Cox South Medical Center
- Volume 20 - Issue 1 - January 2012
- Posted on: 1/5/12
- 1 Comments
- 5611 reads
Our acute myocardial infarction (AMI) Throughput Team is designated to oversee our door-to-balloon process. This team meets quarterly and is attended by leaders from the emergency medical service (EMS), emergency department (ED), cath lab, and inpatient nursing. The team is facilitated by our cardiovascular services quality coordinator and serves multiple process oversight roles. Trend and outlier review provides surveillance. Performance improvement initiatives are identified and implemented using Focus-PDCA (plan, do, check, act) methodology.
Case-specific feedback is provided to participating areas for most ST-elevation myocardial infarction (STEMI) cases within 72 hours of arrival.
Who transports the STEMI patient to the cath lab during regular and off hours?
The ER transports our acute patients to the cath lab.
What other modalities do you use to verify stenosis?
We have both intravascular ultrasound (IVUS) and fractional flow reserve (FFR) (St. Jude Medical). We have seen increasing use of both over the last four quarters.
What measures has your cath lab implemented in order to cut or contain costs?
At the organizational level, we have sole vendor contracts for implantable devices and stents. We also participate in a regional purchasing cooperative in order to leverage group pricing. At the department level, procedure charge accuracy and supply utilization is continuously monitored. To improve charge capture, we are currently in the process of implementing a bar-code system (GE MacLab).
What quality control/quality assurance measures are practiced in your cath lab?
Operationally, we focus on radiation safety. We perform annual physics inspection of personal protection equipment. Education is a valuable tool to be sure everyone is aware of best practices for minimizing unnecessary radiation exposure. We teach “As Low As Reasonably Achievable” (ALARA). We also have cath lab team members who participate on our organizational radiology safety team and partnership council.
Departmentally, we rely heavily on our ACC-NCDR reports to inform improvement of our clinical processes and outcomes. Case complication reporting is monitored via our clinical documentation tool. Select cases are discussed monthly by our physicians at a case review. Finally, mortality cases are reviewed in a peer-protected environment, a minimum of quarterly when necessary.
To which registries within the ACC-NCDR does your lab submit? Do you use any other outside data collection registry?
We submit data to the ACC-NCDR for both the CathPCI registry and the implantable cardioverter defibrillator (ICD) registry. Over the last 12 months, we have formed a registry team to optimally balance registry data integrity and clinical workflow. This initiative has improved data integrity and allowed a dramatic increase in registry case reporting volume, to the extent that we are now submitting diagnostic cath procedures in addition to our interventional procedures.
How does your cath lab compete for patients? Has your institution formed an alliance with others in the area?
Cox is one of two major health systems within Springfield, Missouri, with full interventional cardiology capabilities in addition to surgical and ancillary support, and with systems capable of supporting among the largest patient volumes in the state. Additionally, both facilities have their own EMS systems that operate in overlapping areas of the region. As such, these two institutions have traditionally tended to co-exist rather than compete.
CoxHealth has joined the Missouri Department of Health and Senior Services (DHSS) on an innovative and aggressive initiative to improve STEMI care for Missourians. Legislation creating the Time Critical Diagnosis (TCD) system provides structure to support systems for trauma, stroke, and heart attack. This continuing effort has taken shape over the past few years through collaboration among stakeholders from across the state. The ultimate vision is the establishment of a system of care for STEMI patients that would allow for patients to enter the system via EMS or at participating facilities, and to be triaged, treated, and transported when indicated. Ideally, the system will align systems of care toward pursuit of a common goal: efficiently delivering STEMI patients to definitive care.
However, the recent advent of ‘open-access’ insurance plans by large independent payers is sure to place an increased focus on patient satisfaction and access, quality of care, and efficiency of service. Toward those ends, we look forward to continuing to be the best for those who need us.
How are new employees oriented and trained at your facility?
We assign a proctor to work one-on-one with our new employees. They work together in procedures. First the new employee watches, then slowly transitions into doing more and more, until they are working independently to the point that both the preceptor and new employee feel comfortable with them working independently.
What continuing education opportunities are provided to staff members?
We have established a fund in the hospital foundation that we use primarily for education. As in most hospitals, the education budgets have been eliminated and the fund allows for us to have some dedicated money. This money may be tax-deductible donations from the staff, physicians or philanthropists. Some money is brought in by surveys completed by staff that is deposited into this fund. Most recently, we have brought in speakers to help prepare staff to sit for the registered cardiovascular invasive specialist (RCIS) exam and for continuing education points in early January. This was actually supported by our physician group (Ferrel Duncan Clinic), which graciously donated money to our Foundation Fund. This money helps send staff to conferences and helps with any expenses associated with education.
How do you handle vendor visits to your lab?
Vendors are allowed to visit monthly, with scheduled visits. They must adhere to our hospital policy guiding vendor access, which requires registration with our purchasing department.
How is staff competency evaluated?
Staff has an annual evaluation and competency is evaluated at that point in time. Evaluations are performed by the director of the cath lab. Recertification of core compentencies is completed annually.
Does your lab have a clinical ladder?
Our nursing co-workers can be recognized by participating in our STAR clinical ladder. It rewards nursing staff for participation in areas of education and research, community involvement, clinical excellence, and nursing leadership. Our radiologic technologists also have a clinical ladder that operates in a very similar way.
Within what time period are call team members expected to arrive to the lab after being paged?
We have a dedicated night crew four nights during the week that assist with emergent cases, in addition to performing stocking, clerical, and data collection duties. Additionally, we recently implemented a weekend team to provide cath lab coverage during daytime hours on Saturdays and Sundays, working 12-hour shifts. A back-up call team is available during off-weekend hours and nights for cases of concurrent emergency procedures.
Do you have flextime or multiple shifts?
Yes, we have team members who work 8-hour, 10-hour, and 12-hour shifts, starting at multiple times to help with better utilization of work time.
Has your lab recently undergone a national accrediting agency inspection?
Over the last 12 months, we have been surveyed by the Joint Commission, as well as state and federal health agencies.
Where is your cath lab located in relation to the operating room (OR) and ED?
Our cath lab suite is located on the fourth floor of the main tower on our campus. The operating suite is located on the lower level of the same building, accessible from the cath lab by an adjacent bank of patient care-only elevators.
In October of 2010, we opened a new, state-of-the art emergency department, attached to the south side of our main building. The ED is on the lower level and connects to the main building on that level, as well as via a patient-only-hallway on the second floor.
What trends have you seen in your procedures and/or patient population?
Over the past four years, all procedure volume has shown a net 20% increase, with electrophysiology and ICD procedures leading growth.
What is unique or innovative about your cath lab and staff?
Having a night team and weekend option team helps set us apart. This is beneficial for many reasons. There is no delay caused by waiting for the call team to arrive for acute patients. Stocking and cleaning of the procedure rooms can be completed much more easily and consistently, without accruing overtime. The call burden has been reduced dramatically. Even though staff still takes what we call “back-up call,” the odds of being called in are very minimal. The most important point is the safety aspect it brings. In the past, we have expected our staff to be fully competent immediately after working a full day shift, and being called into the hospital in the middle of the night, sometimes multiple times. Yes, our staff is very competent, but the biggest chance of making a mistake is while being sleep deprived. By rearranging our duties (ACC registry data collection, etc.) to these off hours, it can be done effectively and still be within productivity standards.
Is there a problem or challenge your lab has faced?
Call once was the biggest problem, but has been resolved with the night and weekend option teams. Communication is and probably will always be an ongoing challenge.
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”?
The hospital has 9 counties that we consider our primary referral area, but Springfield is also surrounded by a large, rural community. We have an additional 13 counties that also refer to our hospital. We are also very close to Branson, a popular city for many retirees.