Cath Lab Digest

Coding is managed by our coding department, with collaboration and review by the nurse manager, coder and finance. The cath lab staff is very involved in the charging process and reviews charges daily.

How does your lab handle hemostasis?

In our lab, we do use vascular closure devices such as Perclose (Abbott Vascular) and Angio-Seal (St. Jude Medical). When manual pressure is required, we use the SyvekPatch (Marine Polymer Technologies, Danvers, MA), and the TR Band is used for radial procedures. Post-procedure patients are managed for 15 minutes in cath lab before being transferred to critical care or a stepdown unit. Outpatients are recovered in the holding area prior to being discharged home. At times, we employ a FemoStop device (St. Jude Medical), usually for intra-aortic balloon pump (IABP) removal or persistent bleeding.

What is your lab’s hematoma management policy?

If a hematoma is noted, manual pressure is applied. Once hematoma is controlled, the size is documented along with distal pulses and assessment data. High-risk patients are transferred to critical care for further monitoring.

How is inventory managed at your cath lab?

We currently utilize the Pyxis system (CareFusion, San Diego, Calif.). Purchasing of equipment and supplies involves a physician and the manager to present new items to the hospital’s Products Committee for review and approval. Staff monitor inventory levels and communicate with materials management, who reorder supplies.

Has your cath lab recently expanded in size and patient volume?

Volume has slightly increased and we are seeing more critically ill patients than in the past. We do plan to add an electrophysiology (EP) program.

Is your lab involved in clinical research?

Not at this time.

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

Our average emergent cath-related complication rate is less than 1%.

Can you share your lab’s average door-to-balloon (D2B) times and some of the ways employees at your facility have worked together to keep D2B times under the mandated 90 minutes?

Our current door-to-balloon time average is 63 minutes. MRMC’s D2B goal was lowered to 75 minutes in July 2009. MRMC is an accredited cycle III chest pain center with percutaneous coronary intervention (PCI). The chest pain center committee, which includes front-line staff and managers from the ED, emergency medical services (EMS), cath lab, pharmacy, lab, cardiologist, ED physicians, air ambulance, quality assurance, Mended Hearts volunteers (www.mendedhearts.org), and the hospitalist group, meets monthly to discuss metrics, case reviews and opportunities for improvement. MRMC paramedics call ST-elevation myocardial infarctions (STEMIs) from the field and activate the cath team and cardiologist. The ED has a STEMI kit that contains all supplies and medications to expedite the care of the STEMI patient through the ED to the cath lab. The ED also has a red STEMI folder that has the four forms needed by everyone. ED, EMS and cath lab staff participates in mock drills throughout the year to look for areas of improvement. Our chest pain center coordinator is a resource for the surrounding city hospitals and EMS. She follows all STEMI patients and reports back to the transferring facility and EMS. These are just some of the tools that have been instrumental in helping us achieve our goals, decrease our D2B times, and provide excellent care to our patients.

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

We are continuously evaluating our procedure codes and charges. We work with our materials management to keep supply cost down. Nurse auditors review our charts for correct codes and charges. All procedures are reviewed to determine revenue compared to cost. This information is shared with physicians along with cath lab financial updates. Staffing productivity is also monitored closely. Cost containment is implemented when volumes are low.

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

The STEMI program or D2B time core measure is our most aggressive quality measure.
The department also participates in an outpatient surgical infection quality measure for pre-procedural antibiotic administration.

Maury Regional Hospital has also been awarded the Bronze Performance Achievement Award for heart failure by the American Heart Association.

The lab participates in American College of Cardiology (ACC) National Cardiovascular Data Registry for cath, PCI, and defibrillator data collection and analysis.

Outpatients receive a follow-up phone call to check recovery status and ensure they understand discharge instructions.

The staff rounds on inpatients to assess access sites and answer any post procedural questions.

Inpatient MI is also being reviewed. We utilize a CAT (Critical Access Team) for inpatient chest pain.

How does your cath lab compete for patients? Has your institution formed an alliance with others in the area?

Maury Regional Medical Center is an Accredited Chest Pain Center.
The hospital has been recognized with the following awards: