Cath Lab Digest

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?