Cardiology Information Systems Enhance Care and Workflow at Saint Louis University Hospital
In the J. Gerard Mudd Cardiac Catheterization Laboratory, we perform a wide range of diagnostic and interventional procedures, including right and left heart catheterization (PTCA), atherectomy, aortic and mitral valvuloplasty, coronary and peripheral thrombolytic therapy, intravascular stents, peripheral and renal vascular angioplasty, and laser angioplasty. In three cath lab suites, we perform approximately 1500 diagnostic angiograms and between 400-450 interventional procedures annually. Our staff consists of five registered nurses, five cardiovascular technologists, one manager, one inventory manager, three interventional physicians and four diagnostic physicians.
Hemodynamics: A lost art
The director of our cath lab is Morton J. Kern, MD, FACC, author of The Cardiac Catheterization Handbook (Mosby), Hemodynamic Rounds (Wiley-Liss) and several other titles. Dr. Kern’s name is well-known to many in the field of interventional cardiology. As you can imagine, we run our cardiac catheterization service by the book, with a sharp focus on patient care, angiographic and hemodynamic methodology, and proper technique.
The hemodynamic monitoring system we use in our lab is Vericis® PhysioLog from Camtronics (Hartland, WI). Dr. Kern and our cath lab team selected PhysioLog after evaluating hemodynamic systems from several vendors in late 2002 and early 2003.
Selecting the right hemodynamic monitoring system is a critical decision because hemodynamic data provides vital diagnostic information. Hemodynamic data study is a lost art in many cardiac cath labs, says Dr. Kern. And that’s unfortunate, because the underlying standard for the evaluation of many cardiovascular abnormalities, especially those involving cardiac valves or cardiomyopathy, is the study of pressure waveforms.
With respect to hemodynamic monitoring and recording systems, you need to have several things, notes Dr. Kern. It needs to be accurate. It needs to be correctly timed and precisely calibrated. It also needs to be easy to use for the nurse or technologist who is recording the case, as well as fast with respect to recording and recalling data. The Camtronics hemodynamic system meets these requirements in all respects.
Less paper, more focus on the patient
There are a number of other features of the PhysioLog system that have improved patient care and workflow in our lab. One of the features our staff appreciates is how the waveform visualization enhances patient safety. On our prior system, if you were performing a PCI and you needed to see a 12-lead ECG, you lost the ability to monitor the invasive pressures. With PhysioLog, we are able to view 12-lead or cardiac output and the invasive pressures simultaneously on a single screen.
PhysioLog’s full disclosure waveform recording is another feature that we’ve found beneficial. The system records and stores over 100 hours of waveform data on a central server. Being able to quickly recall this data is very useful in certain circumstances. For example, if the person monitoring the case fails to record a pull-back pressure, there’s no need for the physician to do it again, because we know the PhysioLog system has recorded it. It’s easy to go back and get the reading just by punching in the time. PhysioLog also enables us to collect information that was not obtained and is vital for review with our departmental conferences and as reference material for publication. Various waveforms can be observed during a case, such as with ectopic beats and subsequent hemodynamic changes, that are not always recorded to the hemodynamic archive. These waveforms can be recalled, recorded and utilized.
The system has also allowed us to eliminate all of the paper forms that we previously used for procedural documentation and inventory tracking. It uses templates that you can customize for each procedure type or for any other aspect of the case that requires documentation. Now, instead of a circulating nurse having to carry a clipboard with five or six paper forms that need to be filled out, all this information is entered on PhysioLog.
Any devices that are not included in a PhysioLog custom kit can be easily entered by using the bar code scanner. At the end of the case, the system prints a report with all the items used for the procedure. It’s faster and more accurate than the paper-based method we used in the past.
PhysioLog’s statistical reporting tools allow me to be a more effective lab manager. The system has a template-based, drag-and-drop charting which ensures that we get accurate and consistent procedural documentation, regardless of who records the case. This makes us feel confident about the integrity of the data stored in the database. The management reporting tools allow me to pull up statistical reports on a number of important metrics, including room turnaround, procedure times, inventory per physician, and cases by physician, just to name a few. I also use these reports to justify staff overtime to hospital administration.
Assembling these types of reports in the past was very time-consuming and required combing through piles of records and hours of manual tabulation. I estimate that PhysioLog’s management reporting capabilities save me one hour per day for each report I generate.
System improves communication
The SLU Cardiology division has also installed Camtronics' Vericis Cardiovascular Information system for image management.
The ability to review studies at several sites is a significant advantage. To better understand their patients’ diseases, physicians want to see the images, and they can do that from the Vericis workstations we have distributed throughout the facility and at our offsite outpatient office, says Dr. Kern. The system also provides secure web access to studies, so physicians can view images from a laptop computer in their home or office.
The Vericis system also gives our physicians the ability to compare multi-modality studies side-by-side. It's very helpful to have a complete echo study on a patient prior to a procedure because we can see the problems we are going to be addressing, observes Dr. Kern. It’s useful after the cath as well, because it allows us to make sure the information correlates, and if it doesn’t, identify the reasons why.
The system empowers us to communicate quickly and precisely. All the information from the procedure is immediately available, and that allows us to convey accurate information to the primary care physician, surgeons or whoever else is involved with the care of the patient.
In summary, I would say that the key benefits we’ve realized with the Camtronics system are improved communication, streamlined workflow, and more accurate data. These are important advances for any cath lab service, no matter the size.
Matt Johnson, RN, can be reached at firstname.lastname@example.org