Cath Lab Digest - September 2007 - (Page 22)

22 SPOTLIGHT SEPTEMBER 2007 Dr. Jeff Fletcher with our “Time is Muscle” slogan we’ve used in our successful efforts to reduce our door-to-balloon time. By working closely with every department involved in the process, we have reduced our door-to-balloon time to 75 minutes the past two quarters. We are continuing to finetune our efforts even further. Our median door-to-balloon (DTB) time for the most recent quarter was 69 minutes and for the previous two quarters, was 75 minutes. We have collectively found several ways in which to save minutes, or in some instances, save seconds. Within what time period are call team members expected to arrive to the lab after being paged? Our call team is expected to arrive within 30 minutes after being paged. We are not a teaching hospital, so an attending cardiologist is not always on site. The cardiologist usually arrives sooner than the call team. Although there is no formal time frame for the cardiologists, we do expect that they will arrive within 30 minutes also. Does your lab utilize any alternative therapies (guided imagery, etc.)? No. What trends do you see emerging in the practice of invasive cardiology? It seems that more and more devices, along with expensive supplies, are essential to our practice. In addition, now that everyone’s outcomes are posted online, we are involved in a myriad of initiatives to improve any practice that may affect those outcomes. For example, our median doorto-balloon (DTB) time for the most recent quarter was 69 minutes and for the previous two quarters, was 75 minutes. We have been working with cardiologists, emergency department (ED) doctors, ED staff, cath lab staff, pulmonary services and several other hospital representatives on a “MI Improvement Committee” for about a year. We have collectively found several ways in which to save minutes, or in some instances, save seconds. Our committee began by monitoring all the time intervals (ED arrival, time to EKG, time leaving ED, arrival time in cath lab, balloon inflation, etc.). We then met as a large, multi-disciplinary team to determine where we needed to improve, and then brainstormed on anything that might save us even a few seconds. We met monthly at first and now we usually meet once a quarter. Here are some of the initiatives we have implemented: • Lateral pages that go simultaneously to the call team, security and nursing supervisor. • The ED physician now activates the call team. Previously, only the cardiologist could do so. • An EKG tech is now stationed in the ED around the clock. • We had GPS satellite clocks installed in all the ED rooms as well as the cath lab so our time documentation could be more accurate. • The pharmacy and ED put together a red ST-elevation myocardial infarction (STEMI) box that holds everything the ED staff needs to quickly get the patient ready for transport to the cath lab (IV tubing, IV start kit, clipper blade for prepping and commonly used drugs, including clopidogrel, heparin bolus and infusion, NTG infusion and Lopressor® [Novartis, East Hanover, NJ]). • The importance of the slogan “Time is Muscle” has been stressed to staff and they are given feedback on individual DTB times. Their efforts to decrease DTB times has truly been a team effort with the ED staff and with each other. All these minutes and seconds we are saving have really made a huge difference. We are very proud of our DTB time. Has your lab has undergone a Joint Commission on Accreditation of Healthcare Organizations (JCAHO) inspection in the past three years? Do you have any recommendations for labs which are about to undergo this inspection? Make sure contrast is locked! We underwent an inspection last year, and the inspector had nothing but praise for Dr. William Crowder and Nita Butts, Cath Lab Director Dr. Myrna Alexander Dr. Myrna Alexander How do you handle vendor visits to your lab? Vendors have to schedule their days in the lab and we try to schedule only one per day. If we are evaluating or using a new product, the vendor is allowed to be here a few days if necessary for evaluation or training. They are required to check in with Materials Management, wear an ID badge, and sign a Health Insurance Portability and Accountability Act (HIPAA) agreement. How are new employees oriented and trained? What licensure is required for all professionals who work in your lab? Most employees go through a twoday hospital orientation, but the RNs have to attend classes that last several days before their department-specific orientation can begin. All new employees are assigned to a preceptor, and work with that person until they have demonstrated the appropriate knowledge and skills that are required to work independently. New staff are able to take call after demonstrating competence in all procedures that can be done as an emergency. RTs must keep their registry updated and RNs are required to keep their license current. Critical care experience is always preferred, but some of our best nurses came to us with cardiac experience but no critical care experience. Advanced cardiac life support (ACLS) is required for all our nurses, and basic life support (BLS) is required for everyone else. Does your lab have a clinical ladder? No, we do not have a clinical ladder. How is staff competency evaluated? New employees have to demonstrate their competence to their preceptor and nurse manager. Competency is thereafter a matter of informal observation on the part of the nurse manager, peers and physicians. How does your lab handle call time for staff members? Each RN and RT rotate the weekday and weekend call. We require one RT and two RNs on our call team. The call team’s shift is 8:30 am – 5:00 pm, whereas most of the other staff members work 7:30 am – 4:00 pm.

Table of Contents Feed for the Digital Edition of Cath Lab Digest - September 2007

St. Dominic Hospital The Genous Bio-engineered R Stent Percutaneous Treatment of Peripheral Arterial Chronic Total Occlusions: Device Options and Clinical Outcomes Contents Clinical Editor’s Corner Percutaneous Revascularization of Peripheral Chronic Total Occlusion — Which Patients, Why, and How? Myocardial Infarction and Syncope: A Manifestation of the “Raynaud-Prinzmetal Syndrome”? Essential Technical Components of the Transradial Approach If You Build It, Will They Come? Evidence-Based Medicine with Drug-Eluting Stents Back to School: The Value of Education in Cardiovascular Services The ACVP Standards and Competencies: Are You Using Them Effectively? What Do You Think? My Experience with Fibromuscular Dysplasia and Stroke A Brief Review of Fibromuscular Dysplasia Letter to the Editor A Look at On-the-Job Training: Perceptions, Reality and Our Profession Doing the Wave: Inventory Management with RFID The Ten-Minute Interview with… Paul Pinsker, RCIS CLD’s Annual Salary Survey Harrisburg Area Community College Volunteer Survey CEU Education Center SICP* Section Ask the Clinical Instructor: A Q&A Column for Those New to the Cath Lab Clinical & Industry News

Cath Lab Digest - September 2007

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