By Serena Agusto-Cox | News & Views

At CHI Memorial Hospital – Chattanooga, a groundbreaking initiative is reshaping the way high-risk patients prepare for coronary artery bypass graft (CABG) surgery. By launching a targeted prehabilitation (prehab) pilot program, the hospital’s cardiopulmonary rehabilitation team has addressed a long-standing gap in care, helping patients once deemed “inoperable” to qualify for life-saving procedures. Matthew Thomas, director of Cardiopulmonary Rehab and Employee Fitness at CHI Memorial Hospital – Chattanooga, says there has been an unmet need.

This pioneering effort earned the hospital the prestigious 2025 Dr. Linda K. Hall Innovation Award from AACVPR, recognizing its bold approach to expanding access, improving outcomes, and redefining the role of rehabilitation in surgical care.

Targeting the Untreated: A New Path for High-Risk Patients

For many patients with multiple comorbidities, advanced age, or poor baseline physical function, CABG surgery is often deemed too risky, effectively removing a potentially life-saving option from their care plan. Recognizing this gap, the team at CHI Memorial Hospital – Chattanooga launched a prehabilitation pilot program to identify and support these high-risk individuals.

The program began by defining clear criteria to identify patients considered functionally “unfit” for immediate surgery. From there, the team developed a structured pathway to improve surgical readiness. Key elements included:

• Individualized assessments tailored to each patient’s physical and medical profile
• Multidisciplinary collaboration to ensure holistic care
• Risk stratification to prioritize those who would benefit most
• Outcome tracking to measure progress and refine the approach

This targeted strategy laid the foundation for a transformative model of care that empowers patients and expands access to critical interventions.

Building Buy-In: The Foundation of Prehab Success

Gaining early support from leadership and staff was essential to the success of CHI Memorial Hospital – Chattanooga’s prehab initiative. According to Thomas, the team secured executive buy-in by presenting a compelling case. “We highlighted the ethical imperative to serve these patients, the potential for improved quality metrics, and ultimately, the ability to perform life-saving surgeries currently deemed impossible,” he says. They also highlighted long-term benefits such as reduced readmissions and more efficient resource utilization.

To foster staff engagement, the team delivered targeted training that underscored the importance of evidence-based prehab for high-risk populations. Each team member was given a clearly defined role, which helped build confidence and ownership. Throughout the design phase, cross-departmental collaboration ensured that workflow concerns and logistical challenges were addressed early, creating a strong foundation for implementation.

“Finally, by remaining transparent in our communications and by celebrating early successes, staff felt a sense of shared ownership of the program,” Thomas adds. A multi-tiered communication system kept everyone aligned through daily updates shared among physiologists, physicians, and patients and weekly multidisciplinary rounds bringing together nurses, social workers, and other stakeholders. Biweekly meetings focused on process improvements, complementing weekly collaborative reviews of patient progress.

These communication strategies were anchored in the hospital’s Center of Excellence framework, which emphasizes standardized data collection, outcome tracking, and continuous quality improvement. This structure not only supported the program’s launch but also positioned it for long-term sustainability and growth.

From Concept to Care: Prehab Takes Shape

Clinical exercise physiologists led the prescribed exercise regimens and closely monitored patient progress, while heart failure coordinators ensured adherence to guideline-directed medical therapy and managed symptoms. Additional program partners streamlined referrals and addressed musculoskeletal limitations and psychosocial barriers.

The multidisciplinary team bridged teams from the hospital prehab program to in-home care and community partners and ancillary departments, including case managers, dieticians, and art therapists. “The success of our prehab program is a testament to extraordinary interdisciplinary collaboration,” explains Thomas. “We shifted cardiopulmonary rehabilitation from a reactive post-event model to a proactive and preventative approach. It transformed our rehab department into a critical upstream partner in surgical preparation, rather than solely a downstream recovery service.”

By assessing patients’ readiness to learn and identifying any learning barriers, staff were able to empower patients in their own care. Staff also engaged with additional tools to foster self-management:

• Motivational interviewing techniques to address behavioral change
• Tailored educational materials, including in-house resources and Krames booklets with disease-specific guidance
• Individualized goal-setting, self-monitoring tools, and positive reinforcement strategies
• Tracking compliance through attendance records, exercise logs, and regular assessments

When patients struggled to adhere to their treatment plans, staff responded proactively. They communicated their concerns and coordinated with nurse managers and case managers to improve adherence. The pilot program also engaged spouses, family members, and caregivers in the process to provide support and a shared commitment to improved health outcomes.

Prehab Changed Lives

After the prehab protocols were fully integrated into the pilot program, high-risk patients demonstrated significant improvements, some of which were observable before surgery. “Patients once considered ‘inoperable’ because they were deemed too high risk for CABG surgery achieved the functional and physiological readiness for surgery after engaging with the program,” says Thomas.

Prehab participants consistently demonstrated measurable gains in baseline functional status. On average, patients improved by 1.1 METs (metabolic equivalents), as assessed by the 6-minute walk test (6MWT). This demonstrates significant improvement in aerobic capacity and endurance, which is a critical indicator of postoperative recovery potential,” Thomas explains.

Although the pilot program was modest in scale, early data revealed promising trends. Thomas points out, “Prehab patients experience a reduction in postoperative complications related to mobility, respiratory function, and deconditioning.” Preoperative conditioning also contributed to faster recovery times and shorter hospital stays, which may translate into reduced resource utilization and lower health care costs. “Our prehab patients consistently demonstrated similar lengths of stay, compared with historical controls of similar risk profiles who did not undergo prehab, leading to better resource utilization and reduced infection exposure,” he says.

Additional benefits included better surgical tolerance and healing due to nutritional interventions that corrected preexisting malnutrition. Patients also reported feeling less anxious and more confident about the surgery and recovery process, underscoring the program’s impact on emotional readiness.

Beyond individual outcomes, CHI Memorial Hospital – Chattanooga’s cardiopulmonary rehab program has seen sustained growth over the past 5 years, with an approximate 18% year-over-year increase in patient interactions. Physician satisfaction remains high, particularly within the exercise oncology program, further validating the program’s interdisciplinary success.

Blueprint for Innovation: Launching Your Own Prehab Model

Cardiopulmonary rehabilitation programs across the country can replicate CHI Memorial Hospital – Chattanooga’s success by adopting similar prehab strategies, particularly for high-risk surgical patients. From day one, rehab staff must engage cardiologists, surgeons, nurses, and dieticians through clear communication channels to build a shared understanding of both the purpose and process of prehabilitation. But Thomas cautions, “A shared vision that emphasizes multidisciplinary collaboration is a non-negotiable.”

A successful prehab model moves beyond a one-size-fits-all approach toward individualized assessments and tailored interventions to address not only physical function, but also nutritional, psychological, and social readiness. Additionally, patients need to understand that they will have an active role in their prehab journey. Data collection is also essential, not only for tracking outcomes but also for building a compelling case for program expansion.

Programs can maximize reach and minimize costs by leveraging existing infrastructure. Group education sessions, community partnerships, and telehealth follow-ups are practical ways to extend services. Even with limited budgets, innovation is possible. “Be creative in adapting your current infrastructure to support this new model of care,” Thomas advises. “The 'innovation' is often in shifting the timing and focus of intervention. Prioritize areas like nutritional screening and basic protein supplementation, home-based walking programs with tele-coaching, or breathing exercises that require minimal equipment.”

Educational resources, including simplified handouts on nutrition, surgical expectations, and exercise routines, help patients take ownership of their care. Free materials from reputable organizations can supplement in-house content, ensuring accessibility and consistency. “Even on a low budget, with passionate and empowered rehab staff and physicians, prehab can prove its worth in addressing the needs of high-risk patients,” Thomas says.

Innovation Saves Lives

The AACVPR Dr. Linda K. Hall Innovation Award affirms the transformative power of CHI Memorial Hospital – Chattanooga’s prehab initiative. It’s a testament to what’s possible when creativity, collaboration, and compassion converge in patient care. According to Thomas, “The award signifies that our team’s innovative approach to patient preparation has made a tangible difference, saving lives and improving quality of life.”

By reimagining the role of rehabilitation, the team didn’t just improve surgical outcomes, they gave patients a second chance at life. Their work demonstrates that innovation isn’t always about new technology; sometimes, it’s about rethinking when and how we intervene. Cardiopulmonary rehabilitation teams that start small and think big can build life-saving interventions through collaboration and data-driven strategies, even with limited resources. Prehab programs are just one more patient-centered service that leads to improved health outcomes for even the highest-risk patients.