Cath Lab Digest - November 2007 - (Page 18)

SPOTLIGHT NOVEMBER Table 1. Conversion Factors Analytic SI Units(Canada) Urea (BUN) Creatinine mmol/L umol/L Multiply by 2.80 0.011 American System Units mg/dL mg/dL we can deliver. In our cath lab at Henry Ford, diversity is not just the “right thing to do,” it’s what makes us a leader in the industry. What’s special about your city or general regional area in comparison to the rest of the U.S.? A benefit of living in Michigan (particularly the Detroit area) is its proximity to Canada. You’re a bridge or tunnel away from another country. Detroit is home to one of the largest theatre districts west of New York. The Detroit Institute of Arts is the fifth largest art museum in the country, known for its world-class collections, and the Museum of African American History is the largest of its kind in the world. Alternately, Detroit has been known as the Motor City or Motown, and has developed a reputation during its history as a haven for automobiles and music. The city of Detroit makes the ideal place for the North American International Auto Show, an annual event held in January. Detroit was also the site of a modern musical renaissance in the 1960’s when Hitsville USA produced artists such as Smokey Robinson, Marvin Gaye and others. Hitsville USA is a tourist attraction located on West Grand Boulevard, just across the street from Henry Ford Hospital. Detroit and our Canadian neighbors also enjoy exciting casinos on both riverfronts. We have the best professional sports (and fans) in the country for our Detroit Tigers, Detroit Red Wings, Detroit Pistons and our Detroit Lions. Detroit is linked to Windsor by the Ambassador Bridge, making it an important port of trade with Canada. How is the “culture” of the cath lab affected? American blood laboratories use a different version of the metric system than does most of the rest of the world, which uses the System International Unit (SI units).The SI is a standard recognized around the world — except by the United States of America, which will probably adopt it in due time. In some cases, transition between the two systems is easy, but the difference between the two is most pronounced in the measurement of chemical concentration (see Table 1). The American System: mg/dl The American system generally uses mass per unit volume (milligrams per deciliter of blood). By considering the weight of a substance in the blood, it is less accurate. The term “mg/dl” then is the abbreviation for milligrams (mg) per deciliter (dl) and describes how much lipid is present in a specific amount of blood. A deciliter is on tenth (1/10) of a liter (a liter being just over a quart) or about 1/4 of a pint. The SI System: mmol/L The SI system (Systeme International) in Canada, Europe, and other countries, uses moles per unit volume (millimoles per liter of blood). By considering the number of molecules of a substance in the blood, it is more accurate. Since mass per mole varies with the molecular weight of the substance being analyzed, conversion between the American and SI unites requires many different conversion factors. As a result, when patients are transferred from Windsor, Ontario, Canada conversion tables are used to convert many of the SI system lab units used in Canada to the American system. Thirty-seven percent of Henry Ford Hospital employees are Canadian. Six of our RNs in the cath lab live in Windsor. Visa screen, homeland security procedures and the close gap between the U.S. and Canadian dollar have now become challenges for recruitment of RNs and other allied health professionals from our Canadian neighbors. The Society of Invasive Cardiovascular Professionals (SICP) has added two questions: 1. Do you require your clinical staff to take the registry exam for Registered Cardiovascular Invasive Specialist (RCIS)? Do staff receive an incentive bonus or raise upon passing the exam? No, there is no incentive or requirement currently in place to take the registry exam for RCIS. 2. Are your clinical and/or managerial team members involved with any professional organizations that support the invasive cardiology service line, such as the SICP, ACVP, or regional organizations? Yes, some members are involved with the Alliance of Cardiovascular Professionals (ACVP) and/or are members of the American Heart Association (AHA). ■ specifically trained, in the event of an acute MI, to respond immediately to the cath lab along with our cardiology fellow. They have become proficient at setting up and positioning the patient, so that when the cath lab team arrives we are immediately able to continue the process. These nurses have also become familiar with streamlining this process through one single “hotline phone” between our ER, admitting department, ambulance service, cath lab member call team, attending cardiologist and fellow staff. Our door-to-balloon times for our Detroit campus average within 70 minutes. Even more impressive, our cath lab door-to-balloon time average has been within 22 minutes. We have expanded the process to include nonHenry Ford Health System institutions, including local Canadian facilities, have provided community education and maintained a commitment whereby every patient with an acute MI arriving to our emergency room (ER) from an outlying hospital ER will receive PTCA within 90 minutes of presentation. Does your cath lab do electives on weekends and or holidays? We do not perform electives on weekends and holidays. Only urgent and emergent cases are performed. Has your lab has undergone a Joint Commission on Accreditation of Healthcare Organizations (JCAHO) inspection in the past three years? Staff should plan vacation time accordingly. Just kidding! I would recommend that you maintain a constant state of readiness. Maintain quality documentation, and continually strive to improve standard of quality. The focus was on patient identifiers including final time out, and incorporating patient safety goals to everyday practice. We also participate in unscheduled in-house surveys similar to JCAHO to ensure continual compliance. Where is your cath lab located in relation to the operating room (OR), emergency room (ER), and radiology departments? The cardiac cath lab is located on the second floor, the emergency room is on the ground floor, and the OR is on the 4th floor. Radiology departments have different locations throughout the hospital, but the main radiology department is located on the 3rd floor. Computed axial tomography (CAT) scan and ultrasound are located on the second floor, next to the cath lab. How do you see your cardiac catheterization laboratory changing over the next decade? Various members of the HFHS cath lab contributed their thoughts in response to this question (see also the large quotations from Dr. Kim and Dr. Greenbaum): We will continue to improve efficiency. We have seen the treatment of STEMI patients improve greatly. We continue to strive to streamline the process of getting those patients to the lab as soon as possible. In the future, to save additional minutes, we hope to initiate protocols for electrocardiograms to be performed in the field by our ambulance service en route to the cath lab at HFHS. — Christina Swanson MSN, NP Advancements in the use of stents coated with bioabsorbable polymers, reducing the risk of stent thrombosis, have been promising. — Amjad Farha, MD Please tell the readers what you consider unique or innovative about your cath lab and its staff. For us, having a diverse workforce has resulted in a strong cath lab culture and values. When Patti Renaud, RN, Assistant Clinical Management, was posed this question, she responded, “Our cath lab is truly a melting pot of cultural differences, personality and professional backgrounds. When faced with a crisis or personal tragedy, every one of us rally together and support each other.” Our focus on diversity goes beyond social and moral responsibility. Despite a variety of backgrounds, we are a team, building on collective strengths to provide our patients with the best possible care Kathleen Arnold can be contacted at kathleenam488@yahoo.com

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

Henry Ford Heart and Vascular Institute Treating Patients with Complex Vascular Disease with a Multi-Disciplinary Approach Improving Patient Compliance with Antiplatelet Medications Clinical Editor’s Corner Cath Lab Nurse/Tech Vascular Access and Closure Using the StarClose® Device The Clinical and Economic Impact of Measuring Fractional Flow Reserve FFR and Choosing an Optimal Revascularization Strategy Finally! The New Registered Cardiac Electrophysiology Specialist (RCES) Credential Use of a Mobile Lab to ‘Test the Waters’ at a Rural Hospital Remembering a Cardiac Cath Lab History ACVP• Membership Page What Do You Think? The Ten-Minute Interview with… Ernie Livingston, RN, BSN SICP* Chapter Updates Who’s in Charge? Working to Eliminate Bottlenecks: Florida Hospital’s Cardiac Cath Lab Achieves Greater Efficiency and Higher Satisfaction Preserving Left Ventricular Function during Percutaneous Coronary Intervention Ask the Clinical Instructor: A Q&A Column for Those New to the Cath Lab Making the Most of Your First Impression: Interviewing Tips and Techniques CEU Education Center Clinical & Industry News Meetings Calendar

Cath Lab Digest - November 2007

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