Little Rock Cardiology Clinic, P.A. Cardiac Catherization Laboratory
- Posted on: 6/19/08
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What is the size of your cath lab facility and number of staff members?
Little Rock Cardiology Clinic, P. A. is a physician owned and operated clinic that provides multiple cardiac diagnostic services. The clinic is comprised of twelve cardiologists and one internal medicine physician. Services include: nuclear medicine, laboratory, radiology, echo, and most recently, cardiac catheterization laboratory. The cardiac cath lab is the first freestanding outpatient cath labs in the state of Arkansas, and was built with the vision of making the patients feel comfortable when undergoing a diagnostic invasive procedure such as a cardiac catheterization or peripheral angiography.
The idea of building a cath lab was further driven by the results of the CREDO study (Clopidogrel for Reduction of Events During Observation, Bristol-Myers Squibb & Sanofi-Synthelabo, 2002).
The cardiac catheterization department is staffed with 8 full-time employees and 4 PRN employees:
FTE: 3 BSN, RN (2 of which are currently working toward their MS); 1 BA, RN; 1 RN; 1 BS, LRT(R), CV; 1 LRT(R); and 1 receptionist
PRN: 1 BSN, RN; 2 RN, LT; and 1 RN
The pre/post procedure care is performed by 3 RNs and the cath labs are staffed with 2 RNs and 2 LRT(R).
What types of procedures are performed at your facility?
We have two equipped cath labs, in which, we perform approximately 50 cases per 4-day work week. We do diagnostic right and left heart catheterizations along with imaging of the bypass grafts and internal mammary arteries. We also perform diagnostic peripheral angiography. Currently, we do not do cardiac or peripheral interventions.
What percentage of your patients are female?
Our case mix consists of 50% female patients.
What percentage of your diagnostic cath patients go on to have an interventional procedure?
Approximately 32% of our patients go on to have a percutaneous coronary interventional procedure, while approximately 12% of our patients are referred for coronary artery bypass grafting.
Who manages your lab?
The cath lab is managed by Jonathan Clopton. His educational background consists of a PhD in Health Administration, a MS in Radiologic Administration, a BS in Radiography, and he is also a Registered Cardiovascular Invasive Specialist (RCIS). He is responsible for the day-to-day operation of the cardiac cath labs, along with fiscal management and resource utilization. He also develops strategies to improve financial performance for assigned departments, including expenses, revenues, efficiency, and productivity.
Do you have cross-training? Who scrubs, who circulates and who monitors?
Yes, cross-training is encouraged in the cath labs. RNs are the only team members that administer narcotics. All cath lab staff is required to maintain current ACLS and BLS certifications. All pre and post procedure care is performed by RNs that are ACLS and BLS certified. We have also found that for diagnostic procedures, a procedure can safely be performed by two staff members, including one scrub LRT(R) and one RN that circulates and monitors.
Does an RT (radiologic technologist) have to be present in the room for all fluoroscopic procedures in your cath lab?
No, to the best of my knowledge, the state of Arkansas allows individuals holding the state licensure to perform procedures using ionizing radiation as long as it is under direct supervision of a physician. In Arkansas, a radiologic technologist can obtain a state license after passing their national registry. A state license can also be obtained by individuals that have passed the RCIS (registered cardiovascular invasive specialist) registry from CCI (Cardiovascular Credentialing International). There are those individuals in the state that were able to take advantage of the grandfather period and get grandfathered in as an LT (licensed technologist). This was a wonderful opportunity for those individuals. Having a Arkansas state license as an LT allows individuals with a non-radiation background an opportunity to continue performing their job duties in a specific department, such as a RN scrubbing in the cath lab.
Which personnel can operate the x-ray equipment (position the II, pan the table, change angles, step on the flouro pedal) in your cath lab?
Routinely, the scrub will position the II, pan the table and change the angles, and the cardiologist will step on the flouro pedal.
Does your lab have a clinical ladder?
We do not have a clinical ladder at this time.
What are some of the new equipment, devices and products introduced at your lab lately?
Our first cath lab opened in February of 2003 and our second cath lab opened in December of 2003, both with all new GE equipment (GE Medical Systems, Waukesha, WI). We have two GE LC+ single plane digital cath labs with flat panel monitors and two GE MacLab® 7000 hemodynamic systems. Each patient is continuously monitored by a GE Dash® 2000 hemodynamic monitor, which is linked to both of the nurses’ stations. We have two GE imaging review stations, one CRSPC and one DDS; at this time, archival is maintained on CD.
We also have two ACIST CMS systems (ACIST Medical Systems, Inc., A Bracco Company, Eden Prairie, MN) which we have found to increase our overall procedure efficiency and to more accurately manage the patients' contrast dose. We have also found the ACIST CMS multiple dose system to greatly reduce the overall turnaround time between procedures when compared to the single dose system. By using the ACIST CMS multiple dose system we have reduced our contrast waste; thus increasing our profit margin.
How is coding and coding education handled in your lab?
As most managers would probably agree, understanding the value of accurate coding is important. It is important to have experienced, registered coders stay current on all the frequent updates that occur in coding. An attempt is made to attend as many coding educational opportunities as possible to maintain compliancy in our coding practices.
It is important to have an excellent relationship between the cath lab and the billing department, which we have worked hard to establish. One way we found to improve communication between the cath lab and the billing department was to allow the individuals coding to spend some time in the cath lab, seeing procedures and interacting with the cath lab staff.
It is also important that the cath lab staff have an opportunity to sit down with the registered coder and learn proper coding mechanics. It is essential to overcome the educational barriers that exist between the two departments. This also establishes a foundation and a sense of appreciation between the two departments.
How does your lab handle hemostasis?
One of the unique things about our cath lab is that we follow a 4 and 5 French policy on our left heart catheterization and diagnostic peripheral angiography procedures. This enables manual pressure to be applied for approximately 10 minutes, followed by a minimum of one hour of monitoring prior to discharge. Routinely following the diagnostic catheterization, the patient returns to their room, at which time the sheath is removed. The patient will be instructed to lie flat on their back with the affected extremity extended for 30 minutes. At this time, the patient’s head will be elevated 40-45 degrees or to a comfortable level for the patient. The patient will remain inclined for 30 minutes, during which time they will be offered something to eat and drink. One hour following sheath removal, if their puncture site is stable, the patient will be assisted to the restroom. Following the patient’s restroom visit, the patient will be allowed to change into their own clothing and will receive their discharge orders. All of the patients are escorted to their means of transportation. We do not use closure devices.
Does your lab have a hematoma management policy?
We have a quality assurance program in place to properly document and track any hematomas.
How is inventory managed at your cath lab?
Our cath lab has an individual budget. The ordering of supplies is primarily done by a strong cooperative effort among all the staff. The cath lab manager is responsible for approving all purchases.
Has your cath lab recently expanded in size and patient volume, or will it be in the near future?
Our cath lab department was initially built with the expectation of expanding to a second lab as census increases. The second lab was completed in December of 2003. Our future plans are to implement an archival network in conjunction with an electronic medical records system.
Our cardiology practice is on the fore front of modern technology. In February of 2005, we will be completing our newest addition a CTA department. We are installing a Siemens 64 multi-slice CT scanner (Siemens Medical Systems, Malvern, PA) with primary focus on cardiac and peripheral imaging. We are excited about the opportunity to provide our patients with the most cutting-edge technology available on the market.
Is your lab involved in clinical research?
At the time this information was submitted, we are looking into performing some diagnostic clinical research. We are also in the process of performing a conscious sedation study.
Have you had any cath lab-related complications in the past year requiring emergent cardiac surgery?
What measures has your cath lab implemented in order to cut or contain costs?
Negotiations were made during the development process to get the best quality products. As in most cases, volume plays a major role in product pricing. We purchase the majority of our supplies using a Group Purchasing Organization (GPO). Strong efforts are made to maintain close par levels.
What type of quality control/quality assurance measures are practiced in your cath lab?
We have a continuing quality assurance/quality control program with daily and monthly checks.
We perform point-of-care testing. Fluoro times are documented to monitor for the prevalence of radiation burns. We make a courtesy follow-up phone call to every patient after their procedure to answer any questions or concerns they may have.
How does your cath lab compete for patients? Has your institution formed an alliance with others in the area?
Our cath lab competes for patients based on physician referral patterns and insurance alliances that have been established with larger healthcare networks. Being a freestanding clinic, we have made agreements with area hospitals in the event of an emergency.
How are new employees oriented and trained at your facility? What licensure is required for all professionals who work in your lab?
We have developed and implemented an orientation program for new employees. The program will provide the new employee with an orientation of sufficient scope and duration to inform the new employee about his/her responsibilities. A preceptor is assigned and will direct the orientation phase, consisting of 4-5 weeks or individualized on person's experience. BLS and ACLS are required. Our cath lab team consists of: RNs, RTs and one RCIS.
What type of continuing education opportunities are provided to staff members?
Little Rock Cardiology Clinic, P. A. offers recertification for BLS and ACLS annually. Vendors are always helpful in providing educational opportunities to receive CEUs on new products. Efforts are being made to send staff members to national meetings annually.