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Quality Improvement Projects 2022

As part of our Centers of Excellence Certification, we request information about quality improvement projects from each institution. On this page you will find highlights from each of our 2022 GOLD standard programs along with contact information if you would like to learn more about their projects.

Highlights

Brigham and Women's Hospital/Dana Farber Cancer Institute

  1. Established a pathway for referral of childhood and young adult cancer survivors of chest radiation therapy
  2. Established an immuno-tox team and have a pathway for evaluation and management of ICI myocarditis
  3. Establishing a clinical pathway for risk factor optimization in patients with lung cancer who are being treated with chest radiation and also prostate cancer patients who are being treated with androgen deprivation therapy

For more information contact:

Dr. Anju Nohria

[email protected]

City of Hope National Medical Center

  1. Institution of a technetium pyrophosphate protocol in Nuclear Medicine for diagnosis of transthyretin cardiac amyloidosis
  2. Institution of mobile, handheld review of live inpatient telemetry using Airstrip
  3. Comprehensive mapping of echocardiography measurements from Tomtecto Epic for reporting and data tracking
  4. Acquisition of cardiac event recorders for long term monitoring and diagnosis of occult arrhythmias, followed by work with GE to integrate SpaceLabs Holters and Preventice long term event recorders into MUSE for streamlined workflow and reporting to Epic EMR

For more information contact:

Dr. Faizi Jamal MD

[email protected]

Hartford Health Care Heart and Vascular Institute Cardiology Oncology Program

  1. Created structured workflows that integrate care (referrals, scheduling,clinical messaging)
  2. We have worked with our IT department to implementintegratedEHR Cardio-Oncology prompts. The prompts appear in patients who are ordered for high-cardiovascular risk oncology treatments. The prompt advises oncologists that the patient is high risk for cardiovascular complications and to consider a referral to cardio-oncology.
  3. Created a bimonthly interdisciplinary cardiac tumor board to discuss cardiac mass cases from throughout Georgia. The board includes experts in cardiology, cardiothoracic surgery, oncology, radiation oncology, cardiovascular imaging, pathology, and endocrinology.

For more information contact:

Dr. Anant Mandawat

[email protected]

Emory University

  1. Ambulatory Cardio-Oncology Consult Order in EPIC– This ensures cancer patients are being referred to cardio-oncology specialists within the program rather than general cardiologists. In addition, it is the most accurate tool we have to track patient volume
  2. In-Patient Cardio-Oncology Service– We are launching an e-consult service continuously staffed by one our cardio-oncologists in a rotating schedule. Patients will first be evaluated in person by a general cardiologist in the acute care setting. If subspecialized cardio-oncology expertise is needed thereafter it will be provided that day as a formal e-consult.
  3. ECG Optimization– We have provided education, developed a business plan for obtaining additional ECG machines, and are working with our IT department to streamline a work queue that makes ordering an ECG as easy as ordering a simple imaging test.

For more information contact:

Noa Mencher

[email protected]

Indiana University Health

  1. Electronic Health Record(EHR)Integration: We have dedicated “Cardio-Oncology Consult order” in our EHR which providers across the variousIU/IUHsystem can use to place anin personor virtual consult order.
  2. Cardio-Oncology Nurse Coordinator:We have a dedicated Cardio-Oncology NurseCoordinator who triages these consults, facilitates appointments,and necessary testing.
  3. We are working with our Pediatric Survivors Cardiology Clinic andour AYA Survivors clinic to develop standardized and structured Cardio-MetabolicScreening in Pediatric Cancer Survivors using the Childhood Cancer SurvivorStudy Cardiovascular Risk Calculator to identify those at risk for heart failure,ischemic heart disease, and stroke.

For more information contact:

Dr. Suparna Clasen

[email protected]

Lehigh Valley Health Network

  1. Created aLung cancer screening process within the EMR which notifies PCPs that their patient may be at risk and should be screened for Lung Cancer.

For more information contact:

Mercedes Scott

[email protected]

Lee Health, Naples

  1. Leveraging the EHR to embed the Mayo Risk calculator to identify patients at high risk for cardiology/cardio-oncology assessment.
  2. Development of a risk assessment tool for cancer intake personnel to be embedded in the EHR
  3. Developed strategies to help identify high risk patients and involved the pharmacy staff to help. They added a pop up that insures there is an assessment of LV function prior to starting cardio-toxic therapies. Lipid profiles are routinely drawn with oncology clinic labs.

For more information contact:

Dr. Anita Arnold

[email protected]

Methodist LeBonheur Healthcare/University of Tennessee Health Sciences Center, St. Jude Children's

  1. Created Pediatric Cardio-Oncology Database
  2. Developed Cardio-Oncology Magnetic Resonance Imaging Protocol

For more information contact:

Dr. Jason Goldberg

[email protected]

Mayo Clinic Rochester

  1. Determination of follow-up cardiac function assessment in cancer survivors per NCCN and ASCO guideline
  2. Initiatives for quality metrics and general outcome metrics
  3. Mayo enterprise wide clinic network

For more information contact:

Dr. Joerg Hermann

[email protected]

Cardio-Oncology at Mount Sinai Cardiovascular Institute

  1. GLS estimation during echocardiography in all patients undergoing cancer chemotherapy and immunotherapy as a marker of early cardiotoxicity
  2. Protocols instituted for Breast Oncology to detect CTRCDbased on ACC/ASE guidelines to guide breast cancer treatments based on LVEF and GLS measurements on echocardiography and early referral to Cardio Oncology
  3. Protocols instituted for Division of Myeloma to do monthly measurement of BNP levels to detect early carfilzomib cardiotoxicity
  4. Protocol initiated for measurement of EKG and Troponin in first 3 months of initiation of checkpoint inhibitors to detect early immune mediated myocarditis from immunotherapy
  5. Protocol initiated for Division of Neuroendocrine Tumors For 6 monthly measurement of nt-ProBNP measurements in carcinoid patients for early detection of carcinoid heart disease

For more information contact:

Dr. Gagan Sahni

[email protected]

Cardio-Oncology Center of Excellence, Ohio State University

  1. Improving the patient and clinician experience through App-based care (developed a cardio-oncology App, with refinement and testing ongoing) in conjunction with the Department of Bioinformatics (initial experience presented at AMIA Clinical Informatics, and local OSU Research Day conferences-manuscript in development)
  2. Working to establish and integrate the CMR registry, with an institutional cardio-oncology (3,000+) patient registry

For more information contact:

Dr. Daniel Addison

[email protected]

University of Texas Southwestern Medical Center

  1. 3D and strain echocardiography:training for sonographers imaging service faculty for dedicated cardio-oncology protocols>
  2. Electronic consults: development of an eConsult system for Cardio-Oncology to facilitate rapid contact and interpretation in clinical context of abnormal test results.
  3. Telehealth: development of Cardio-Oncology-dedicated telehealth resources, which has facilitated access to virtual visit for patients during covid-19 pandemic, and have proven to be a valuable resource for patients located at significant distance to SCCC, in North Texas
  4. Inpatient consult service: implementation of a new consultative service for cardio-oncology questions
  5. Immunotherapy related adverse events (iRAE) prevention: The UT Southwestern Medical Center Multidisciplinary Immunotherapy Workgroup has implemented EMR tools for screening and monitoring of patients for multisystemic iRAE’s, including myocarditis, based on national guidelines (NCCN)

For more information contact:

Dr. Vlad Zaha

[email protected]

Thalheimer Center for Cardio-Oncology - Abramson Cancer Center - Perelman School of Medicine at the University of Pennsylvania

  1. Anthracycline EPIC flag and total dose calculator
  2. BTK: pre-start CO consult
  3. CML kinase: pre-start CO consult
  4. Strain-modified TTE order in EPIC to include GLS inclusion
  5. ICI myocarditis treatment algorithm
  6. 5-FU rechallenge protocol

For more information contact:

Dr. Joseph Carver

[email protected]

Istanbul Faculty of Medicine

  1. Establishment of Preventive Oncology Department
  2. Workflow Chart For Cardio-Oncology

For more information contact:

Dr. Cafer Zorkun

[email protected]

Cardio-Oncologia Samaritano

  1. Development of safety policy: This policy is applied in all Americas oncologic services located in the State of Sao Paulo . It is a project on cardiovascular monitoring and safety for patients undergoing chemotherapy (CT) and radiotherapy. We propose the routine evaluation and cardiological follow-up for patients undergoing Chemotherapy, focusing on the indications, follow-up exams and the frequency indicated for each drug used.

For more information contact:

Dra. Ariane Macedo

[email protected]

Centro Hospitalar Universitário Lisboa Norte

  1. Our team promoted the development of a task force between the Cardio-Oncology Working Group and the Portuguese Association of Cardiovascular Intervention aimed at implementing national guidelines for interventional cardiology decisions in cancer patients.
  2. Cardio-Oncology Unit Coordinator who meets with the team quarterly
  3. An established referral protocol based in electronic process
  4. A fast pathway referral process for both echocardiography (with a dedicated echocardiography technician) and consultations
  5. An outcome-based audit process conducted yearly, as part of a broader continuous accreditation process of the Cardiology Department
  6. We have a local task force working on the development of a Survivor’s Card with instructions for the follow-up after the discharge of the Unit

For more information contact:

Dra. Manuela Fiuza

[email protected]