Clinical Editor's Corner: Kern

Small Innovations Can Make a Big Difference: The Role of Staff Initiatives to Drive Efficiency in the Cath Lab

Morton Kern, MD
Clinical Editor; Chief of Medicine, 
Long Beach Veterans 
Administration Health Care 
System, Long Beach, California; 
Associate Chief Cardiology, 
Professor of Medicine, University of California Irvine, Orange, California
mortonkern2007@gmail.com

Morton Kern, MD
Clinical Editor; Chief of Medicine, 
Long Beach Veterans 
Administration Health Care 
System, Long Beach, California; 
Associate Chief Cardiology, 
Professor of Medicine, University of California Irvine, Orange, California
mortonkern2007@gmail.com

Every cardiac cath lab around the world is staffed with hardworking men and women of various backgrounds, experiences, education, and work ethics. Every lab strives to be its best at all times. Each team member has the opportunity (or should have) to contribute to making their lab, “the best that it can be” (forgive my borrowing an expression from our U.S. Army). I have experienced many such opportunities while working in several labs in different areas of the country over the last 30+ years. I am continuously impressed with my team members’ dedication, interest, creativity, and as this Editor’s Page title reads, their “Innovation and initiative”, which certainly can drive efficiency. 

I was prompted to share how very creative our team members can be when one of our nurses recently created a procedural checklist to help with our technical organization, increasing the lab’s turnover time and efficiency. Before I discuss this small innovation, I wanted to review a few other examples of staff initiatives and innovation that we shared in these pages a few years ago.1 
The Backstop and Colored Barrel Syringes

From my lab in the 1990’s, the J.G. Mudd Cardiac Catheterization Laboratory at St. Louis University, we, like most everyone in those days, used hand injections with a multiple stopcock manifold and often drew blood into “waste” syringes which we emptied (squirted) into a bowl on the back table. Some team members were more careful about splashing the bloody contents than others, but in a hurry, almost anyone could make a mess, sending spray all over the place. We put gauze into the waste bowl to minimize the splash, but this hardly worked. My head nurse, Mr. Rob Roth, came up with a brilliant idea. Rather than squirting the contents into an open bowl even if filled with gauze, why not make a closed container with a hole in the top to capture all the spray? He built a prototype splash catcher and from that idea, Merit Medical designed their version, called the BackStop, now copied and used widely around the world. A brilliant, simple, innovative, and safe technique and example of staff innovation. 

Another of Rob’s innovative ideas came about after I grabbed an unlabeled syringe from the back table with what looked like saline. I couldn’t immediately understand why the patient’s heart rate and blood pressure should shoot up after flushing the Swan catheter, but I quickly realized that the presumed saline syringe actually had diluted epinephrine (we used it for a hypotensive event). The medicine syringe was not clearly labeled. This event would not occur today, since the Joint Commission wisely requires that all syringes have labels of their contents, regardless of whether it is a drug or just saline. I asked Rob how we can quickly scan the back table to know what syringes contain a specific medications, whether nitroglycerine, etc., or just saline flush syringes. Rob suggested we get color rings to fit over the barrel of the syringe, the color coded to the medication. This was a great idea which was further improved upon again by Merit Medical’s CEO, Fred Lampropolis, who brought the first prototypes of crystal clear plastic syringes with a brightly colored plastic plungers. There was no mistaking what was in these syringes. The company later printed the names of different medications on the syringe to further reduce errors. I marveled at another simple, brilliant, and innovative solution to a common problem in the lab. 

Other Innovations

A complete listing of such small innovations that have improved cath lab flow or operator effectiveness must be enormous. In the field of interventional cardiology over the last 3 decades, we have all seen innovations, many of which came from suggestions from the cath lab staff, that helped develop new catheters, stents, balloons, injectors, novel atherectomy devices, thromboaspiration devices, and a family of equipment for radial procedures, to name just a few. Many of these innovations were substantial improvements, while others faded over time, as we should expect in such an evolving environment. I’ve listed a few innovations that came from the nurses and technologists who worked with me over the years. Some of these innovations now reside in the historical records of the obsolete or unknown, but serve to show how we did catheterization over the last several decades. Other initiatives and innovations have survived to this day, with the rare few being commercialized for all to use (Table 1). 

The Procedure Equipment List – Simple but Effective

Most recently, the innovation and initiative of my cath lab team in the VA Long Beach was demonstrated by Ms. Lynn Derocco, RN, providing a list of needed procedural equipment. This list helped our team with better procedural organization, speed, and efficiency. The list (Table 2) makes it possible for both new and old staff members to gather what’s needed for both routine and specialized procedures rather than have to memorize and recall what is needed or wait to have the operator request the routine gear and have it pulled off the shelf piecemeal. While this concept is not new and in fact may be in place already in some labs, it was new to us, and we found it helpful and innovative (at least to me). I’m sure you’d agree that we should applaud and encourage such initiatives. 

The Bottom Line

Through each team member’s ability to see what’s needed and apply their energy to small innovations and personal initiatives, the lab will continue to be the marvelous operating theater it is, in which all participants enjoy working, and sharing common goals and responsibilities to produce the safest and best results for our patients.

References

  1. Kern MJ. New ideas from cardiac cath lab staff. Cath Lab Digest. 2008 Apr; 16(4). Available online at http://cathlabdigest.com/articles/New-Ideas-Cardiac-Cath-Lab-Staff. Accessed January 25, 2017.
  2. Roth R, Akin M, Deligonul U, Kern MJ. Relationship of different radiographic contrast media viscosity to flow through coronary catheters of similar internal diameters. Cathet Cardiovasc Diagn. 1991; 22: 290-294.
  3. Roth R, Modrosic K, Brown M, Kern MJ. Initial experience with a new compression device for hemostasis after femoral arterial puncture. Cathet Cardiovasc Diagn. 1992; 26: 241-244.
  4. Fox K, Roth R, McIntosh T, Kern M, Thomas M. Initial clinical experience of a novel device (the “Friend catheter”) for local anesthetic delivery around indwelling arterial sheaths. J Invas Cardiol. 1998; 10: 12-16.
  5. Kern MJ. Technical pearl: streamlining the Swan. Catheter Cardiovasc Interv. 2007 Jul 1; 70(1): 160.
  6. Kern MJ. The Armen glove for radial access prep – a better way. Cath Lab Digest. 2010 May; 18(5). Available at http://www.cathlabdigest.com/articles/The-Armen-Glove-Radial-Access-Prep-%E2%80%93-A-Better-Way. Accessed January 25, 2017.

Disclosure: Dr. Kern is a consultant for Merit Medical, Abbott Vascular, Philips Volcano, ACIST Medical, Opsens Inc., Boston Scientific Inc., and Heartflow Inc.