Launching an LAAO Program: How Cleveland Clinic Assisted an Affiliated Institution

Not long after Saint Francis Medical Center entered into a cardiology and cardiovascular surgery affiliation with Cleveland Clinic in early 2014, the Southeast Missouri facility turned to Cleveland Clinic to help it create a transcatheter aortic valve replacement (TAVR) program.

That experience (profiled in this earlier Consult QD post) was a success, prompting the 306-bed nonprofit tertiary care institution to turn to Cleveland Clinic for guidance in launching another offering in its structural heart disease program — this time for left atrial appendage occlusion (LAAO) with the Watchman™ device.

Site visit for firsthand observation

The effort started with a February 2018 site visit to Cleveland Clinic’s main campus by several key players in the planned Saint Francis LAAO program: three physicians (an interventional cardiologist, an imaging cardiologist and an electrophysiologist) plus an advanced practice nurse serving as coordinator of the institution’s structural heart program.

During the visit, the Saint Francis staff observed the Cleveland Clinic LAAO team perform a couple of Watchman procedures in the electrophysiology lab as well as manage several LAAO patients at different stages in the course of care, from workup through post-procedure discharge. The structural heart program coordinator consulted with nurse practitioners before and after LAAO procedures and visited extensively with Cleveland Clinic Heart & Vascular Institute registry, coding and billing specialists to learn fine points of data abstraction relating to LAAO procedures for purposes of compliance, coding, billing, quality reporting and patient follow-up.

“We came prepared with questions to allow us to implement processes from Cleveland Clinic’s program in a smaller organization like ours,” explains Jennifer Cotner, MSN, APRN, ACNP, Structural Heart Program Coordinator at Saint Francis.

Implementation and outcomes

The Saint Francis team applied their learnings in short order, performing their first LAAO procedure within a month after the site visit. A full-fledged program was soon up and running, with 42 patients evaluated for LAAO within the first year and 25 LAAO procedures performed. Saint Francis now performs LAAO procedures every other Tuesday. Outcomes to date have been excellent, as detailed in the table below.

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Ongoing support

Key Cleveland Clinic team members provide ongoing support to their Saint Francis counterparts as needed. For instance, electrophysiologist Mohamed Kanj, MD, who met with Saint Francis staff during their site visit, provided at least six second opinions on Saint Francis patients who were considering an LAAO procedure during the first year of the Saint Francis program’s operation. Additionally, Cleveland Clinic’s LAAO registry team continue to advise and support their Saint Francis colleagues on questions of coding and reporting.

Indeed, a key aspect of the training provided to Saint Francis by Cleveland Clinic involved education relating to the American College of Cardiology’s LAAO Registry™. Cleveland Clinic data specialists provided templates to assist with proper abstracting, documentation and reporting for the registry.

Additionally, as a Cleveland Clinic Heart & Vascular Institute affiliate organization, Saint Francis is entitled to complimentary attendance at Cleveland Clinic’s annual Cardiac Registry and Analytics Boot Camp, a three-day event designed to share best practices in maintaining cardiac registries, data validation and accuracy, analytic outcomes reporting and physician engagement efforts. This year’s boot camp is slated for Nov. 13-15 on the Cleveland Clinic main campus.

Reflections on the partnership

For its part, Saint Francis is delighted with the progress it has made in just one short year of offering LAAO services. “The support we have received from Cleveland Clinic has been invaluable to the development and expansion of our structural heart program,” says Saint Francis interventional cardiologist Steven Joggerst, MD, who leads the LAAO program. “Dr. Kanj and his team readily shared their expertise, experience and ideas, allowing us to make a smooth transition to this technology. They have always provided timely responses to our clinical questions and concerns. It is a privilege to be affiliated with Cleveland Clinic.”

“It has been gratifying to see the Saint Francis team flourish in their use of LAAO technology,” observes Cleveland Clinic Section Head of Cardiac Electrophysiology and Pacing Oussama Wazni, MD, who met with the team during their site visit. “Through Cleveland Clinic’s affiliate program, we have gained considerable experience in helping smaller centers adapt new technologies to the size and scope of their programs. This helps the affiliate centers distinguish their programs in their local markets and it also sharpens our use of the technology by guiding another center in its use. The collaboration is inevitably a win-win.”

For information on affiliation and alliance opportunities with Cleveland Clinic’s Heart & Vascular Institute, visit clevelandclinic.org/heartaffiliates.