Business Plan: Cardio Center Business Proposal This Business Plan

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Cardio Center Business Proposal

This business plan outlines the structure, goals and financial aspects of creating a new cardiac catheterization lab and heart treatment center in central Florida. It will be called "CardioCenter," and extend its message of expert urgent cardiac care within a 25-mile radius. It will cover how such a center should be built, what are its fundamental goals, and how it can compete against established centers in the area.

The goal of the new cardiac catheterization center is to provide services to primary care physicians and first-level cardiologists, and to provide faster and more-targeted services to patients who require catheterization and may not be close enough to a major catheterization center.

Mission of the New Center

The mission of this center will be twofold: (1) provide round-the-clock emergency catheterization diagnostic and interventional capabilities to patients who are not close enough to such a center today, and (2) to help those patients, post-catheterization, to live more healthy lifestyles and comply with their treatment regimens in order to improve their prognoses.

Strategies of CardioCenter

Within central Florida, centered around Orlando, there are three major heart centers with round-the-clock facilities available for cardiac catheterization. These centers advertise their availability, and can tout their ability to improve patients' outcomes by improving "door to balloon" time down to less than 60 minutes. Such a strategy of rapid catheterization has been shown to significantly improve the morbidity and mortality of patients (Bradley, 2006). Although many existing facilities have attempted to adapt their workflow to improve "door to balloon time," many have not, as the structural and schedule changes involved in a general-care hospital pose difficulties. The strategy at CardioCenter will be to provide a dedicated structure and staff to be able to offer round-the-clock service and world-class treatment to patients who are brought to the center.

The other key part of the strategy is to locate CardioCenter far enough away from the major Orlando Centers in order to create a "catchment" area for patients who may not be within 60 minutes of "balloon time" from the time the ambulance picks them up at their home. By locating CardioCenter in the Ocala area, we will be the sole center within a 75-mile radius with a complete cardiac catheterization facility and 24-hour service. That means that those who live within Ocala (population 48,000) and Marion County (population 316,000) will have better access to CardioCenter than to the Orlando-region healthcare centers (U.S. Census Bureau, 2006). Not only can we offer better service, but we can do so in a center of population that is growing faster than almost any other county in the United States (U.S. Census Bureau, 2006).

Mission Statement

The mission of CardioCenter is to provide the best cardiac care in central Florida. We expect to complete this mission through our dedication to one goal: cardiac care. Although many of the Orlando-area centers have extensive cardiac treatment facilities, we will benefit the patient by being set up entirely to treat cardiac emergency cases, and the post-MI care that is needed by patients. Our unique and sole focus should benefit patients by providing (1) staff which has greater experience than anywhere else in the region in treating the specific diseases we are responsible for, and (2) facilities which expedite the patient from the door to the cath lab, and insure that the patient receives dedicated, focused care during his/her stay, and (3) post-AMI care that is second-to-none in providing in-center and outpatient support to insure that the patient and his/her family sticks with their prescribed regimens and improves their chances.

Vision Statement

Our vision statement is: "Time is Heart Muscle." The ability to diagnose patients quickly and get them to treatment makes all the difference in their subsequent morbidity and mortality.

Organizational Structure

Most hospitals are organized to treat a number of varied patient conditions, from obstetrics to cancer treatment to Emergency Room treatment. While many hospitals have erected cardiology centers, they do not have the dedicated staffing and physical structures that are needed to optimize cardiac care. Most hospital structures and personnel are scattered throughout the institution. In a typical general hospital, the organization responds in the following ways to the admission of a suspected heart attack patient in the Emergency Room:

Unless the patient is suffering massive coronary event, there could be a waiting period before a physician or nurse sees the patient and makes a first diagnosis.

A generalist resident (or sometimes an intern) receives the patient. In many cases, the patient and/or his/her family may need to complete billing paperwork before visiting with a physician.

The physician may order tests to determine whether or not the patient has had a cardiac event. At the same time, a nurse may be asking the patient or his/her spouse about the patient's previous medical history.

The blood is drawn and sent either to a small lab within the ER, or, more commonly, to the central laboratory. It can take up to half an hour to determine whether or not the patient's Troponin, Myoglobin and CK-MB results are elevated. It may also take that long for a physician to review the patient's EKG to determine if there is an ST elevation or other heart anomaly that is indicative of a heart attack.

If the patient is older than 65, the physician may have elected not to deliver clot-busting drugs because of a concern about hemorrhagic stroke (Neuhaus, 1995); for that reason, the patient may have suffered inadequate treatment for longer than 60 minutes before any thrombolytic drug was delivered.

In a center with a 24-hour staff prepared for cardiac catheterization, the on-call interventionalist may be called for a consult with the on-duty ER physician. A decision would be made at that time to send the patient up to the cath lab to perform an angiogram, and perhaps an angioplasty if it is indicated. Note that the cath lab is generally on a different floor, and many times in a different part of the hospital.

The patient is wheeled up, prepared, and brought in for cathing. It may take up to 10 minutes for the staff to arrive, the access to the femoral artery to be completed, and the introducer and guidewire to be threaded up around the aortic arch and into the cardiac arteries.

The average time, even in a well-equipped and prepared center like that used in this example, might be over 60 minutes. (Majid, 2005). In fact, the average reported door-to-balloon time is 100 minutes, with great variation.

Our Mission Statement is our guiding principle: If "Time is Muscle," then we must do everything possible to short-circuit this unacceptably long time from door to balloon time, and do everything we can in our organization and structure to insure that patient care comes first.

The organization for suspected AMI should be as follows:

The ambulance driver is alerted to a possible AMI. Upon arriving at the site, the EMT crew makes a preliminary assessment that the patient may have suffered or be suffering an ACS event. The EMT tending to the patient communicates by phone or telemetry with CardioCenter's dedicated EMT-interface nurse, who takes down as much information as possible and alerts the staff in "Receiving" (not ER) that a potential AMI patient may be arriving.

Upon arrival, the patient and/or spouse or close family member is asked about their previous cardiac history and primary care physician. At that point, the EMT-interface nurse contacts the primary-care physician or cardiologist in order to alert them to the possibility of an ACS event, and to take any relevant information.

An immediate, bedside panel of cardiac enzymes is run on the patient for four cardiac enzymes: CK-MB, BNP, Troponin I and Myoglobin. The results are generated in less than 3 minutes. The experienced nurse interprets the results and communicates them to the cardiologist, or the cardiologist reviews that data immediately.

Upon preliminary diagnosis that the patient is suffering an AMI event, the patient is wheeled a short distance (on the same floor) to a cardiac cath prep room, where the patient is administered valium, then a local anesthetic, before being wheeled into the cardiac cath room. The staff, already alerted to the possible arrival, is on hand and ready for the cut-down.

The patient is cathed and angiogram performed within a few minutes. If the patient requires a stent or balloon angioplasty, the physician is fully-qualified to perform the angioplasty right then.

The patient is delivered to CICU, where an on-staff cardiologist takes over and assures that the patient's vital signs are followed as needed. This includes on-going monitoring of the patient's EKG, cardiac enzymes, PCO2 and other results that can indicate whether or not the patient is undergoing a secondary event.

If needed, the interventionalist can converse with a cardiac surgeon (who is on staff, but may not be on site) about the potential need for bypass surgery. The cardiologic specialists can communicate using the latest web-based angiogram communication tools, which allow them to be looking… [END OF PREVIEW]

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