Figure 1. A CASE STUDY

Developing Productivity Standards for a Cath Lab
The Setting
A 300+ bed, not-for-profit hospital located in the Midwest consolidated and relocated all cardiac services to a new “heart center” facility (hospital-within-a-hospital model). The new facility increased the number of available cath/electrophysiology (EP)/peripheral vascular (PV) labs and included adjacent observation and chest pain evaluation units. The hospital also developed new acute myocardial infarction (AMI) protocols to reduce the “door-to-cath” times.

The Problem
The cath labs were directed by hospital senior management to reduce FTEs and increase productivity to meet the established work labor units. This necessitated the closure of a cath lab and limiting the volume of cardiac cases, resulting in decreased revenue, physician dissatisfaction, and low staff morale. The manager increasingly used overtime and pay incentives to complete add-on cases.

The Solution
Conduct an analysis of the existing work labor units (WLUs), a comparison against benchmarks, and determine appropriate staffing levels.

Action Steps
1. Analysis of established WLUs
2. Revision of WLUs
3. Benchmarking
4. Determine the appropriate WLUs and required FTEs

Analysis
The department manager worked with the hospital finance department to analyze the established WLUs and to determine the methodology used in the development of the WLUs. The analysis indicated that the WLUs were no longer valid due to changes in the procedure mix and complexity, as well as the impacts of converting to computerized charting and an increase in data collection.

Revision of WLU WLUs were revised for each procedure performed in the cath/EP/PV labs. Each procedure was (a) broken into stages (pre-procedure, procedure, post-procedure); (b) monitored to determine the time required to perform each stage; and (c) observed to determine the type and number of persons required to perform the work.

Benchmarking
Several sources were used to benchmark the recommended staffing mix and ratios. A comparative database was created by reviewing the spotlight interviews published in Cath Lab Digest and EP Lab Digest from January 2004 through June 2006. The data compiled included only those hospitals operating the same or similar numbers of labs. Other sources included Sg2, Heart Rhythm Society, American College of Cardiology (ACC)/Society of Cardiovascular Angiography & Interventions (SCAI), Society of Invasive Cardiovascular Professionals (SICP), Society of Chest Pain Centers, and the 2006 Annual Survey of Hours from the Labor Management Institute. Also, other lab managers were informally surveyed regarding their staffing ratios.

Findings
The revision of WLUs and comparison to the benchmark data indicated that changes in procedure complexity, adoption of new technology, and the addition of an observation and chest pain evaluation unit required more FTEs than budgeted based on the “old” WLUs.