Sutter Medical Center - Sacramento
- Posted on: 6/19/08
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Does your lab perform elective cardiac interventions?
Yes, we perform elective cardiac interventions. As a tertiary referral center, many of our patients are referred to us from both Sutter and non-Sutter facilities throughout the greater Northern California, southern Oregon, and western Nevada areas.
In addition to our Holding Area, Sutter Medical Center has an 11-bed cardiovascular interventional unit (CVIU), where the majority of our post-PCI patients are cared for. Having this specialized unit has helped our throughput for our interventional patients. On the CVIU, the nurse-to-patient ratio is 1:3, allowing these nurses to closely monitor for early complications, manage sheath removal, provide detailed patient and family teaching, while attending to other patient care needs.
Have you had any cath lab-related complications in the past year requiring emergent cardiac surgery?
Our rate of acute complications requiring emergent cardiac surgery is well below national benchmark. We attribute this to the expertise of our interventional cardiologists and the training and skills of our exceptional nursing and technical staff.
What measures has your cath lab implemented in order to cut or contain costs?
We have many initiatives in place to control costs. Ninety percent of our interventional devices are consigned, including all pacemakers, ICDs, stents, balloons, and guiding catheters. We also have a rigorous procedure in place for negotiating costs up-front, including establishing a one-price level for our stents (except drug-eluting), balloons, and guiding catheters for coronary and peripheral vascular products. Our Materials Management Coordinator carefully tracks the cost of daily supply orders in a spreadsheet, which is benchmarked against our monthly supply budget. This gives us a daily view of what we're spending and how it stacks up against our budget. We also have a rigorous process to ensure accurate, and appropriate, charge-capture, so supplies aren't missed.
How is coding and coding education handled in your lab? How is coding communication handled with the billing dept.?
Procedural coding information is built into our MacLab Hemodynamic System. During procedures, the procedures/codes are selected by the CVT and print out on the report. Procedural codes for each procedure are verified on a daily basis. This information is then sent to our Central Billing Office for processing.
What type of quality control/quality assurance measures are practiced in your cath lab?
In addition to the routine daily equipment quality control, review of turn-around times, compliance with current history and physicals and pre-sedation assessment regulations, we collect and submit data to ACC, STS, and NRMI. In 2005, we plan to begin submitting data to the CRUSADE database as well as implementing the American Heart Association's Get With the Guidelines. We routinely gather patient satisfaction information from our patients and share this information with staff and other departments as needed.
How does your cath lab compete for patients? Has your institution formed an alliance with others in the area?
Sutter Medical Center-Sacramento is an affiliate of Sutter Health. The Sacramento region is a unique market, in that it is predominately managed care. There are five hospitals within the Sutter Sacramento-Sierra region and our campus provides tertiary cardiac catheterization and open-heart surgery services for these hospitals, as well as several other smaller, non-affiliated hospitals in the region. Physicians and cardiologists who work with Sutter Health have outreach programs in the rural areas and refer patients in for services when necessary. Additionally, the Sutter Specialty Network markets our services to area physicians and hospitals.
How are new employees oriented and trained at your facility? What licensure is required for all professionals who work in your lab?
The SMCS cath lab hires RNs, CVTs, and RTs. The CVTs may have Radiological Technologist licensure, LVN licensure, or Respiratory Therapy licensure. All RNs and CVTs are required to have ACLS. Invasive RNs are also required to be PALS-certified. CVTs are also required to be RCIS-certified. The EP technologists and the EP RNs are required to be NASPE-certified. RCIS and NASPE certifications must be obtained within two years of hire. Some of our nurses are also CCRN-certified.
In addition to hospital orientation and nursing orientation for RNs, newly hired staff are assigned a primary preceptor who guides their orientation experience. Our orientation plan is based on the 2002 recommendations from the Society of Invasive Cardiovascular Professionals (SICP). Each newly hired staff member is given a detailed orientation checklist to complete with their preceptor. Like many cath labs in California, we currently use traveling staff, both RNs and CVTs, and they complete the same checklist as our core staff members.
Orientation is tailored and individualized, depending on the staff knowledge level and previous clinical experience. Ongoing conferences are held with the staff member, their preceptor, the clinical nurse specialist, and the director to review progress and provide feedback. During their orientation period, the newly hired staff person shadows their preceptor and works the same schedule, though they are not expected to be on-call or work after-hours until their orientation is complete.
What type of continuing education opportunities are provided to staff members?
Sutter Medical Center-Sacramento and Sutter Heart Institute provide ongoing educational opportunities appropriate for the cath lab professional. Sutter Heart Institute holds several meetings each year: Cardiovascular Medicine/Surgical Update, Arrhythmia Update, and Cardiovascular Nursing, which are open to all interested staff throughout the hospital and region. We also have access to the Continuing Education Consortium, a regionally-based education program which provides courses such as "Cath Lab and Beyond,” a 35-contact-hour program designed for the new cath lab professional, as well as arrhythmia interpretation, basic and advanced hemodynamics, and various critical care topics. BLS, ACLS, and PALS is provided by the hospital to all staff that are required to take it for their jobs.
How do you handle vendor visits to your lab? (Are they allowed in the cath lab at any time? Badges? Limited times or areas? Etc.)
Vendor visitation is coordinated by our Materials Management Coordinator and our current policy was developed by our System Procurement process. Vendors are permitted to visit once monthly, unless there are special circumstances, such as extended rollout of new products that required extensive physician/staff training. They are required to be badged and are set up in the cath lab hallway where they can interact with staff and physicians. They can be present in the procedure room only at the request of the physician.
How is staff competency evaluated?
Ongoing competency assessment is done and is reflected in annual performance reviews. New this year is the addition of quarterly skills labs, where hands-on training and competency assessment with various procedures, equipment and devices is assessed. Stations we have completed to date include AngioJet, ICE, WaveWire, intra-aortic balloon pumping, carotid stenting, and sterile technique. Future stations will include procedural sedation, IVUS, and Rotoblator® (Boston Scientific Corporation, Maple Grove, MN).
Does your lab utilize any alternative therapies (such as guided imagery, etc.)?
At this time, we do not use any of these techniques.
How does your lab handle call time for staff members? Is there a particular mix of credentials needed for each call team? Do you have flex time or multiple shifts?
On a typical workday, we will have 20-25 staff members working. Our routine hours for procedures are Monday through Friday, 0730 - 2130. We have overlapping 8-hour shifts, with staff arriving at 0600, 0700, 1200, and 1300. After hours, weekends, and holidays are covered by a 4 person 'on-call' crew. Currently, staff are on-call one week night per week and every 4th - 5th weekend.
What trends do you see emerging in the practice of invasive cardiology?
We see the volume of our interventional procedures increasing and expanding to include more peripheral work, including carotid stenting. We have also seen a tremendous growth in our electrophysiology/device volume. There are 7 electrophysiologists who have privileges in our lab, so we expect this trend to continue.
Has your lab has undergone a JCAHO inspection in the past three years?
We just successfully completed JCAHO review in late August/early September of this year. To prepare for this, we developed a core team of unit experts from our Holding Area and the procedure rooms who were key supporters for the process. Specific areas of interest to the surveyors were staff training and competency, sedation practices, and medication management.
Where is your cath lab located in relation to the OR department, ED, and radiology departments? If you could choose one department to be adjacent to, which would it be?
At our facility, all of these departments are located on the first floor and are within close proximity to one another, which is very convenient for patient flow. The clinical laboratory is in close proximity also. We are presently in the Master Planning phase of designing our new hospital, which will open in late 2009.
Please tell the readers what you consider unique or innovative about your cath lab and its staff.
The uniqueness of our lab centers around our mix of pediatrics and adults. We have four pediatric interventional cardiologists, 1 pediatric electrophysiologist, and more than 50 adult cardiologists and electrophysiologists. While this is challenging at times, it provides the staff with a wide range of experience. There's never a dull day in our busy lab, because of our mix of diagnostic, interventional, multiple clinical trials, EP, device implants, cardioversions, tilt tables, and pediatric cases.
Is there a problem or challenge your lab has faced? How it was addressed?
As with many labs in California, the shortage of RNs and cardiovascular technologists is one of our biggest issues. We are using some experienced traveling staff to supplement our teams while we continue to aggressively recruit RNs and CVTs into our lab.
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?