Cardiovascular Business - October/November 2007 - (Page 33) lab to maintain a complete inventory. “We try to secure stents on consignment, but that can be problematic as the cath lab focuses on emergent rather than routine procedures. In addition, one type of drug-eluting stents has a very short expiration date,” explains McDowell. On the EP side, the lab consigns ablation catheters, which are shipped to the hospital for the day of the scheduled procedure. Bayview employs a variety of technology and processes to streamline inventory management and ensure billing compliance. “First, because we have a small staff we can designate a single person to touch the probe to the product in each case. Second, we complete an audit within 24 hours of every case, which serves two purposes. It catches any errors and provides a basis for training and education,” explains McDowell. cardioverter defibrillators (ICDs), IT created a dropdown list to prompt physicians and ensure regulatory compliance. Inventory management remains a challenge. On the front end, the documentation system tracks used inventory, but the lab lacks an automated system to record incoming items. “Staff has to stay on top of inventory,” states Wimsatt, “but I’m not convinced an automated system would significantly improve management.” A sneak peek into the cath lab of the future The new facility Inova Heart and Vascular Institute opened three years ago in Falls Church, Va., with seven dedicated catheterization labs, three dedicated EP rooms and a combination cath and EP room. Rooms are equipped with a variety of Philips Medical Systems Allura Xper FD 10 and FD 20 cardiovascular x-ray systems, including single and bi-plane systems and a single plane FD 10 that accommodates both EP and cath procedures. One of the main changes since the institute opened its doors, says Wimsatt, is the tremendous increase in peripheral vascular work. “Our peripheral vascular volume has increased almost 200 percent, mainly due to a partnership with area cardiovascular surgeons.” Interventional work is also on the rise as new x-ray systems offer improved maneuverability and dexterity to facilitate lesion access. Wimsatt says a thorough, site-based cross-training program helps Inova Heart manage the evolving procedure mix. The regulatory front presents other challenges. The Centers for Medicare & Medicaid Services (CMS) and Joint Commission on Accreditation of Healthcare Organizations (JCAHO) have adopted major changes in documentation requirements, says Wimsatt. The cath lab turns to its IT staff to create and update templates and dropdown menus in its documentation system. For example, when CMS instituted new criteria for implantable Look for a relaxing of interventional angioplasty criteria, says McDowell. The C-Port-E research project demonstrated the viability of angioplasty in hospitals without open heart surgical backup. The next step is to approve interventional angioplasty in hospitals such as Johns Hopkins Bayview Medical Center. → Vulnerable plaque assessment. Imaging technology and clinical know-how aren’t quite ready for prime time, says Dunn. But the cath lab could play a role in diagnosing and treating patients with vulnerable plaque. → Tackling total occlusion. New systems such as Siemens Axiom Artis dFC Magnetic Navigation (developed in partnership with Sterotaxis Inc.) provide access to conventionally inaccessible places. “It will open up new procedures,” predicts Dunn. → Cardiac CT. PinnacleHealth plans to place a 64-slice CT scanner in its cath lab. “Some sites indicate that cardiac CT can decrease cath lab volume, but we expect coronary, peripheral vascular and EP work to increase because the scanner will find previously undetected blockages,” explains Acquaviva. The Pennsylvania cath lab also may offer as triple abdominal aortic aneurysm (AAA) procedures in the future, and it plans to explore the research potential of percutaneous surgical procedures such as mitral valve replacement. Smart management Cardiac cath labs are changing. Conventional cath procedures are down, and competition and regulation are up. Smart labs are adapting by diversifying into EP and peripheral vascular work, cross-training staff, keeping close tabs on and consigning inventory and proactively planning for future developments. CardiovascularBusiness.com Cardiovascular Business 33 http://www.CardiovascularBusiness.com
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