Cath Lab Digest

It was interesting that in my conversation with the nurses, they also said that they think that call back performance, despite any degree of fatigue, is still of high quality (i.e., patient care is not comprised) due to the adrenaline rush. Although overworked and under-paid (and as an aside, in my opinion, everyone is under-paid who works in the cath lab), these nurses are still as conscientious and caring about work in the cath lab as they have ever been. As in every cath lab I have worked in or visited, the nurses and technologists are the most dedicated, involved, and responsible people in medicine, but they are certainly not immune from fatigue.

I have discussed many different physical and psychological aspects of personal interactions that affect the cath lab work environment in these pages before, but it is worth reviewing what we can do to improve the work lives of our team.

Overcoming obstacles to ‘call’ fatigue

1. Plan your work hours. Find the right balance. Not too many, not too few, and not too late (when possible). It is possible to look at the schedule and plan. Plan not only the day and reshuffle the schedule during the day as the case flow dictates, but also the call schedule every week or, if necessary, every day. Poor planning often leads to late hours and perhaps, unnecessary hours.
2. Find the right staff balance. The team should have enough bodies to do the job and then one more (in case someone requires medical or personal leave, including vacations). With a skeleton crew, it is even more important that the team functions well together and is on the ‘same page,” meaning they hold the same goals regarding patient care, safety and satisfaction. To reduce unnecessary stressors, all of us, especially the physicians, should show up to the procedure on time, work to assist in faster patient preparation, be organized, and share the needs of the procedure to make the steps more efficient. After the procedure, help move the patient, turn the room over, and prepare for the next patient. How many nurses and techs are needed? The answer depends on the lab activity, budget and goals, but it really is a simple answer: “More.”
3. Encourage physician and administrative support in establishing the “best place to work.” Team leaders should try to minimize activities that lead to unnecessary overtime and prolonged worked days. We all know that there will be unavoidable delays in the cath lab, either from a prolonged patient procedure or from systematic malfunctions (physician delays, transportation, computer glitches, pharmacy duties, etc.). 

Among the many aspects of the cath lab environment, the attitude and support of physicians and their approach to the team has a large effect that can be either positive or negative. The cath lab is not just another ‘lab’. It is an organic, functioning unit comprised of interacting team members benefiting from favorable, polite, and efficiently communicated interactions.

Finally, it makes sense to me that we should be sure everyone has time off and time to grow (leisure time and educational time). On-call hours are usually well paid, but at times, painful. The more call taken without a break, the more exhaustion accumulates, leading to fatigue, inattention, mood swings, and rarely, medical error. Is there a limit to the amount of call a team member can take? I am not sure on this one, but it seems the answer is no. In the end, it is up to the individual to be their own best advocate for rational on-call duty.

References

1. WorkForce Software. 2010 Workforce Management Trend Survey. WorkForce Software White Papers. Available online at http://go.workforcesoftware.com/2010-Workforce-Management-Trend-Survey.h... WhitePaper&ls=/. Accessed March 15, 2012.
2. Society for Human Resource Management. Available online at http://www.shrm.org/Publications/HRNews/Pages/FatigueFactors.aspx. Accessed March 15, 2012.
3. Attacking fatigue in the workplace. May 11, 2011. Available online at http://www.prweb.com/releases/2011/5/prweb8402631.htm. Accessed March 15, 2012.

Disclosure: Dr. Kern reports that he is a speaker for Volcano Therapeutics and St. Jude Medical, and is a consultant for Merit Medical and InfraReDx, Inc.

LETTER TO THE CLINICAL EDITOR

Re: A Better Way to Secure Radial Artery Sheaths

February 24, 2012

Dr. Kern,

I wanted to share with you and the readers a better way I found to keep radial sheaths in place. Instead of a Tegaderm (3M) or an Opsite (Smith & Nephew), we use a Statlock device (MAQUET Cardiovascular) that uses the Statlock to secure the intra-aortic balloon pump catheter to the leg. The Statlock locks the sheath in place and it will not move when doing catheter exchanges (see figures). The doctors really love it. The model number is 0684-00-0472.

The method of applying the Statlock to radial approach is as follows: