Stanford Health Care TAKEheart Profile

Challenges to CR participation at Stanford Health Care

Stanford Health Care is a large academic medical center with 613 beds, approximately 2,800 medical staff, and more than 1,300 residents and fellows. Stanford Health Care serves over 5,000 individuals for advanced heart and vascular care, with approximately 1,300 patients eligible for cardiac rehabilitation (CR) each year. Before participating in TAKEheart, referral orders were not consistently signed by physicians. Mapping workflow processes highlighted key gaps preventing referrals. The CR team's goal was to resolve this issue to increase CR enrollment for eligible patients before their discharge from the hospital.

Championing Improvement by Participating in TAKEheart

Jonathan David, MSN, RN, EBP-C, CCRP, NE-BC, the Cardiac Rehab Nurse Coordinator for the Inpatient Cardiac Rehabilitation program, served as Stanford Health Care's TAKEheart champion.  David decided to participate in TAKEheart to achieve three goals: (1) develop a standardized referral process, (2) automate the referral process, and (3) implement effective care coordination.

David participated in the TAKEheart training modules and learning community webinars where he learned best practices from subject matter experts and colleagues and found ways to address the gaps discovered in Stanford Health Care's system. TAKEheart trainings motivated David and his team to work more closely with the IT staff in improving the referral process. The IT team reviewed the automatic referral modules and participated in TAKEheart's Epic electronic health record (EHR) Q&A. David used the TAKEheart Implementation Guides to confirm that best electronic referral practices were actually being implemented.

Next Steps for Stanford Health Care

David and his colleagues on the Stanford Health Care team have found the training modules and implementation guides quite helpful as they continue to explore ways to improve care coordination. Through participation in TAKEheart, they have planned key next steps toward ensuring excellent care coordination. Thus, they continue to close some loopholes and work closely with their IT team to ensure all eligible patients are signed up for their first CR appointments before discharge.