing medications to prevent blood clot formation. Antithrombotics (prevents clot formation) and anticoagulants (blood thinners) may be prescribed to prevent blood clots. Cholesterol medications may also be prescribed as an effective secondary prevention for patients who have had an ischemic stroke. Smoking is another strong risk factor for stroke. Lexington Medical Center has a free smoking cessation program and participation is highly encouraged.

In 2019, through collaboration with the American Heart Association/American Stroke Association Get with the Guidelines© program (GWTG), LMC achieved the American Heart Association/American Stroke Association GWTG Gold Plus, Target: Stroke Honor Roll Elite Plus Award. This recognition reflects LMC’s dedication to providing quality stroke care.

Stroke
Medications for Blood Clots
(Higher Percentage is Better)

Source:
Quintiles/American Heart Association Get with the Guidelines ©

Stroke
Prevention at Discharge
(Higher Percentage is Better)

Source:
Quintiles/American Heart Association Get with the Guidelines ©

Metabolic and Bariatric Surgery

Combating one of our nation’s leading health concerns, obesity, bariatric surgical procedures reduce comorbidities such as hypertension, diabetes, sleep apnea, and gastroesophageal reflux disease through weight loss. Lexington Medical Center has performed over 7,000 bariatric surgeries since 1998. Our surgeons and patients work together to choose the most appropriate procedure that will address their own personal health needs, which includes the gastric bypass, sleeve gastrectomy, adjustable gastric band, and gastric balloon.

As a fully accredited Center through the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program, LMC hosts a comprehensive program that is proud of the high level of bariatric care offered to our patients. Hallmarks of our well-established program include two bariatric surgeons performing each procedure, a multi-layered patient support system that includes patient education and support groups, and the availability of bariatric care 24 hours a day, 7 days a week, 365 days a year. Our team is committed to continual improvement of the care we provide through the long-term monitoring of each surgical case.

 

History of Bariatric Surgery at LMC

Total 7126
(1998 - March 2019)

We have a rich history of bariatric surgery at LMC. We perform a variety of bariatric procedures, including revisions of previous surgeries. Recently, the sleeve gastrectomy surpassed the gastric bypass as our most-performed procedure.

Bariatric Surgery Length of Stay (days)
(Lower Numbers are Better)

Our goal after bariatric surgery is to enable our patients to return home as quickly as possible. Our team works hard to achieve this measure and we are proud of our low length of stay rates.

Reoperations and Readmissions after 
Laparoscopic Sleeve Gastrectomy
(January 2018 – December 2018)

Our providers and team use a multidisciplinary approach to avoid reoperations and readmissions after bariatric surgery.

An “expected rate” is the estimated rate of reoperations and readmissions which LMC was expected to have during the time frame, taking into account the complexity of surgical cases performed and comorbidities of the patients.