Cath Lab Digest - March 2008 - (Page 8)

8 CLINICAL EDITOR’S CORNER MARCH 2008 How does a cath lab director assist in making cath cases start and finish at reasonable times? The issue about how long an angioplasty may take is more difficult and dependent on many factors. The operator selects angioplasty cases based on the severity and number of the lesions, potential for complications (risk level), and his skill and judgment. The time allotted for ‘routine’ angioplasty/stenting thus varies widely. Remember the old adage of experienced interventionalists that says, “There is no such thing as a simple angioplasty,” meaning things can go bad at any moment due to the unanticipated response of patient’s artery (as an aside, that’s why we never say, “This case will be a slam-dunk,” a sure way to invoke evil spirits and a complication). All of these factors vary from operator to operator, but a routine time allotment for an uncomplicated angioplasty should probably be no more than two hours, barring unforeseen difficulties. If we focus strictly on chronic total occlusion (CTO) interventions, how much time should be allotted is more operator dependent. While there may be no upper limit to the hours that an operator may work, in my own experience, if indeed you cannot cross a total occlusion within an hour (or 2 at the very most), continuing to try and force your way through a CTO despite the numerous specialized guide wires and multiple niche devices, it is unlikely you will be productive. Complications will increase with time on the table. While I understand that in Japan the art of CTO angioplasty has risen to new levels, matching that of bypass surgery in some centers, I do not believe most operators in clinical practice will be willing to spend more than three hours on a single chronic total occlusion angioplasty. Should these operators decide to take on the “endless” CTO procedure, then arrangements must be made in advance for this type of case, since it can kill an entire schedule for the laboratory and other operators on that day. How does a cath lab director assist in making cath cases start and finish at reasonable times? This is a delicate problem and is best handled with diplomacy and tact. However, plain speaking also works. One method may be to provide a list of procedure times, case types, and identification of those cases which took an excessive amount of time (of course, being HIPAA-compliant) to all the cath lab operators in a blinded fashion. In this way, the list can serve to bring peer pressure and new insight into operator’s performance through the cath lab’s unbiased perspective. In concert with the peer process described above, a problem operator can be provided the data to demonstrate that his comparative procedure times are a significant deviation from his peers for similar cases on an average day. To further assist the operator and his procedure times, the lab can also suggest ways they can help. For example, using an especially experienced and trusted assistant may mitigate this problem. In this way, lab turnover on his working day might improve so that the staff, patient and the operator will not suffer. 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. Addressing factors which slow cath lab room turnover are as important as addressing case times, but these issues are generally easy to identify and fix. For example, in our system, the biggest delay in case start times is transportation from the floor to the lab. Document the times and call the hospital supervisor. It is important to recognize that many of our perceptions about our own performance (both in and out of the lab) may be at odds with others’ views. It is a wise manager (and friend) who can put this into perspective and gently assist the unknowing back to reality. ■ In this issue Will diagnostic catheterizations eventually be eliminated by cardiac CT? — Find out what Dr. Stephan Achenbach, founding and immediate past president of the Society of Cardiovascular Computed Tomography (SCCT) thinks on page 20. “Delayed enhancement imaging is a way to visualize the presence, location and extent of myocardial infarcts. Even very small infarcts can be identified due to the spatial resolution of MRI.” — Find out what Dr. Robert O. Bonow has to say about cardiac MRI on page 22. “A team mentality is the only successful method of getting the patient on the table and ready to go in five minutes or less.” — Gerard Lagasse, RCIS, writes specifically for new staff taking care of the cardiac emergency patient on page 68. “Integrating IVUS into the cath lab, where it is always on and ready, means IVUS use is just a matter of grabbing an extra catheter and turning on a button.” — Michael C. Foster, MD, FACC, shares his intravascular ultrasound experience on page 42. http://www.datascope.com

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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