Cath Lab Digest

We have the Prucka CardioLab (GE Healthcare), the Carto XP Navigation and Ablation System (Biosense Webster), Stockert RF generator (Biosense Webster), and the Thermocool Ablating System in EP. For our EP/implant clinical documentation and all ACC-NCDR database information, we use the Apollo Advance (Lumedx, Oakland, CA). Our digital live archival system is by Heartlab (An Agfa Company, Westerly, RI). For coding, we use ProVation® MD and Fusion (ProVation Medical, Minneapolis, MN) for our cardiologist dictation system (Jewish Hospital is the beta site for ProVation MD). We use the Witt system (Philips Medical, Bothell, WA) for hemodynamics and clinical data.

How is coding and coding education handled in your lab? How is coding communication handled with the billing dept.?

Coding is handled by the tech/supply manager who takes care of the chargemaster and servicemaster. The facility has CodeCorrect (Yakima, WA) to help with coding questions through patient accounting.
The appropriate staff attends seminars and there are patient accounting team members who assist with all coding.

How does your lab handle hemostasis?

We use vascular closure devices, such as Perclose (Abbott Vascular, Redwood City, CA) and Angio-Seal (St. Jude Medical, Minnetonka, MN) in the lab. The SyvekPatch® Marine Polymer Technologies, Danvers, MA) or manual pressure is used in recovery.

Does your lab have a hematoma management policy?

Yes, we of course apply manual pressure to obtain hemostasis. Our lab also has a reporting mechanism called the Hematoma Tracking form, that records such information as the physician involved in case, devices used for hemostasis, etc.

How is inventory managed at your cath lab? Who handles the purchasing of equipment and supplies?

The Pyxis system (Cardinal Health, San Diego, CA) is utilized for storage and inventory of supplies. The Lawson system (St. Paul, MN) is utilized to order equipment for purchases. Our director takes care of capital equipment, which is submitted in the budget and taken to a committee. Working with the cardiology department, the cath lab management determines physician needs and decides which products are stocked based on utility and pricing.

Has your cath lab recently expanded in size and patient volume, or will it be in the near future?

We will be expanding with the arrival of Stereotaxis equipment and procedures (St. Louis, MO). We have also seen a 15% increase in interventional procedures from last year.

Is your lab involved in clinical research?

Yes, our lab is involved in several research studies, some of which include:

SPIRIT III: a large-scale pivotal clinical trial comparing Abbott Vascular’s Xience V everolimus-eluting stent to Boston Scientific’s Taxus® paclitaxel-eluting stent;

SPIRIT IV: evaluating the safety and efficacy of Abbott’s Xience V Stent System for the treatment of coronary artery disease in a more complex U.S. patient population;

TRITON TIMI-38: a multi-center randomized trial in patients with acute coronary syndromes undergoing percutaneous coronary intervention comparing the platelet inhibitor CS-747 with clopidogrel (sponsored by Eli Lilly).

Have you had any cath lab-related complications in the past year requiring emergent cardiac surgery?

Yes, our most recent ACC data shows a 0.625% rate of emergency CABG.

What other modalities do you use to verify stenosis?

We use angiography, the FloWire® (Volcano Therapeutics, Rancho Cordova, CA), PressureWire (Radi Medical Systems, Wilmington, MA), intravascular ultrasound (IVUS), and hemodynamic pressure gradients. On one hand, it has somewhat decreased our revenue, but on the other, many patients and physicians come to our facility versus other facilities due to our expertise with this equipment.

What measures has your cath lab implemented in order to cut or contain costs?

Employees have directed time off during slow periods. We have also involved physicians with purchasing decisions and made them aware of pricing. We have started price transparency in our department.

What types of quality control/assurance measures are practiced in your cath lab?

In addition to using AVOX and Accuchecks, we track door-to-balloon times, hematoma rates and submit data to the ACC-NCDR database.

How does your cath lab compete for patients?

Jewish Hospital has formed alliances with five area hospitals: Clark Memorial Hospital, Sts. Mary & Elizabeth Hospital, TJ Sampson Hospital and King’s Daughters Hospital. We are also developing more and stronger physician relationships.

How are new employees oriented and trained at your facility? What licensure is required for all professionals who work in your lab?

New employees are mentored with team members of specific disciplines or areas of expertise. Licensure is required for RN and RT(R). CVT and RT(R)(CV) are not required.

What types of continuing education opportunities are provided to staff members?

Continuing education opportunities are available through education for RNs, CEUs provided by various vendors and opportunities for team members to attend meetings, such as TCT (Transcatheter Cardiovascular Therapeutics) and the annual Heart Rhythm Society meeting.

How do you handle vendor visits to your lab?

Vendors are allowed on a daily basis or on a rotating schedule, depending on their product line. Pharmacy vendors are allowed one day of the month. They check in with central supply and obtain a badge. Vendors must wear their company nametag onsite. Vendors who plan to have patient contact must have current TB test results and company information on file. They are allowed in-room only if asked by the physicians.