The Key Steps of a Cardiac Cath Lab Operational Assessment
In today’s economy, getting the most value from your cath lab, in terms of operational throughput, human capital, and patient and physician satisfaction, is crucial to survival in the increasingly competitive market for cardiovascular services. In the case of a growing or expanding program, understanding the complex workings and interrelationships within the cath lab setting is especially important to future success. The cath lab is a unique environment, with staff working elbow-to-elbow with the cardiologist in a collaborative setting to provide care in an often intense clinical situation. Ensuring that a cath lab is operating efficiently and effectively, while also providing the highest quality care, is not always easy.
In order to maximize teamwork, we recommend performing a detailed, comprehensive operational assessment. This assessment can be an invaluable tool for creating a competitive edge in terms of clinical outcomes, operational efficiency and/or financial performance. In any assessment process, it is important to first understand the baseline performance. Key steps must be taken to evaluate the program from start to finish in order to define areas of outstanding performance and also those that could use improvement. Despite the industry-wide focus on quality and the endless quest for ‘best practice’ at all hospitals, implementing change can be difficult (sustaining change can be even more of a challenge!).
Consider a Neutral Third Party. A thorough assessment of operations can be performed internally, though the process is best completed with a neutral third party. Often, an external consultant is needed to make the “tough” recommendations and bring fresh ideas to the table for improvement and/or change. An example of a simple problem that often involves strong recommendations is related to on-time case starts. In our experience, most cath labs struggle with this issue (particularly with the first case of the day and on-time starts for those to-follow cases), and sustainable solutions can be elusive. A root-cause analysis can bring hard data to what often becomes ‘finger-pointing’ between staff and physicians, or between the cath lab and the patient care areas. Another area of stress in cath lab operations that requires tough decisions is associated with on-call for staff. This is a particularly difficult issue for cath labs that are moving from diagnostic-only care to interventional services, and can be the basis of burn-out and employee dissatisfaction in busy interventional labs that are not well managed. These issues and other operational parameters need to be explored as part of the assessment.
Key Assessment Steps
Step 1. A physical tour of the cath lab and related areas is often a great place to begin to understand your cath lab’s baseline operations, and identify areas of strength and those that need some attention. Taking a patient’s perspective from facility entry points such as outpatient or emergency room entrance areas can start the patient flow evaluation process. For example, pay attention to signage while mapping the patient path. Are the signs easy to read? Do they include multiple languages, if applicable to your patient population? Can patients easily navigate from one destination to the next within the cardiovascular care continuum? These and other questions, along with interactions with the various staff and communications with other departments, can provide valuable information about daily operations.
Step 2. Interviews with cardiovascular department leaders, cardiologists, cardiovascular surgeons, anesthesiologists and other key physicians is the best next step. During the interviews, open-ended questions enable the interviewee to provide insight with more than a simple ‘yes’ or ‘no.’ This interview process can serve multiple purposes. Clearly, an understanding of operations is the focus, but the interviews can be a vehicle to also gather market intelligence. It can be important to find out what drives the physicians to practice at your hospital, how you measure up to other hospitals where they practice, and why they may refer cases to one or the other. Find out what the likes and dislikes are which relate to their patients and work flow. Often, from this dialogue, a S.W.O.T. analysis (Figure 1) can be created that allows the organization to classify findings in a way that can be shared with key constituents.
Step 3. A cardiovascular data query is another vital step in the process of evaluation. There are a variety of cardiovascular data sources — both financial and quality-related — which can provide detailed clinical and financial outcomes information. Examples of databases are the American College of Cardiology National Cardiovascular Data Registry (ACC-NCDR), STS (Society of Thoracic Surgeons) or others in which the hospital participates to gain access to national and regional benchmarks. We have found that most hospitals are rich in financial and clinical data, but the challenge is that it often resides in disparate systems, which need to be mined and aggregated to create a clearer picture of performance.
Open discussion in team meetings about cath lab data such as volumes, outcomes, quality and financial perspectives can set the stage for making improvements in the service line.
Patient, staff, and physician satisfaction data opens insight into another variety of workable items as well. We advise organizations to become familiar with the National Patient Safety Goals and other national or state regulatory requirements for patient care areas to ensure the cath lab is compliant.
Discussions with the team must be followed with a clear written plan with accountable parties and time frames for resolution identified.
Step 4. It is essential to review the financial data from coding and billing for the cath lab department by comparing charges to billing. Are there outliers with charges missed? Are there discrepancies between physician documentation and the coded procedures? It is also crucial to determine if the chargemaster has been updated with all the latest codes and procedures being performed in the cath lab, especially during times of change in the Centers for Medicare & Medicaid Services’ inpatient prospective payment system (IPPS).
Step 5. Another important element to assess (which may also come out in Step 2) is how patients are scheduled and if it works efficiently for the cardiologists, patients, and cath lab staff. Is there a holding area for staging patients pre- and post-procedure? If so, does it cover the cath lab sufficiently with staffing and hours of operation? Identifying the cause of extended turnaround times or procedure delays can put emphasis on a solution for time management improvement.
After synthesizing all the information, a multidisciplinary team meeting on a frequent schedule with a physician champion will be beneficial to develop an action plan based on the assessment. Together, the team can find workable solutions to address each problem area.
Overall, an operations assessment creates a baseline for efficiency, and can identify areas needing quality improvement or process improvement. All stakeholders, including patients, hospitals and physicians, can benefit from the findings. And while initiating change internally can be difficult, a third party can help bring the tough issues to the table for discussion and resolution. Often, a “that’s the way we’ve always done it” mentality can hinder necessary change. Bringing new perspectives, altered thinking and fresh ideas can be an exciting and rejuvenating process. Strong leadership from the management team and physicians is crucial in setting the tone for the assessment and acceptance of recommended actions.
To meet the industry need for these important evaluation services, Corazon has combined operational assessments with an evaluation of the financial aspects of cardiovascular program performance in our CORE product (Corazon Operations and Revenue Evaluation). For more information, call (412) 364-8200.
Jayne Kulp is a Senior Consultant with Corazon, offering heart and vascular program consulting, recruitment and management resources. To reach Jayne, call (412) 364-8200 or email firstname.lastname@example.org.