Cath Lab Digest - April 2008 - (Page 20)

20 SPOTLIGHT APRIL 2008 Helen Carrico, RN, reviewing a case. Jim Stokes, RT, at the controls, charting an interventional radiology case. Can you describe your STEMI program? Kaiser Permanente envisioned a system in which our department would expedite emergent angioplasty and stenting to the county residents and Kaiser Members of the North Bay Area. We received overwhelming support from our local emergency medical (EMS) agencies and other departments within our Kaiser facility that have assisted us in meeting the majority of our door-to-balloon times (DTBT) under 90 minutes. Due to the success of our lab, other small dual-use labs are being built and designed to model our suite at other Kaiser facilities around the Bay Area. Our emergent heart alert program (designed to reduce our DTBT) has been effective due to the collaboration of local EMS agencies. All local EMS paramedics are trained by local EMS medical directors with our attending cardiologists to rapidly recognize STEMIs in the field. The EMS paramedics are authorized to initiate the Emergent Heart Alert through the emergency department (ED) without a cardiologist’s verification. The cath team on standby is paged and many times has met the ambulance rig and the patient at the ED door, ready to take the patient directly into the cath lab. All ambulance rigs in Marin County have 12-lead EKG capabilities. The County of Marin EMS, representatives from local EMS departments and both receiving hospitals meets bi-annually to review the quality of transport and EKG interpretation of emergent STEMI patients transported to our labs. Our Emergent Heart Alert algorithm can actually be initiated by a paramedic in the field — in fact, fully 30% of our STEMI patients are called in the field. This has greatly reduced our DTBT. It can also mean the patient can be expeditiously triaged in the ED and go straight to the cath lab. Every Emergent Heart Alert post procedure is debriefed with the physicians and staff immediately to discuss what we can do better and what we did well. We have formulated tools that have shaved minutes off from our already excellent times. The ED has a run review every other month with ED RNs, ED physicians, paramedics and EMTs to discuss recent ED cases. We have designated RNs who are available to attend those meetings to present current DTBTs and receive feedback about recent Emergent Heart Alert cases. Also, our medical director, Dr. John Kennedy, is committed to facilitating educational inservices during run reviews. How is coding and coding education handled in your lab? How is coding communication handled with the billing deptartment? As a Kaiser member, the patient pays only co-pay, based on their chosen benefit, when they are admitted for the procedure. The staff enters the CPT codes into our computer system, for tracking purposes and Medicare reimbursement. Our Kaiser patients don’t have any other charges outside of their co-pay. A nonmember’s insurance will be billed for any procedures done. How does your lab handle hemostasis? Most groin sheath removal is done with manual holds. Some cardiologists will use the Angio-Seal device (St. Jude Medical, Minnetonka, MN) to close. Our vascular surgeon will use the Starclose device (Abbott Vascular, Redwood City, CA) to close. The interventional radiologists prefer a manual hold in the recovery area. Only RNs are designated by the Department of Health in California to be able to pull the sheath. RNs and RTs can hold. The lab staff is responsible for obtaining hemostasis prior to transfer to PACU (Post Anesthesia Care Unit) or the telemetry floor. Our nurse practitioner, Lance Benedict, NP, follows up with each cardiac patient once they arrive to the telemetry floor. He provides education prior to admission and follows up after discharge with a phone call and followup clinic appointment. He is also a great resource for the staff. Our lab staff follows up with all IR patients to review access site/s status within 72 hours to follow up on patient well-being and ensure that all instructions were understood. Does your lab have a hematoma management policy? Yes. Our facility has developed a standard of care for arterial and venous sheath and groin management. When pulling any sheath, our standard of care is to have the FemoStop device (Radi Medical Systems, Wilmington, MA) available, though it is infrequently needed. How is inventory managed at your cath lab? Who handles the purchasing of equipment and supplies? The Pyxis system (Cardinal Health, San Diego, CA) is used for all medications and par levels are maintained by our pharmacy. We have a perioperative specialist, Colleen Cerda, who orders and maintains stock levels for most other consumables, including stent stock. We have dedicated materials management personnel who stock all general supplies. All inventory par levels for wires, balloons and catheters are tracked by the Spacetrax inventory management system (InnerSpace Corporation, Grand Rapids, MI). Spacetrax creates a detailed case report inclusive of CPT coding, procedure time, staff list and all equipment and devices utilized. However, general inventory is the responsibility of everyone in the lab. Product rotation and expiration control is performed by all staff members and cross-checked by the Spacetrax system, which is controlled and maintained by the department’s perioperative specialist. Capital cost items are purchased through our yearly capital equipment budget. Has your cath lab recently expanded in size and patient volume, or will it be in the near future? Our STEMI cardiac patients come from Marin County. Currently, the policies and procedures in place for the paramedics in surrounding counties limit them from crossing county lines for an emergent STEMI. Our department’s IR caseloads have doubled in the past 6 months, due to the diverse range of procedures done by our new interventional radiologist, Naveen Kumar, MD and vascular surgeon, Jeffry D. Cardneau, MD, FACS. As a result of the increase in referrals, we have instituted a new 10-hour shift, to assure that our patients and their families are cared during an expanded schedule. The longer work shift has provided time for the RNs in the department to call past and future patients, and for the team, the capability of meeting our 30-minutes arrival time for emergency STEMI procedures during peak traffic periods. Is your lab involved in clinical research? Not at this time, although we are

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

Cath Lab Digest - April 2008 Kaiser San Rafael Medical Center Orbital Atherectomy: A New Treatment for Complex Peripheral Arterial Disease Ask the Clinical Instructor: A Q&A Column for Those New to the Cath Lab Contents Clinical Editor’s Corner CEU Education Center The Missing Link in STEMI Interventions — Thrombus Aspiration during Primary Percutaneous Coronary Intervention Predicting Stent Thrombosis Using A Clinical Risk Score Use of a New Guidewire: The Tigerwire Should I Stay or Should I Go? Weighing Options for New Opportunities Navigating Tortuous Coronary Sinus Anatomy Using a Bipolar Lead The National Society of Radiology Practitioner Assistants (NSRPA) Holds 9th Annual Educational Conference For Medical Imaging Physician Extenders and Mid-Level Healthcare Providers Cath Lab & Beyond: A Meeting Update The Ten-Minute Interview with… Dale Hansen RT, CVT Sometimes, You Just Know Twin Circumflex Arteries: A Rare Coronary Artery Anomaly What Do You Think? Meetings Calendar News from the American College of Cardiology (ACC) Scientific Session and the Society of Cardiovascular Angiography & Interventions (SCAI) Annual Scientific Sessions in Partnership with the ACC i2 Summit Clinical & Industry News Cath Laughs Classifieds Advertisers Index

Cath Lab Digest - April 2008

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