Strength Through Interprofessional Collaboration: A Second-Opinion Service for Affiliate and Alliance Hospitals

Second-opinion case review has been a long-standing offering of the Advisory Services program of Cleveland Clinic’s Heart, Vascular & Thoracic Institute (HVTI), and for good reason — physicians and other caregivers recognize that collaboration and consultation results in the best care.

Cleveland Clinic HVTI physicians are highly invested in care collaboration, regularly discussing cases with their colleagues to determine the best plan of care for patients. They also recognize that physicians at other institutions may sometimes have limited opportunities to discuss unique, complex or high-risk cases with colleagues in diverse cardiovascular subspecialties.

That recognition prompted HVTI Advisory Services to formalize a process whereby physicians at hospitals that have affiliate or alliance relationships with HVTI can request a second-opinion case review from Cleveland Clinic when they would like an additional perspective on the plan of care for a patient. Such requests are frequently made for input on surgical/procedural timing or appropriateness, staging of a procedure or whether there’s a need to escalate care. Other requests may center on unique anatomy or consideration of a specialized approach to a given case.

“At Cleveland Clinic, we routinely discuss cases among our colleagues — cardiologists, interventionalists, surgeons — to enhance our plan of care for any procedure that is interesting or unique or may pose a higher risk of mortality,” says Edward Soltesz, MD, MPH, HVTI’s Director of Cardiac Surgery Affiliate and Alliance Programs. “Good decision making goes hand in hand with technical expertise in achieving high-quality outcomes, and physician judgment is critical in appropriate planning and execution of a successful procedure. We encourage our affiliate and alliance physicians to use our second-opinion process to review complex and unique cases with Cleveland Clinic physicians and determine the best strategy for the patient.”

How it works

The HVTI Advisory Services team developed standardized workflows between Cleveland Clinic and its affiliate/alliance hospitals to allow for seamless electronic transfer of radiology images and patient documents to facilitate a virtual second opinion (Figure 1). The affiliate/alliance hospitals are provided a contact list for HVTI’s consultant team to support their second-opinion requests for any case requiring expertise in cardiac surgery, interventional cardiology, electrophysiology, heart failure or cardiovascular imaging. Patient documents and images are reviewed by an HVTI physician, and findings and recommendations are then communicated to the requesting physician.

Figure 1. Schematic showing how the HVTI second-opinion process works for affiliate and alliance hospitals.

Since 2012, over 970 second opinions have been delivered by Cleveland Clinic to its affiliate and alliance hospitals and other select hospitals through this service. As shown in Figure 2, a majority of second-opinion requests involve surgical cases.

Figure 2. Graphs detailing utilization of HVTI’s second-opinion service by all affiliate and alliance hospitals (left) and by Valley Health System (right).

One organization’s experience

Cardiologists and surgeons at The Valley Hospital in Ridgewood, New Jersey — part of Valley Health System — have regularly used the second-opinion service since Valley began its alliance relationship with Cleveland Clinic’s HVTI in 2015.

“The Valley Hospital is a respected Cleveland Clinic HVTI alliance member that is known for its exceptional patient care and, like Cleveland Clinic, understands the importance of collaboration between hospitals/healthcare providers,” says Suma Thomas, MD, MBA, Vice Chair of Strategic Operations in HVTI. “This has been demonstrated by Valley’s use of the second-opinion process to optimize patient care.”

As detailed in Figure 2, 172 second-opinion requests from The Valley Hospital were completed through the end of 2021.

“These second-opinion consultations have been extremely valuable in adding the experience and perspective of the outstanding clinicians at Cleveland Clinic to our excellent general cardiologists and subspecialists here at Valley,” says Gerald Sotsky, MD, Chair of Cardiac Services for the Valley Medical Group. “Our patients benefit greatly from this team-based, collaborative approach.”

The longtime alliance relationship between Valley and Cleveland Clinic’s HVTI allows for a comprehensive understanding of Valley’s capabilities and resources. This ensures that recommendations offered through the second-opinion process involve reasonable and actionable treatment strategies.

Valley patients notably appreciate their physicians’ ability to collaborate with physicians at the nation’s top-ranked program for cardiology and heart surgery (per U.S. News & World Report), as it gives them confidence that all treatment options are being considered. “It is very reassuring to me as a surgeon when I can offer my patients a second opinion from Cleveland Clinic,” says Juan Grau, MD, Director of Cardiothoracic Surgery at The Valley Hospital. “I can lean on the experience of one of the premier cardiac surgery programs in the country and know that my patients will receive a thorough review of their specific clinical issues to augment my own expert opinion. The team at Cleveland Clinic sees an extraordinary volume of clinical cases, and that expertise supports me in my clinical decision making, allowing me to provide optimal care to my patients here at Valley.”

In some particularly complex cases, multiple physicians may be involved in a second-opinion request to determine the best course of action. “As the only heart failure cardiologist at Valley, I find it immensely valuable to have access to the world-class heart failure team at Cleveland Clinic for second opinions on difficult cases,” says Kariann Abbate, MD, Medical Director of Heart Failure Cardiology and of the Cardiac Care Unit at The Valley Hospital. “The advice I have received has expanded my knowledge base and skill level. Our patients and their families are reassured when they know the Cleveland Clinic heart failure team is helping to enhance their care.”

For information on affiliation and alliance opportunities with Cleveland Clinic’s HVTI, email Amanda Lesesky at leseska@ccf.org.