Cath Lab Digest

Meet the Cardiac Catheterization Lab team at Forbes Regional Hospital in Monroeville, Pennsylvania.  Formed from a blend of diverse community labs in the Pittsburgh area in 2008, the team soon learned the necessity of collaboration as the new facility transformed patient services from diagnostics only to a comprehensive heart and vascular center; essentially moving from community-based to tertiary care. With everyone pitching in and learning as circumstance demanded, the team coalesced around a strong belief in accreditation to drive best practice.  

“Accreditation puts us on a path to drive best practices in our institution,” says Dan Oslowski, Manager of the Cardiac Catheterization Lab. “We chose Accreditation for Cardiovascular Excellence (ACE) because of their collaborative nature; we felt their program was appropriate for us,” he continues. “Other accreditation bodies take a global look. ACE is singularly focused on the quality of the cath lab and PCI, legitimizing your cath lab processes.”

How ACE Accreditation Works

Step 1: Preparation for Online Application

After acquiring three other accreditations (Stroke Certification, Heart Failure Certification, and Chest Pain Center Certification), the cath lab at Forbes Regional Hospital decided to obtain ACE accreditation in April 2012. They first reviewed requirements and processes from the ACE website, then secured administration’s approval, noting that the price of service was never an issue. Dr. Paul Kleist, Quality Director for the cath lab, said, “Our market is very competitive. We can advertise our accreditation credentials which other hospitals nearby cannot. We feel this gives us a competitive edge.”

Carolyn (Carrie) O’Leary, Clinical Research Coordinator, printed off the requirements and noted that the summary was quite thick. “When I first looked through, I thought, ‘Oh my goodness’; it just seems a little overwhelming at first, but as you go through it, you realize it’s not. Most of the requirements are processes we’re already doing and we only needed to tweak some of them. We felt it was something we could do.” Forbes Regional agreed that the process would be a multi-disciplinary approach and the effort had to pool from different departments such as Biomed, Medical Records and Admissions. “You definitely need physician approval and buy-in, because some modifications and changes will affect them,” states Ms. O’Leary. “We had the backing of Dr. Aashish Dua and Dr. Kleist, our medical and quality directors, because they realized we were working to do the best thing for the patient.”

Once buy-in from the team was secured, the ACE accreditation process began. Responsibilities were assigned and everyone met once a week to report progress, verify criteria and determine next steps: whether to work with an existing protocol or develop a new process. “Everyone gave their knowledge and special skill set to support the accreditation process,” confirmed Ms. O’Leary. “It couldn’t have been achieved without the team approach. Our collaboration with ACE accreditation was the catalyst that created a cohesive, blended culture that focused on key quality indicators. We used the process as a springboard to make ourselves better before receiving accreditation.”   

For example, the cath lab realized that the existing radiation exposure tracking plan needed to be adjusted to conform to current quality protocols. “Prior to our accreditation process, we would measure and record fluorodose exposure by time only. ACE requires a total dose to be recorded in mGy as well as DAP measured in microGym2.  We changed our policy to include more stringent warning levels and follow-up procedure. It’s a team effort that requires the attention of the physician, scrub, circulator and person on the monitor. This change drives increased awareness and improved patient safety,” said Ms. O’Leary.  

“Another procedural change we took dealt with the contrast-induced nephropathy (CIN) score,” notes Mr. Oslowski.  “We did the standard things that most cath labs do: we hydrated our patients before the procedure and if they had an elevated creatinine, we might start them on a bicarb. But we didn’t have a policy for that and that was one of the ACE requirements. The medical director of our cath lab, Dr. Dua, created a process to evaluate every patient admitted to the lab to get a CIN score. Depending on this number, we would call a physician and start the patient on bicarbs sooner; we would implement this an hour before starting the procedure. Now every patient gets a CIN score to determine optimal care. Our pre-procedural pause now includes the CIN score, maximum dye load that the patient should receive, and their serum creatinine clearance. The result is greater attention to issues and concerns, and makes the procedure safer for patients.” This amended practice “is based on an integrated team approach of highly skilled care delivery, and ensures the safety and comfort of our patients,” confirms Dr. Dua.