I started in cath lab/specials at our 378-bed community hospital back in 1979. At that time patients were admitted the night before to the telemetry unit. The admitting process was tedious and consisted of multiple phone calls to the cardiologist regarding orders, lab results, and other patient issues. The post care was filled with the same issues and led to poor outcomes. In 1980, I was asked to open an area where the patients could come in that morning and go home from that evening. No hospital in our area had such a unit. There was little information to reference regarding outcomes for same-day discharge on cath lab patients. The community standard was not to send patients home the same day. All eyes were on us to see just how safe same-day discharge would prove to be.

   The hospital gave us a wing on the fourth floor at the very end of the hall, with 8 beds.

   Along with 8 beds came 8 end tables, 2 RNs and 1 LVN. Unit hours were Monday through Friday 7am – 8pm. The patients were asked to pre-admit the day before, with labs/chest x-ray, etc. The patients went through general admitting the next day. Most patients were not happy about having to take the day off before to pre-admit. The first patient was ready at 7:30 am for case start at 8:00 am.

   Our outcomes were not bad, considering the fact that we still used 7 Fr sheaths, all patients received 5,000 units of heparin, no closure devices were used, and there was no such thing as stents. We had a high rate of hematomas, rushed multiple patients for emergent coronary bypass, and one death from a retroperitoneal bleed.

   Today, our knowledge is vast in the care of these patients, including our understanding of recoil, restenosis, and our use of various medications like eptifibatide (Integrilin), abciximab (Reopro), bivalirudin (Angiomax), clopidogrel (Plavix), and even aspirin. Very few patients go directly for coronary bypass. Even left main stenting has become more of a norm. There is a great deal more control over sheath removal with all the closure devices.

   Our current Angio Recovery unit, as it is called, serves about 4,500 patients a year. We have 12 beds and one is used as a procedure room. Our hours are from 5:30 am to 7:30 pm. All radiology patients come through our department. We care for all cath lab, electrophysiology, device implants, specials, vascular, and radiology biopsy patients. We have a procedure room, do all cardioversions for the hospital, tilt table tests, transesophageal echocardiograms, and any minor surgical procedure deemed necessary.

   Our admitting department is for all outpatients and is separate from general admitting. Our first cases can start as early as 6:45 am, which allows the cardiologist or electrophysiologist to get some cases completed before office hours. Our patients come in, have their IV started and labs drawn, all with a single stick in the same day.

   Physicians, patients, families and nurses love the unit. Our Press Ganey is in the high 90th percentile. We have had many pitfalls, but have made improvements and changes along the way. Our case turnaround time is about 20 minutes. We have standing orders and excellent rapport with all the physicians. Our outcomes are excellent.

   We just recently had another site visit, which is what actually sparked the writing of this article. We feel an angio recovery unit like ours is the best way to go for busy labs. We staff with all RNs and one secretary. The RNs are excellent — and our patient and physician satisfaction speaks for itself!

Mary Cohen can be contacted at mloupitt@yahoo.com