Cath Lab Digest - March 2008 - (Page 6)

6 CLINICAL EDITOR’S CORNER MARCH 2008 EDITORIAL How long should it take to do a cardiac catheterization? MORTON KERN, MD Clinical Editor Clinical Professor of Medicine Associate Chief Cardiology University of California Irvine Orange, California LAURIE GUSTAFSON Executive Editor REBECCA KAPUR Managing Editor ELIZABETH MCTAMNEY Layout/Production Manager O n a recent visit to a hospital on the mid-California coast, a senior cardiologist and director of the cardiac cath lab at a community hospital asked me, “How do I manage it when a doctor seems to be taking an excessively long time to perform a CTO angioplasty?” This is a difficult question to answer. How do you know when a case, any kind of case, has gone on too long? How do you address an individual who seems to be taking an excessive amount of time to do a routine procedure as an expression of poor time management, lack of skill and sophistication, talent, knowledge, or common sense? Is the lab helping or hindering case throughput? How long should a cardiac cath procedure take? PAUL MACKLER President/CEO PETER NORRIS Executive Vice President/General Manager JEFFREY MARTIN Vice President/Group Publisher Cardiology Division ALEX SLONIM Vice President/Associate Publisher of Cardiology CARSON MCGARRITY Senior Account Director NICK OTRANTO Account Manager BRENDA O’CONNOR Cardiology Sales Associate BILL NORTON Vice President, Meeting and Trade Shows LUCINDA BESKA Classified Advertising Sales Manager FRED KLUMPP Manager of Information Systems KATHY MURPHY Production Director STEFANIE TULEYA RENEE OLSZEWSKI Special Projects Editors PATRICIA LEVY Director of NACCME MORTON KERN, MD Clinical Editor Clinical Professor of Medicine Associate Chief Cardiology University of California Irvine Orange, California mortonkern005@hotmail.com A cath lab procedure should take exactly as long as necessary to produce excellent results in the safest possible manner. That is the starting point without addressing the setup and room turnover time. If an operator is chronically late, taking 20 minutes or more to show up, keeping both the staff and the patient waiting, arriving and spending an excessive time on phone calls and unnecessarily delaying procedure start times and further delaying the entire day’s schedule, this operator is slow, no matter how fast his procedure time is. He is also inconsiderate and slow. Occasional late starts are part of the lab routine, but a chronically late operator hurts the lab’s productivity, costs (e.g. overtime) and morale. There are also problems that prolong cases outside the control of the operators. Vascular access can be complicated and prolong case times. However, the operator should identify the fact in advance that vascular disease may be present. With this information, the lab can be prepared to suggest earlier in the access period that the arm approach may be needed to complete the case in a timely manner. Once vascular access has been obtained, manipulation of catheters for coronary angiography and ventriculography should take less than 20 minutes, barring complicating features of vascular disease, aortic tortuosity or hemodynamic instability. Start to finish, a routine left heart catheterization should probably take no more than 30 minutes. Add 15 to 20 minutes for a right heart catheterization. The time for cath lab room turnover should be no longer than the case time. There is no perfect solution to improving case times and lab turnover, but awareness of a problem and supporting data is a good starting point. 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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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