Cath Lab Digest - February 2008 - (Page 24)

24 SPOTLIGHT FEBRUARY 2008 wand to scan devices and equipment. The system automatically flags items for re-order. How is coding handled in your lab? All procedures are “wanded” (instantly and electronically scanned by a pen-sized hand-held device). Outpatient procedures are coded separately, then directed to the general hospital coding department with CPT (current procedural terminology) codes attached. Inpatient procedures are wanded and then confirmed by the coding department before being forwarded to DRG (diagnosis related groups) hospital coding. What measures has your cath lab implemented in order to contain costs? We work very closely with the purchasing department. Bay Regional is part of a 7-hospital system (McLaren HealthCare in Flint, Michigan) and we have compliance contracts for stents and cardiac devices. This facilitates a lower ASP (application service provider) due to increased volume. Bay Regional is part of Premier Corporation and as such manages to negotiate contracts as low as possible. What type of quality control (QC)/quality analysis (QA) measures are practiced in your cath lab? Bay Regional benchmarks its performance nationally by participating in the American College of Cardiology-National Cardiovascular Data Registry (ACC-NCDR). We also submit data to: • STS (Society of Thoracic Surgeons) • ICD (ACC-NCDR ICD registry) • Michigan Blue Cross Blue Shield (The Blue Cross Blue Shield of Michigan Cardiovascular Consortium, or BMC2) • ACTION (Acute Coronary Treatment and Intervention Outcomes Network Registry) • CRUSADE (ACC has now taken over CRUSADE, which used to stand for Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC/ AHA Guidelines). We also participate in Joint Commission national safety goals for standard radiation and blood-borne pathogens, and the ACC GAP-D2b (Guidelines Applied in Practice, Doorto-Balloon Time Initiative). Has your lab undergone a Joint Commission inspection in the last three years? The last inspection was performed in 2005 and there were no findings. We are due for another inspection in 2008. How are new employees oriented and trained in your facility? What licensure is required for all professionals who work in your lab? New employees are assigned a preceptor and undergo a mandatory 90day orientation period. Cardiologists sign off on staff member proficiencies for skills that are specific to the cath lab suite. Though not mandatory or even a requirement of the job, nearly 90% of the nurses, technologists and RCISs chose to undergo the training and complete certification for independently performing arterial access and closure. Orientation for this type of advanced practice does not begin until the staff member has been competently functioning in their current position for at least 6 months. Once identified as a training program candidate, the orientee is assigned a like-licensed mentor/preceptor and enters into a three-month observation period. During this time, they are completely “hands off,” and spend their days scrubbed into cases and aggressively shadowing their preceptors to learn the science of common femoral artery anatomy and the art of successful access and closure. Once this probationary period is complete, the trainee begins attempting arterial puncture on his/her own and is introduced to the StarClose device under strict supervision of the mentor (it is assumed that manual compression techniques have already been mastered). This intensive “hands on” training period generally lasts about MCVI research nurses. Left to right: Jennifer Morris RN, Valerie Bitzer RN, Kelly Kayner RN and Shannon Vasieck RN. Dr. Subba Chavali CVCU staff. Left to right: Bobbie Lopez, Nursing Clerk, Milly Brown RN, Sandy Pafford RN, Bethany LaFray RN and Michelle Dean RN. angiograms are performed on each patient prior to close and the IFU for the StarClose ® device (Abbott Vascular, Redwood City) is strictly followed. Patients whose angiograms demonstrate anatomy or puncture locations unfavorable for vascular closure device use, receive manual compression (see Lee et al, “Cath Lab Nurse/Tech Vascular Access and Closure Using the StarClose® Device,” Cath Lab Digest Nov. 2007, pages 27–30, for more information). What is your lab’s hematoma policy? Hematomas are marked for size and then labeled with a time and date. They are checked every 15 minutes post-procedure. How is inventory managed in your cath lab? One cath lab RT spends 50% of her time doing inventory (20 hours/week). We have an in-house billing and ordering program through McKesson HBOC (San Francisco, CA). We create our own bar-code stickers and use a Daniel T. Lee, MD

Table of Contents Feed for the Digital Edition of Cath Lab Digest - February 2008

Cath Lab Digest - February 2008 Bay Regional Medical Center ENDEAVOR IV: A Zotarolimus-Eluting Stent Versus a Paclitaxel-Eluting Stent in a Randomized Clinical Trial A 3D CT Vessel “Roadmap” Over Live Fluoroscopy for Chronic Total Occlusions Contents Clinical Editor’s Corner An Evaluation of Cath Lab Turnaround Time Commentary: An Evaluation of Cath Lab Turnaround Time Excerpts from Chapter 19. STEMI Interventions – Future Perspectives The Potential Clinical Utility of Intravascular Ultrasound Guidance in Patients Undergoing Percutaneous Coronary Intervention With Drug-Eluting Stents The Ten-Minute Interview with…Debbie Charlton, RN The Society of Invasive Cardiovascular Professionals (SICP) at Transcatheter Cardiovascular Therapeutics (TCT) 2007 The Cath Lab is a Business: Do You Have the Knowledge to Stay Afloat? Incidence and Predictors of Vascular Complications after Invasive Coronary Procedures: A Prospective Analysis Ask the Clinical Instructor: A Q&A Column for those New to the Cath Lab Volunteer Survey SICP* Section Meetings Calendar What Do You Think? CEU Education Center Clinical & Industry News Classifieds Advertisers Index

Cath Lab Digest - February 2008

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