The HeartSMART Program
South Mountain’s HeartSMART program is the first of its kind in a post-acute setting, providing a seamless continuum of cardiac-focused care upon discharge from the hospital.
The Heart SMART program accommodates patients with a broad range of cardiac conditions, including congestive heart failure, post-myocardial infarction, post-coronary artery bypass and valve replacement, and post-cardiac catheter intervention. Co-morbidities and complications are cared for with the renowned high level of skill and expertise of South Mountain’s Rehab Unit, with a heightened sensitivity and focus on the cardiac implications.
The Heart SMART program provides the full scope of post-acute care services as well as cardiac-specific services, including: Lasix administration via IV push; in-house EKG testing; medication reconciliation and compliance; daily weight and condition monitoring; post-cardiac social and psychological services; extensive patient education with a strong emphasis on healthy diet and lifestyle; and post-discharge physician/cardiac center follow-up.
The Heart SMART Program is overseen by a cardiologist affiliated with local major medical centers. The Program Advisor’s direct involvement includes regular weekly rounds and monitoring of each patient’s progress. Significantly, the team works in close coordination with each patient’s primary cardiologist to ensure that his or her established care protocol is implemented. The staff includes RN’s who have been specifically trained in the administration of specialized care for Congestive Heart Failure and other cardiac conditions. The multidisciplinary team includes the medical and nursing staff, registered dietitian, psychologist, social workers, a physiatrist, and discharge planners.
One of the primary components of the HeartSMART program is a highly effective education and post-discharge training program, developed in conjunction with a team of leading cardiac care specialists and hospital clinicians. The innovative educational methodology includes instructional classes, nutrition counseling with vital fat and sodium information, fat versus muscle mass module, as well as hands-on healthy home cooking courses. Research has shown that patients in a post-acute setting are considerably more capable of absorbing and integrating the information than their acute care counterparts.
The comprehensive educational program is designed to promote a seamless transition and continuity of care for patients. The program emphasizes practical implementation of healthy dietary and lifestyle changes, including exercise principles and medication management. Patients are equipped with the tools they will need to maintain these changes following discharge. Likewise, the HeartSMART team ensures that patients reconnect with their primary physician, by actually scheduling a post-discharge appointment with each patient’s doctor or other community-based CHF services provider.