Faculty and staff at Montefiore Einstein’s Wakefield Hospital take great pride in the sense of familiarity at the 327-bed facility. “I know everyone on a first name basis, from the people serving food to my patients, to the nurses and assistants,” says third-year resident Rateb Fouad, MD. “It's a small hospital with large resources. We really know the people we're working with, and that leads to better teamwork.”

In this sense, Wakefield has stayed true to its roots as a community hospital even as it became part of Montefiore Einstein in 2008. Now, as an academic teaching hospital, care there has evolved to meet the needs of both patients, who expect access to services associated with a large academic health system, and residents, who benefit from advanced training in key areas.

The latest sign of this evolution arrived on September 9, when the hospital opened a 10-bed cardiology service located within its longstanding telemetry unit, which offers 24/7 monitoring of patients’ heart rates and other vital signs. Patients on the new service now have access to a dedicated specialist with a great depth of experience, interventional cardiologist Mark Greenberg, MD, professor of clinical medicine.

While cardiac patients have always been treated at Wakefield and sent to Montefiore’s Moses and Weiler Hospitals for advanced care and procedures as needed, the new service reduces the need to transfer patients.  “For a time, there was a perception that patients at Wakefield were less acute,” says Jessica Dekhtyar, MD, medical director at Wakefield. “But as our reputation in the community has grown, there is an appreciation now that our patients are just as complex as those who seek out care at our larger sister hospitals at Montefiore. There is a need for certain specialty services here, and cardiology was chief among them.”

She adds that any time you have to transfer a patient to another facility, it creates delays, which come with risks. And patients want to receive their care close to home. “Our patients really want to be treated in their community whenever possible,” she says. “They want to get all their services here.”

Linda Cesar (seated), telemetry aide, with resident physician Dr. Rafic Nabbout, in the telemetry unit’s monitoring room.

In talking about the need for the cardiology service, she continues, “We knew from a quality and safety standpoint it was important. From a residency education standpoint, it was important. And from a patient experience standpoint, it's important. These are all top priorities.”

For residents, a major enhancement to their training 
Hospitalists and internal medicine physicians can provide initial treatment for certain cardiac conditions with great success. But from a resident’s perspective, the chance to learn directly from a cardiologist is invaluable. Grace Kajita, MD, associate professor and program director for the Wakefield Residency Program, feels that her own training in a cardiology-heavy program gave her an advantage. “I felt comfortable providing a lot of care with the support of good cardiologists, and I think this is important for all general internists,” she says. “Even if you don't want to become a cardiologist, it's really valuable to have a core knowledge in this specialty.”

Because she believed this is such an important part of training, she arranged for residents in the highly competitive program at Wakefield to rotate through the cardiovascular critical care unit at Weiler Hospital, which they will still do. But having a cardiology attending physician on the telemetry service at the Wakefield campus adds an important new facet to residency training.

“Doing rounds with a cardiologist, seeing patients together, reviewing echocardiograms, or if the patient had a cardiac catheterization, reviewing the imaging with Dr. Greenberg, is a great teaching benefit for our residents,” agrees Olena Slinchenkova, MD,  chief of service for hospital medicine  at Wakefield and associate program director for residency training. “As a hospitalist, I have some knowledge, but I’ve never done these procedures. Dr. Greenberg has done hundreds of them.”

Dr. Greenberg spent his entire career at Montefiore Einstein and arrived at Wakefield in September with 40 years of experience as an interventional cardiologist. Before this new role, he recently helped open a new cardiac catheterization lab at Montefiore Nyack Hospital, which went on to win a quality award from the American Heart Association.

In addition to leading daily rounds with residents, he provides a weekly 15-minute lecture on key topics in cardiology to the residents currently rotating on the unit. “We get great insights, from the physiologic standpoint of the heart to the anatomy, to the pathologies,” says Dr. Fouad, who was in the first group of residents to train on the new service. “It gives us a great understanding of the fundamentals and then extrapolating that to what could be the underlying pathology or disease process. Specialty training is always really appreciated by the residents, especially from someone with Dr. Greenberg’s level of experience. It's been pretty fun.”

“The residents here are the cream of the crop, and so are our nurses,” says Dr. Greenberg. “You see the sign on the building, ‘Magnet Hospital for Nursing Excellence,’ but once you’re inside, you can really feel it. The standard of patient care at Wakefield is excellent.”

For patients, more attention from a specialist 
Before the new cardiology service was established, Richard Lucariello, MD, the longtime clinical director of noninvasive cardiology at Wakefield, saw all the patients across the hospital whenever a consult was needed. “He was perhaps the single busiest consulting physician at our location,” says Dr. Dekhtyar. “His dedication to our patients at Wakefield has been and continues to be tremendous.”

Dr. Greenberg’s presence benefits all patients at Wakefield who are in need of a cardiologist’s expertise, allowing both physicians more time with them. “I recently observed Dr. Greenberg in one of his patients' rooms as he was making rounds, sitting down with the patient and the residents and explaining the plan of care,” says Armila Baksh, MSN, RN, administrative nursing director for the telemetry unit, 5 North, and a 10-year veteran of the unit who began her nursing career there. “It warmed my heart. I told him later, that's what our patients want. They want to see their providers make that connection with them. When nurses ask our patients what we can do to make their hospital stay better, communication is something we hear again and again.”

Adding the cardiology service also changed the staffing model for the unit, adding a new, separate care team to cover the 10 cardiology beds. This has also improved efficiency and training on the unit.

“Before, this floor was always known among the residents as an especially demanding rotation, because the acuity of the patients is a lot more severe,” says Dr. Fouad. While this is always challenging for providers, it’s especially difficult at an academic hospital, where ideally there is time for teaching at the bedside as part of how care is provided. “There's always demand for those monitored beds,” says Dr. Kajita. “So the unit has very high turnover, and they're sicker patients. Attendings found it hard to teach, even though they were really trying their best. Patient care obviously comes first.”

With an additional team covering the 10 cardiology beds, there is more time for training to occur, and patients reap the rewards as well. “The third team helps us be more efficient throughout the entire unit,” says Baksh. “When providers have more time and attention for each patient, it can mean faster discharges, which benefits everyone.”

“Patients, staff, residents—everyone at Wakefield wants to feel like we are at a top academic medical center, because that is the level of care and teaching we provide here,” says Dr. Dekhtyar. “The new cardiology service helps us toward that goal.”