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HOSPITAL FOR SPECIAL CARE 10 Whole-patient perspective Cardiac Care at Hospital for Special Care (HSC) is provided by an interdisciplinary team with expertise in the treatment of complex cardiac disease. is includes ("acute on chronic") heart failure patients requiring advanced therapies who have failed traditional methods of treatment. e interdisciplin- ary approach encompasses the medical team, nursing services, physical, occupational and speech therapy, dietitians, social work, case management, pharmacists, and therapeutic recre- ational specialists. ese team members have advanced cardiac training and encompass a true collaborative approach. Cardiac patients receive specialized programs to meet their individual needs with the goal of optimizing medication management, increasing functional abilities, improving self-management through education, improving quality of life, reducing the cycle of hospital readmissions. "What's different about this program is that it deals with all of the encompassing complexities for patients suffering from congestive heart failure and who may need chronic obstruc- tive pulmonary disease (COPD) management. We look at the whole patient, maintaining wellness and addressing acute hos- pital readmissions," said Dr. Marcy Goldstein, a pulmonolo- gist who handles complex respiratory cases, but also complex cardiac cases along with a cardiologist. "Home release is the targeted outcome," said Goldstein. "Making sure patients are empowered with education is the goal for things like medication management and nutrition. But education is needed for their families as well, who may help with things like infusions after release." Each customized transition plan to address chronic heart pa- tients' needs is overseen by a case manager, ensuring all spokes of the wheel of care are turning — keeping patients out of acute care facilities and at home with quality follow-up care, func- tionality and independence. n CARDIAC CARE Who Will Benefit? • Patients who have a diagnosis of heart failure and need IV medications (diuretics, dopamine, milrinone, dobutamine) • Patients who have had recurrent admissions to an acute-care hospital for management of heart failure • Patients who need preparation for an LVAD (Left Ventricular Assist Device) implantation ("pre-hab") to improve strength prior to surgery and those who have recently received a LVAD, are coming to HSC for treatment, therapy and education prior to returning home Therapies Occupational and physical therapies focuses on improving strength and endurance by working on functional activities, exercises and by teaching compensatory skills. Therapeutic recreation addresses leisure interests, adaptations and community reintegration needs. Speech language pathology is available on a consulting basis to address any unique needs related to swallowing or cognition. Outcomes Our outcome data includes admissions from local acute-care hospitals and emergency rooms: • 92 admissions • 80% discharged home • Average length of stay: 21.9 days • 6% heart failure readmission rate to referring hospital within 30 days