Cath Lab Digest - March 2008 - (Page 28)

28 SPOTLIGHT MARCH 2008 Some of our Admission Recovery Unit staff. Seated, from left to right: Some of our Admission Recovery Unit staff. Seated, from left to right: Joan Stultz, RN, Gloria Morandarte, Joan Stultz, RN, Gloria Morandarte, RN manager, Gail O’Neill, Unit Secretary. Second row, seated: Lynda Michaels, RN, Regina Freeman, Secretary. Second row, seated: Lynda Michaels, RN, Regina Freeman, CVT, Novlette Henry-Small, RN, Back row: Elaine Diamond, RN CVT, Novlette Henry-Small, RN, Back row: Elaine Diamond, RN ,, Lynne Camak, RN, Karen Kennedy, Lynne Camak, RN, Karen Kennedy, RN, Colleen Houlihan, RN, Tim Noonan, Volunteer, Konny King, RN, Liz Sheehan, RN. Noonan, Volunteer, Konny King, RN, Liz Sheehan, RN. Volcano’s newest IVUS platform with Virtual Histology. We also have started to do atrial septal defect (ASD) (Amplatzer, AGA Medical Corp., Minneapolis, MN) and patent foramen ovale (PFO) closures (CardioSeal, NMT Medical, Boston, MA). We have the NOGA cardiac mapping system (Biosense Webster, Johnson & Johnson Corp, Diamond Bar, CA) installed to assist with research for chronic end-stage chest pain. Can you describe the system(s) you utilize and how they work in cath lab daily life? We have six Philips (Bothell, WA) digital cath labs and one (1) Siemens (Malvern, PA) lab. One of the Philips rooms is primarily a peripheral room with a 15” image intensifier and digital subtraction. Other labs are able to accommodate renals and iliacs when subtraction is not required. How is coding and coding education handled in your lab? Our cath lab has a product specialist, Chuck Naylor, who handles charge capture and coding. He communicates with the finance department for all coding-related issues. All new product information is sent to coding specialist to have a service code assigned and placed on the Charge Master. The coding specialists will then notify Chuck, who will put the new equipment or procedure on the charge sheet. The charge sheet is periodically updated to add or remove any procedure or equipment. How does your lab handle hemostasis? Patients are either transferred to our Admission Receiving Unit (ARU)/ Discharge Recovery Unit (DRU) or to telemetry beds in the hospital. Both manual and mechanical compression is used for sheath removal, and we use the D-Stat hemostatic patch (Vascular Solutions, Minneapolis, MN) in combination with manual and mechanical pressure. If the patients are transferred to the ARU, the nurses who receive the patients are responsible for sheath removal, which is performed either by the nurse or the patient care technicians. We also have two sheath pullers who are responsible for sheath removal post procedure if the patient is transferred to an inpatient bed. We also use Angio-Seal (St. Jude Medical, Minnetonka, MN), Perclose Proglide (Abbott Vascular Devices, Redwood City, CA) and Starclose (Abbott Vascular) following the procedures for vascular closure. What is your lab’s hematoma management policy? We do not have a set hematoma management policy; we strive not to have any hematomas following sheath removal! We do have sheath pullers for the whole house who have been trained extensively by our ARU/DRU staff and the clinical educator for safe and effective sheath removal, as well as to free the nurses on the floors to provide better patient care. How is inventory managed at your cath lab? Who handles the purchasing of equipment and supplies? Product specialist Chuck Naylor is in charge of inventory management. We have a manual system of ordering, which will be changed to an automated inventory management system (Lawson, St. Paul, MN) in 2008. Chuck handles purchasing of equipment and supplies with the approval of the department director, Tony Petrillo, RN. Has your cath lab recently expanded in size and patient volume, or will it be in the near future? Dr. Marc Unterman, explaining the findings of the case to the patient. Yvonne Love, our most senior CVT, is assisting. We have recently added a new biplane EP lab, which can double as a cath lab, and we are redoing the other two EP labs. We have also recently added 17 beds to our ARU/DRU department. Is your lab involved in clinical research? Yes. The Saint Joseph’s Research Institute (SJRI) is very active in preclinical and clinical cardiovascular research. Nicolas Chronos, MD, the President/CEO of SJRI, is an invasive cardiologist who practices in our cath lab. Dr. Chronos actively recruits new studies. Have you had any cath lab-related complications in the past year requiring emergent cardiac surgery? Unfortunately, yes. Our patient population is high risk with multiple comorbidities. Can you share your lab’s average doorto-balloon (DTB) times and some of the ways employees at your facility have worked together to keep DTB times under the mandated 90 minutes? For the year 2007, 84% of the patients who came in with a ST-elevation myocardial infarction (STEMI) diagnosis had interventions done under 90 minutes. Average DTB time is 69 minutes. When the patient is brought in the emergency room (ER) with active suspicious cardiac symptoms, an ECG is performed within 5 minutes of arrival. Some of the EMS ambulances are equipped with 12lead ECG which can be transmitted to the ER prior to the patient’s arrival. The ER physician activates the cath lab team as soon as a STEMI is identified, using a one-call paging system. All cath lab staff carry a pager individually assigned to them by the hospital which is included in this one-call system. The manager and clinical educator also carry pagers included in this system. The ER physician then pages the interventionalist on call to accept the patient. If it is during off hours, the cath lab staff is required to respond within 30 minutes of the page. What other modalities do you use to verify stenosis? We use Volcano IVUS with Virtual Histology and WaveMap to further assess stenosis. It does not affect cash flow since it is bundled in our procedure cost. What measures has your cath lab implemented in order to cut or contain costs? We have gone to one vendor for our cath packs, drapes and gowns. We have established par levels for each interventional product available. What type of quality control/quality assurance measures are practiced in your cath lab? We run quality control on the Hemochron ACT machines and the whole blood oximeter daily. We have performance improvement initiatives regarding room turnaround time, wait times, expired products, DTB times, medication administration and documentation. How does your cath lab compete for patients? Has your institution formed an alliance with others in the area? Atlanta has a very competitive market. We have the state-of-art x-ray equipment and technology to keep our physicians committed to bringing their patients to our cath lab. As Atlanta’s only Magnet hospital, we provide high-quality nursing care for all of our patients on a daily basis, which keeps patients coming back to Saint Joseph’s Hospital when need arises.

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

Cath Lab Digest - March 2008 Are You Being Paid Fair Market Value in 2008? A Cardiac Cath Lab Professionals Survey by Cath Lab Digest and the Society of Invasive Cardiovascular Professionals Saint Joseph’s Hospital Invasive Imaging Tools for Optimizing Coronary Stent Deployment Contents Clinical Editor’s Corner A Workflow Revolution in Cath Lab Reporting Advantages of a New Digital Lab at Baystate Medical Center Cardiac Computed Tomography: What Does it Mean for the Cath Lab? The Latest in Cardiac Magnetic Resonance Imaging (MRI) Cellular Cardiomyoplasty and Cardiac Regeneration Intravascular Ultrasound in the Cath Lab: A Powerful — and Underutilized — Tool to Improve Patient Outcomes The Stentplus™ Patient Success Program Cardiac Cath Lab Clutter — or, Spring into Action! Groin Bleeds and Other Hemorrhagic Complications of Cardiac Catheterization: A List of Relevant Issues Ask the Clinical Instructor: A Q&A Column for Those New to the Cath Lab What Do You Think? Experience with a New Guidewire: The Terumo Runthrough NS The Ostial Pro™ Stent Positioning System: Perfecting Aorto-Ostial Stent Placement Precious Minutes The Ten-Minute Interview with…Mark Bowles, BSN, CCRN Vascular Care in the Cath Lab: Planning a Smooth Transition Cath Laughs CMS 2008 OPPS Final Rule Review An Extensive Set of Review Courses for the CCI Basic Science, Non-Invasive Echocardiography and Vascular, and ARDMS Ultrasound Exams Meetings Calendar CEU Education Center Clinical & Industry News STEMI Interventions Classifieds Advertisers Index

Cath Lab Digest - March 2008

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