Pinnacle Health Hospital

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Imaging Quality & Our Purchase of ACIST
Just before we considered purchasing the ACIST Contrast Management System (CMS), Pinnacle was evaluating 4F diagnostic catheters. It was suggested that we try the ACIST system for more consistent visualization of the coronary arteries during procedures. The Medical Director and the Invasive Cardiology Director pursued the issue of using smaller catheters, and after trialing the ACIST CMS, we presented a proposal to the Finance Department.

The Implementation Process
We trained numerous staff members over a 3- to 4-week period, and also identified people from the lab who were comfortable troubleshooting the system. The actual learning curve for all staff averaged 4“5 weeks, although those who were comfortable troubleshooting learned the system much more quickly. Throughout, the ACIST customer support has been excellent.

Tips for ACIST CMS Implementation. Cath labs considering the ACIST CMS should approach the implementation process proactively, learning about the system before delivery and utilizing the company technical support (on-line or on-site) as much as possible. We had very good training support from ACIST throughout the process. We did encounter some setup problems with regard to contrast viscosity and how to set the appropriate dials to get optimum pictures, but these were quickly resolved with technical support. There may be additional ways to shorten the learning curve, possibly by training more point people up front. Communication is always the key!

Benefits. Since we implemented the ACIST CMS, the scrub tech stands further away from the x-ray tube, resulting in decreased radiation exposure. Implementation of the CMS system also alleviated a staffing issue by freeing up the scrubber to focus on other issues during the procedure. Once staff became comfortable with the ACIST system, positive support grew for use of the device.

We have found that our cardiologists like the system because of its:

1. Ease of use;

2. Optimum 4 Fr visualization;

3. Less radiation to staff;

4. Reduced contrast usage;

5. Reduced case times;

6. Reduced bed rest and increased unit throughput.

Procedural Advantages: ACIST & the Isovue Multipack®
The Medical Director and the Invasive Cardiology Director did the research on the Isovue 300 Multipack and thought it would also be advantageous to evaluate.

We switched to Isovue 300 mainly because of the cost savings. We were using Visipaque at the time (Amersham Health, Princeton, NJ). Image quality is definitely comparable between the two agents.

Bracco Diagnostics (Princeton, NJ) is the only company which offers a 500ml Multipack, which decreases our inventory. At the end of the day, we waste less contrast.

We have documented monthly statistics for our use of the Isovue Multipack. These statistics showed a downward cost trend in our contrast subaccount.

Between Procedures. Turnaround time between cases has been reduced, since we have eliminated the loading and unloading of an injector, and also the task of hanging contrast between every case.

During Procedures. Pinnacle has noticed less contrast waste and exceptional images. During a procedure, the normal process of loading injectors has been eliminated, and we use the Isovue 500ml Multipack contrast bottle, which helps a little in turnaround between cases as noted above.

Overall, we have noted reduced contrast use, improved picture quality/visualization, and by consistently using 4 French catheters with the ACIST CMS, we routinely ambulate within 1“2 hours, which in turn increases patient satisfaction. We have seen improvement in throughput of our processing unit due to reduced recovery times without added costs of closure devices.