Misty Theriot, RN, VCC, CCA

Nestled about halfway between Houston and New Orleans, Lake Charles is a midsized city in southwestern Louisiana with a Creole and Cajun culture. Its size and location mean its residents could face a long drive for advanced medical treatments. To better serve those residents, Lake Charles Memorial Hospital has stepped up its services to become the first institution to earn the ACC's Transcatheter Valve Certification.

Lake Charles Memorial Hospital performed its first transcatheter aortic valve replacement (TAVR) procedure in May 2018 and earned the certification Sept. 10, 2019, capping an intense effort to better serve its patients. The hospital performed more than 50 TAVR procedures in its first year and is on track to perform more than 60 procedures in its second year.

The hospital's certification preparation effort began at the start of 2019 with a clearly stated deadline, says Misty Theriot, RN, VCC, CCA, the Lake Charles Memorial Hospital Valve Clinic coordinator who led the certification effort. Keys to getting all of the work completed quickly were a desire to better serve patients, strong support from hospital administration, and buy-in from staff members who wanted to assist with the certification process.

"At the beginning, we let everyone know that our deadline was Aug. 30. This helped to create a sense of urgency that we needed to complete all of the requirements in a short time frame," Theriot says. "Our ACC review specialist was great and guided us through the entire process. I communicated with her frequently to ensure that the submitted documents met the requirements. It took quite a few departments throughout the hospital to get all of this completed.

"Being first was not our initial goal. It speaks to the team work of our program and our facility. It also places emphasis on our focus to continue to provide quality patient care with a patient-centered focus."

Phillip Levy, MD, MPH, FACC, chair of the ACC Accreditation Management Board, says, "We are proud to recognize Lake Charles Memorial Hospital as the first recipient of ACC Transcatheter Valve Certification. Lake Charles achieved this distinction by developing processes to standardize patient care, increasing quality measurement and demonstrating their commitment to providing evidence-based, patient-centered care."

Starting a TAVR Program

Hospital staff began talking to its administrators in July 2017 about starting a TAVR program. Staff cardiologists were referring patients to institutions in Houston, a 2.5-hour drive from Lake Charles, a city of almost 80,000. The Lake Charles Memorial health system has 394 total patient beds and is the largest of three hospitals in the area.

"A lot of patients did not have the family support or ability to travel and we saw a large untreated population because of these factors," Theriot says. "This was our initial push to get a program started. Our facility is an acute care community hospital, which is the main campus of Lake Charles Memorial Health System. Our cardiologists provide care to surrounding cities, increasing our service area to approximately 200,000. As a result, we felt that our referral base was enough to sustain a program."

Lake Charles started its program with an experienced team and strong administrative support. The TAVR physicians include Gregory Lugo, MD, a cardiovascular surgeon, who participated in the startup of two other TAVR programs and two interventional cardiologists, Edward C. Bergen, DO, FACC, and Christopher S. Thompson, MD, FACC, who received TAVR training in multiple cardiac centers, including the German Heart Center in Munich, Germany.

That strong foundation allowed the program to hit the ground running, but there were challenges. There was a backlog of patients and the time from referral to evaluation to procedure required about 55 days.

"Some of the challenges we faced are generally present when starting a new program," Theriot says. "One thing we closely evaluated was streamlining our throughput process to decrease the amount of time that patients were waiting. We have implemented processes to improve this and as a result we have been able to decrease that throughput number by nearly half."

Certification Challenge

Building on the initial TAVR success, Lake Charles Memorial staff members began discussing certification at the start of 2019. They learned about the ACC Transcatheter Valve Certification, which is an operational model that merges the latest science and process improvement methodologies. It incorporates recent guidelines and expert consensus statements by recognized professional organizations regarding the care of patients requiring transcatheter valve therapies.

A crucial part of the certification process was completing a gap analysis that gauges what an institution needs to accomplish to be certified. That analysis also examines variations in care and helps develop action plans to implement care efficiencies. Another key was participating in the STS/ACC TVT Registry, which pairs with certification.

"The main struggle we had was with the verification process and not having certain policies in place," Theriot says. "We had to go through the proper steps to create those necessary policies, and that involved multiple departments. It also highlighted documents that needed to be updated and revised."

"Creating our root cause analysis and action plan was an eye-opening experience for us. A lot of the changes and processes we initially implemented were not documented. When that was compiled into a document, it was really good for us to evaluate the effects of making previous changes and to identify additional changes that needed to be implemented."

Benefits of Certification

Certification has had positive effects inside and outside of Lake Charles Memorial in the short time since it was achieved. The certification process created a stronger team and led to other departments wanting to learn about TAVR, Theriot says. The hospital is now promoting its new status among area residents.

"Lake Charles Memorial Health System is very proud of its TAVR program for becoming the first certified program. It has generated so much excitement," she says. "Our goals moving forward are to increase our procedure volume by doing more outreach opportunities and branching to other procedures. Long-term, our goal is to be recognized as an ACC HeartCARE Center, and that is something we are definitely going to work on."

Front row from left to right: J. Gregory Lugo, MD; Christopher S. Thompson, MD, FACC; Edward C. Bergen, DO, FACC. Middle row from left to right: Robin Trafford, RN; Brittany Weeks, RDCS, RVT; Rikki Richard, RDCS, RVT; Misty Theriot, RN, CCA; Stephanie Broussard, RT; James Walters, RN; Whitney Graham, RT. Back row from left to right: Vickie Anderson, RCS, RVS; Thomas Marshall, MD; Megan Jean, RDCS, RVT; Candice Brake, RN; Chase Boudreaux, RN; Lanell Landry, RN; Brittany Khoury, RN; Audie Ardoin, RN; Jimmy Bennett, CCP.

Keywords: ACC Publications, Cardiology Magazine, Female, Humans, Transcatheter Aortic Valve Replacement, Hospital Administration, Goals, Consensus, Root Cause Analysis, Hospitals, Community, Aortic Valve, Heart Valve Prosthesis, Accreditation, Certification, Patient Care, Registries, Surgeons, Patient-Centered Care, Referral and Consultation, Louisiana, Germany, Quality Improvement, Heart Valve Diseases, Angiography, Cardiology Interventions, Cardiac Surgical Procedures