Cath Lab Digest - November 2007 - (Page 27)

27 Inside the mobile cath lab. Having a mobile lab allowed us to really test the waters during that first year or two, to make certain that once we had made that decision to go ahead with the building project, it would be properly utilized. Of course, we also needed to build up our radiology capabilities. We ended up bringing in a new dual-head nuclear medicine camera. Our patients generally start out with an office visit, have a stress test, and then have a nuclear medicine test. The cath option, unless they are having an MI, is really the last option to take care of their issues. The cardiologists usually try to use everything else in their arsenal, in terms of lifestyle changes and medication, before they just take them to the cath lab. Having a mobile lab allowed us to really test the waters during that first year or two, to make certain that once we had made that decision to go ahead with the building project, it would be properly utilized. There was no doubt once we got the mobile cath lab here and saw how it was being used. Soon it had become very obvious that we were going to outgrow our space if we didn’t do something to expand our capabilities in intensive care and progressive care on the nursing floors. Before we moved into the permanent cath lab and did our first case there on August 7th, we had done nearly 1700 patients in the mobile lab since October 2005. That is a volume that many cath labs, even those in an urban area, would feel fortunate to have. Being able to show such high volumes also gave us leverage with the ambulance transportation companies. We favorably negotiated contracts to bring in helicopter service. If a patient had an acute MI and it was determined that they could not use a stent or there was some other risk factor that did not look favorable for treatment in the cath lab, it allowed the cardiologist to make the decision to immediately get the patient on a helicopter to a tertiary care facility in Wichita for open-heart surgery. How often is the helicopter used to transport cardiac patients? A few times a month. Often the cardiologists have a pretty good idea of patient needs from previous testing. I don’t think we’ve had very many patients taken to Wichita as the result of an emergency from a cardiac cath. Years ago, you did see situations where patients would be taken to the cath lab, have complications and need to be rushed into open-heart surgery. But these days, with the changes in technology, the physicians are good about predicting that if they go further in a case it will cause a problem. They know when to pull out and get that patient ready for transport or to not attempt the case at all. How many staff are in the cath lab today? There are about 12-13 people total, with a mix of cath lab technologists and nurses. What is your (now permanent) cardiac cath lab like today? Currently we have one interventionalist and one invasive cardiologist. Dr. Khan was successful in bringing in a second cardiologist. We have one cath lab, but the way we built the area was such that we do have the ability to bring in a second cath lab at the appropriate time. We are doing over 100 cases a month in the permanent lab. The transition from the mobile to the permanent lab was seamless in the eyes of the public and the referring physicians. Once you have the capability, it’s not much of a difference between the mobile and the permanent lab. Some physicians may have a greater respect for a permanent lab that’s not in a mobile setting, but we haven’t really seen that to be the case. We had very good luck using the mobile lab and our patients have excellent outcomes. We have not had a single death in our cath lab since the start of service. We have an excellent cardiology team. The teamwork between our cardiologists and our medical staff as a whole has made all the difference. Ultimately, our partnership with CSI was very beneficial to the community we serve. ■ John Walker can be contacted at john.walker@lpnt.net or tel. (620) 225-8401. Cardiac Services, Inc. is online at www.cardiacservicesinc.com or tel. (800) 722-5742. We also hired some staff with cath lab training, so it was a combination. Once you had the mobile lab set up, how soon did you begin treating acute MI patients? Once the mobile lab was up and running, we began treating MI patients right away, due to the level of training of our interventional cardiologist. We were able to use his expertise to assist through the initial cases while we were getting our staff trained both on-site and at the other hospital location which provided additional training of our cath lab staff. Originally, Dr. Khan was on call 24/7 for cases in the ER because at that time he was the only cardiologist. Also, he was very dedicated to getting the cath lab started and did not want any patient to be transported unless they needed open heart surgery. Helicopter and fixed wing service was available on a “as needed” basis from the beginning of the mobile lab operation. In January 2007, the helicopter service stationed a helicopter at our hospital, dedicated specifically to our patients. Your facility utilized the mobile lab for two years? Yes. It was installed in the fall of 2005, and we used it for almost two years. The last day the lab was physically on-site was August 10th of this year. We used it all the way up to August 6th. It was a long lease period, which allowed us to really go in a whole new direction in our hospital. We increased our capabilities in our other critical care areas, such as our ICU. The cath lab program sparked a building expansion project, and we built a brand-new 10-bed ICU to replace the previous 6-bed ICU. We also brought in a progressive care unit to help with patients that perhaps did not need intensive care, but needed a step-down unit between intensive care and regular medical-surgical care. Cath lab staff at Western Plains Medical Complex. that, we had to build the enclosure area I described to protect the patients from the weather. Building that area took a few days, but if not for that delay, we literally, with the help of CSI, could have been doing cases the next day, as long as we had everything else we needed. Our interventionalist knew the installation date, and the schedule of how many days we thought it would take to build the enclosure. It was just a matter of him having patients, but in fact he had already started attracting patients. Once he came to Dodge City and opened his doors, word traveled fast that he was here and would be able to see and take care of cardiac patients. How else did you get the word out to physicians and patients that you had this new capability? We did a lot of print ads. We also did television and radio. Dr. Khan himself went out to many service clubs and he also met with a lot of the primary care physicians locally and in the outlying areas, to let them know that we now had this capability. We did a lot of marketing in various forms. Did you need to hire new staff for the expansion? We sent some current staff to another hospital in Kansas to get training so we could get our staff up to speed fairly quickly. We also felt like it was in the best interest of the patient care we would be providing to have them trained in the appropriate setting, rather than it being on-the-job training. http://www.cardiacservicesinc.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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