What type of procedures are performed at your facility?
Our cath lab performs diagnostic and interventional procedures. Diagnostic cases include left and right heart cardiac catheterizations, Swan Ganz insertions, coronary and peripheral intravascular ultrasound (IVUS), WaveWire (Volcano Therapeutics Inc., Rancho Cordova, CA), peripheral studies, as well as carotid and cerebral angiograms. Interventional procedures include angioplasty, stenting, rotational atherectomy, thrombectomy, intra-aortic balloon pump (IABP) insertions, pacemaker insertions, pericardiocentesis and percutaneous ventricular assist device insertion. Our peripheral procedures include cryoplasty, SilverHawk (Foxhollow Technologies, Redwood City, CA), endografts, peripheral angioplasty and stenting. We have also started to perform aortic abdominal aneurysm (AAA) stenting in the cath lab, with cooperation between surgeons and cardiologists, and have recently initiated a carotid stenting program. We perform 40“50 cardiac cases each week and 10 peripheral cases a month.

Does your cath lab perform primary angioplasty with surgical backup?
Our hospital has an open-heart program, so we have 24/7 surgical backup. We also provide surgical backup for some surrounding hospitals that transfer cases to our facility.

Have you had any cath lab-related complications in the past year requiring emergent cardiac surgery?
Yes, there is always a potential for this type of complication and some patients have required emergent cardiovascular surgery. However, with the latest technologies available, the occurrence is far less than in the past. Our average for complications is well below American College of Cardiology standards.

Has your cath lab expanded in size and patient volume?
Sherman Health has recently broken ground for our replacement hospital, due to open in 2009. We are looking forward to a state-of-the-art facility as well as serving the surrounding communities.

How does your cath lab compete for patients?
Even though patients™ preferences are important, in reality, private insurance and Medicare guidelines are strict in regards to hospital choice. Based on our solid reputation in the community, cardiologists do not hesitate in bringing their unstable patients to our facility. Patients also make a choice to undergo procedures in our cath lab based on word-of-mouth and recommendations.

What procedures do you perform on an outpatient basis?
We perform diagnostic and interventional left and right heart procedures, as well as peripheral studies.

How did you begin performing peripheral procedures?
Prior to opening the cath lab in its current location, all peripheral cases were being performed in the special procedures lab in the diagnostic imaging department. We have been doing peripheral cases in our dedicated peripheral room for the past five years.

Do different disciplines perform peripheral procedures in the same area?
The cardiologist on staff performs peripheral interventions as well as an interventional radiologist. Cardiothoracic surgeons are also involved in the cath lab with our recent implementation of AAA stenting. In this procedure, the patient is anesthetized with general anesthesia. A cardiothoracic surgeon performs a cutdown bilaterally on the iliac arteries in a sterile environment. The AAA device is deployed by the cardiologist. At the procedure™s end, the cardiothoracic surgeon closes the iliac cutdown sites.

What specific equipment was instituted and/or dedicated towards peripheral cases?
Our peripheral suite is equipped with dual programs allowing for both cardiac and peripheral studies.

What peripheral procedure training was instituted so staff could be competent and skilled?
Our staff has trained in peripheral work through physician education, device representative inservices and hands-on training with physicians during cases. We also send staff to seminars to learn about new techniques and equipment. Some of our staff have come from other facilities and been a great resource.

What percentage of your diagnostic cath patients go on to have an interventional procedure?
About 65% of our diagnostic procedures turn into interventions.

What percentage of your patients are female?
Female patients make up approximately 36% of our population.

Who manages your cath lab?
Our lab manager is David Johnson BS, RT(CR)(CV). He is responsible for Cardiovascular Services, including non-invasive, electrophysiology (EP) and cardiac rehab. He has 18 years of service at Sherman. David reports to Laura Walczak RN, MSN, MBA. Laura is the Associate Chief Nursing Officer of Sherman Hospital. Laura has over 20 years of service at Sherman.

Do you have cross-training? Who scrubs, who circulates and who monitors?
Our entire staff is cross-trained in all positions within the cath lab, which allows for the anticipation of needs in any role. All staff members having passed the required competency exams are permitted to scrub, record and circulate. Any medications are administered by RNs only.

Does an RT (radiologic technologist) have to be present in the room for all fluoroscopic procedures in your cath lab?
Our lab requires a RT to be on duty for fluoroscopic procedures.

What are some of the new equipment, devices and products introduced at your lab lately?
Some of our new devices include the StarClose (Abbott Vascular Devices, Abbott Park, IL) and Boomerang (Cardiva Medical, Inc., Mountain View, CA) closure devices, the SilverHawk® peripheral atherectomy catheter, cryocatheter for peripheral angioplasty and TandemHeart (Cardiac Assist, Inc., Pittsburgh, PA), a percutaneous left ventricular assist device.

Can you describe the system(s) you utilize?
We have 2 Philips (Bothell, WA) digital labs with a third Philips digital lab that is equipped to be used by cath, EP and special procedures.

How do you handle vendor visits to your lab?
Representatives must schedule visits to the lab through a inventory coordinator or charge RN, then check in with purchasing to obtain a vendor pass. Only one vendor is permitted at a time.

How is coding and coding education handled in your lab?
Our inventory coordinator and secretary work closely together to ensure that all charges are entered and billed correctly in a timely manner.

How does your lab handle hemostasis?
To expedite ambulation, we try to deploy a vascular closure device in our patients, such as Perclose®, Starclose (Abbott Vascular Devices, Redwood City, CA) or Angio-Seal (St. Jude Medical, Minnetonka, MN). If the patient has iliac disease or any contra-indication for a closure device, we use manual compression with a hemostasis patch. If necessary, we use a FemoStop® (Radi Medical Systems, Wilmington, MA). Our cardiovascular surgeons prefer a manual hold for any patient having a coronary artery bypass graft (CABG). Most of our patients recover in our ambulatory recovery area. We do recover some patients in our telemetry units and critical care areas, all which are staffed by RNs. Our cath lab staff is also responsible for the removal of IABPs. We have strict guidelines for the training of this duty.

How is inventory managed at your cath lab?
We have an inventory coordinator who does all our billing and reordering of our supplies every day. Our coordinator is a radiologic technologist, but does not actually do any cath lab cases.

Is your lab involved in clinical research?
We are currently not involved in any research studies.

What other modalities do you use to verify stenosis?
We use IVUS and a fractional flow reserve (FFR) wire (the Volcano WaveWire) to physiologically and/or anatomically assess a lesion. The number of cases is not substantial enough to generate revenue.

What measures has your cath lab implemented in order to cut or contain costs?
Our institution had a dramatic cut in staffing which has cut costs for the department. We are constantly working with the billing department and our inventory coordinator on procedures for which we can or cannot charge.

What type of quality control/quality assurance measures are practiced in your cath lab?
To benchmark our performance nationally, we implemented the ACC-NCDR® Cath PCI registry. Equipment quality control includes: activated clotting time (ACT), hemochron OSM3®, IABP, defibrillator and crash cart checks. The bio-medical department does their required patient monitor (PM) and safety checks. Patient satisfaction is measured by an independent outside company (Press-Ganey, South Bend, IN) done on an annual basis. ST-elevation myocardial infarction (STEMI) Audit record is used to monitor our door-to-balloon time in Code Cardiac cases. Strict adherence to the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) standards is highly valued.

Has your lab has undergone a JCAHO inspection in the past three years?
Yes, our lab was inspected by JCAHO in 2006. We passed the inspection successfully.

How are new employees oriented and trained at your facility?
New employees are assigned to a preceptor to use as a resource. The length of training varies, but most new employees are fairly comfortable within a year of their start date.

What type of continuing education opportunities are provided to staff members?
Our staff is highly motivated to further their education. Yearly computer-based competencies, vendors that offer CEU programs and in-services meet some of our educational needs. Any additional continued education is self-directed.

How is staff competency evaluated?
Our staff competencies are done on a yearly basis. A staff member coordinates by using validation tools. Vendors of various products participate by inservicing on equipment used in the labs.

Does your lab have a clinical ladder?
Yes, we do utilize a clinical ladder for RTs and CVTs. Basic entry level would constitute a new employee with little or no experience who through training and competencies can advance to the next level. There are three levels to attain in our clinical ladder.

How does your lab handle call time for staff members?
We self-schedule our call time. Four people are included per call team which, because of cross-training, may consist of mixed credentials.

Within what time period are call team members expected to arrive to the lab after being paged?
Response time to arrive to the cath lab is 30 minutes. The cardiologist is paged for the emergency as well, and has the same response time. Our Code Cardiac times are below the national average for door-to-balloon time (90 minutes).

Does your cath lab do electives on weekends and or holidays?
We only do electives on weekends or holidays when it is absolutely necessary. We try to only do acute cases on weekends. If we do have to come in, it is the call team that responds.

What trends do you see emerging in the practice of invasive cardiology?
Two trends we have noted are a greater interest in chronic total occlusions and hybrid procedures where both surgeon and cardiologist perform the procedure.

Where is your cath lab located in relation to the OR department, ER, and radiology departments?
Our cath lab is on the second floor of Sherman Hospital, while the ER is on the first floor. The OR is located next to our department on the second floor as well. Radiology is located on the first floor along with a special procedure department.
Our rooms are considerably smaller than most hospitals. Two rooms are back-to-back with a control room between them. Our peripheral room is just on the other side of the hallway.
We are excited about the layout at our new hospital. Sherman Health is building a state-of-the-art 645,000 square foot, 255-bed replacement hospital. The 154-acre site will feature the largest geothermal lakes in the world. Geothermal energy is energy derived from the temperature of the earth. The earth absorbs 50 percent of all solar energy, and traps it as heat just below the frost line. Using a heat pump, the heat trapped below the earth™s surface is transformed into energy. Geothermal energy provides buildings with a dependable, eco-friendly and economic heating and cooling system and will save the hospital over $1 million per year in energy costs.
The cath labs will be located on the second floor of the new hospital. They will be adjacent to the operating rooms, the recovery area and sterile processing, as well as the emergency department.

Please tell readers what you consider unique or innovative about your cath lab and staff.
We pride ourselves in having staff of multi-cultural backgrounds as well as a wide variety of staff with additional credentialing. We unite our lifetime and professional experiences in different disciplines to make an exceptionally strong team.

Is there a problem or challenge your lab has faced?
Open-heart surgery programs are soon going to be a standard in many hospitals. Our facility was faced with the opening of 4 new cath labs within a 20-mile radius, which impacted our volume and productivity drastically. We still rely on our stellar 35-year reputation to keep our community and physicians satisfied with the highest quality of care.

What™s special about your city or general regional area in comparison to the rest of the U.S.? How does it affect your cath lab culture?
Sherman Health is located 40 miles northwest of Chicago, an area well-known for teaching and research hospitals. We are proud to be a regional heart center and received in 2005 and 2006 the Distinguished Hospital Award for clinical excellence from HealthGrades and were named one of the nation™s 100 top cardiovascular hospitals by Solutient. The community we serve is a melting pot and rapidly growing.

The Society of Invasive Cardiovascular Professionals (SICP) has added two questions to our spotlight:

1. Do you require your clinical staff members to take the registry exam for Registered Cardiovascular Invasive Specialist (RCIS)? Do staff receive an incentive bonus or raise upon passing the exam?
Our institution does not require staff to be RCIS-certified, but there is an incentive bonus for passing the exam.

2. Are your team members involved with any professional organizations that support the invasive cardiology service line, such as the SICP, ACVP, or regional organizations?
Our lab and the labs in our surrounding area have started up an Illinois chapter of the SICP, which is now over a year old. A few of our clinical staff are members of the American Heart Association, American Stroke Association, Council on Atherosclerosis, Thrombosis and Vascular Biology and the Society for Vascular Medicine and Biology.
Our SICP chapter is evolving wonderfully. It has tripled in membership size in just the first year. Our officials have been elected into office and plans for a website are underway. We will be holding a meeting in October 2007, with details to follow. If anyone is interested in attending, please email Milka Gemaljevic at milka.gemaljevic @ shermanhospital.org.

Milka Gemaljevic can be contacted at milka.gemaljevic @ shermanhospital.org.