Cath Lab Digest - April 2008 - (Page 22)

22 SPOTLIGHT APRIL 2008 The physical layout of the cardiac cath lab at Kaiser San Rafael Medical Center. Staff is generally comfortable with the layout. A total of three pre/post beds would have provided a more efficient workflow. We were given a lot of opportunity to provide feedback and comment in the initial planning stages, and had a significant say in the final design. Our lab is located on the ground floor of the hospital, directly across from the ED back door. We are actually in the radiology department area, down the hall from the CT scanner. The OR is above us on the second floor. What type of quality control/quality assurance (QC/QA) measures are practiced in your cath lab? Our most important measure of QC/QA is reporting to the American College of Cardiology National Cardiovascular Data Registry (ACCNCDR). Our cardiologists host an open community forum with the EMS agencies four times a year. Quarterly, our lab participates in a M&M forum, where selected cases are presented for informational and educational purposes. This forum is open to anyone in the hospital, including the EMS agencies, to attend. We also have cath-ops meetings and IR-ops meetings, each held every other month. During these meetings we discuss how the workflow can be improved. It is a multidisciplinary effort, involving management, staff from our department, plus telemetry staff, guest speakers and physicians. Our DTBT has been segmented into tasks, with each taking an allotted time frame. This enables us to zero in on bottlenecks and facilitate teaching to improve our already excellent times. Each chart is subjected to independent review for completeness and accuracy of documentation. A monthly meeting is scheduled for feedback with each staff member who charts, so charting can be consistent and accurate. Monthly tracers are utilized that monitor 9 safety metrics implemented by Kaiser Permanente system-wide. We also run weekly QC for our I-Stat machines (Abbott Laboratories, Abbott Park, IL) for arterial blood gas (ABG), activated clotting time (ACT) and creatinine, and our glucometer, all validated by our clinical laboratory personnel. How does your lab handle radiation protection for the physicians and staff that are in the lab day after day? All staff are fitted with customized lead aprons. Each staff member was both an apron and collar dosimeter badge which is read and reported monthly to Landauer (Glenwood, IL). Those radiation reports are verified by our facility’s radiation safety committee and radiation safety officer. We report dose-area product (DAP) on all procedures. The procedure room staff is rotated every other case to limit and monitor the amount of fluoro time exposure in the room. How does your cath lab compete for patients? Has your institution formed an alliance with others in the area? Our lab does not really compete for patients. We are relatively centrally located in Marin County, where approximately 45% of the population is a Kaiser member. As part of the Kaiser system, other Kaiser facilities can book plan members in their area for procedures at our facility (as well as servicing our own local patient pool) for both cardiology and interventional radiology. As for emergent angioplasties/stenting, we are one of only two Marin County facilities that perform this procedure. The County of Marin, EMT companies and the other county non-Kaiser medical facility are following the County EMS 12-lead protocol, which states that any in-field STEMIs are to be taken to the nearest (or shortest access time due to traffic) hospital regardless of plan coverage. In keeping with best practices, this provides the fastest DTBT for all residents of Marin and southern Sonoma County. How are new employees oriented and trained at your facility? What licensure is required for all professionals who work in your lab? Our new employees are placed with a primary preceptor for a period from 4 to 6 months, and then move on to autonomous practice. During this period, they are subjected to the most valuable learning cases to assure competency. After an initial 4 to 6 weeks in our facility, they transfer to the cardiac cath and interventions side of their job description at the Kaiser Permanente San Francisco campus (the main Kaiser Permanente facility for the San Francisco Bay Area). This facility provides a large portion of the training for new staff at all of the satellite labs in the Bay Area, and should be recognized for the valuable contributions they provide to the success of Kaiser Permanente’s Emergent Cardiac Intervention program. All RNs are required to be both BLSand ACLS-certified, as well as having at least 1 year experience in a critical care or emergency department specialty area. Our radiologic technologists were all trained on the job at Kaiser Permanente San Francisco, as well as attending selected seminars and lectures, but all had a medical background. All RTs must also have BLS/ACLS certification. Our management team is flexible in scheduling to allow the use of education leave. What type of continuing education opportunities are provided to staff members? Continuing education is encouraged in a daily basis. We have a doing an informal study with guided imagery. Have you had any cath lab-related complications in the past year requiring emergent cardiac surgery? Fortunately, no atypical complications requiring emergent surgery presented in the past year. All of our procedures are reviewed in during our quarterly cardiac cath lab morbidity and mortality (M&M) meetings and by our facility’s quality department. What other modalities do you use to verify stenosis? At this time we utilize imaging only for lesion assessment. We will be using intravascular ultrasound starting in January 2009. What measures has your cath lab implemented in order to cut or contain costs? We work closely with the physicians from both departments to share equipment used in the IR and cardiac caths. This is mainly for space containment, not necessarily cost containment. We are committed to providing state-of-the-art equipment for our operating physicians and our members. Running an interventional radiology department promotes overtime. Knowing that add-on procedures are the norm, which will result in extended days, this promoted our 10-hour shifts followed by the “Standby Team” if procedures are running late.

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

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.