Cath Lab Spotlight

Spotlight: Emory University Hospital Cardiac Cath Lab

Nancy Sarpong, BSN, EUH Nurse Manager, Atlanta, Georgia

Nancy Sarpong, BSN, EUH Nurse Manager, Atlanta, Georgia

Nancy Sarpong, BSN, EUH Nurse Manager, can be contacted at nancy.sarpong@emoryhealthcare.org.

Emory University Hospital, known as the flagship hospital within the Emory Healthcare system, is a 587-bed acute care facility located in Atlanta, Georgia. Emory Healthcare is the largest and most comprehensive health care system in Georgia, and is comprised of six hospitals and 200 provider locations, with over 1,800 physicians in more than 70 specialties. Emory University Hospital dates back almost a century, and is highly decorated with many accreditations and accolades, including Magnet center for excellence in nursing and Mission: Lifeline Chest Pain Center, and has been designated as one of “America’s Best Hospitals”. Emory is proud to be one of the leading academic healthcare systems in the nation. Recently, Emory University and Emory University Hospital Midtown both became accredited by Accreditation for Cardiovascular Excellence (ACE), making us the second and third accredited cardiac cath labs in Georgia. We work within a health care system that is rich in history, research, innovation, and excellence. Emory is considered the birthplace of modern interventional cardiology.

In 1980, Dr. Andreas Gruentzig joined with Emory’s faculty to vigorously research and refine the intervention known as angioplasty. He directed the angioplasty program at the Emory University School of Medicine from 1981 until his death in 1985. One of the key people to help with Gruentzig’s recruitment to Emory was Dr. Spencer B. King III, who then led the Emory interventional cardiology program after Gruentzig’s passing. The Andreas Gruentzig Cardiovascular Center of Emory University was founded and dedicated in memory of its namesake to continue this legacy of innovation, and to foster clinical excellence in the practice of interventional cardiology. 

Dr. John S. Douglas was the first interventional cardiologist in the United States to perform modern-day angioplasty in 1987, placing the nation’s first coronary stent at Emory University Hospital. Dr. Douglas would later succeed Dr. Spencer King as the interventional program director. In 2011, Dr. Habib Samady became the director of interventional cardiology at Emory and director of the cardiac catheterization laboratory at Emory University Hospital. He has continued to uphold the legacy of innovation and clinical excellence in the practice of interventional cardiology.  A number of seminal contributions to this rapidly expanding field have been made by Emory cardiologists working in the Gruentzig Center. Today, Emory is known worldwide as the premier international training center for angioplasty. To this day, we continue our longstanding tradition of being at the cutting edge of interventional cardiology with innovative techniques and the latest research and technology in order to find even more ways to successfully treat cardiovascular disease by the least invasive means possible.

Tell us about the cath lab at Emory University Hospital.

Emory University Hospital’s cardiac cath lab consists of four labs. We have three biplane labs (Toshiba) and one single-plane lab (GE Healthcare). There is also a single-plane lab (Toshiba) in the Emory University Hospital outpatient clinic. Other Emory Hospitals include Emory University Midtown, which has five labs, Emory Saint Joseph’s Campus, with seven labs, and Emory John’s Creek, with one cath lab. Emory interventionists also serve as medical directors of two affiliated hospital cath labs within the Emory extended network, the Atlanta VA Medical Center and Grady Memorial Hospital, both of which house two labs each.  

At Emory University Hospital, we have 16 clinical staff members. Roughly half are nurses with two critical care registered nurses (CCRNs), and two RNs are currently preparing for registered cardiovascular invasive specialist (RCIS) and CCRN credentials. The other half of our staff members are certified RCIS technologists, with a breakdown of two radiology technologists, two cardiovascular technologists, and three paramedics by background. The majority of our staff members have been in the lab 6-plus years. One employee has been here nearly 30 years. The experience range is 1 to 30 years.

What procedures are performed in your cath lab?  

Our lab is very diverse in its procedures. We have a unique mix of practitioners in the lab. Apart from interventional cardiology, we also work with the structural heart team, adult and young adult congenital, vascular surgery, pulmonologists, heart failure physicians, and general cardiologists. 

Procedures performed in our labs include basic coronary angiography right heart caths, angioplasty, high-risk complex angioplasty, chronic total occlusions (CTOs), alcohol septal ablations, and atrial septal defect, patent formen ovale, and ventricular septal defect closures. Emory has a very busy structural heart program where we perform mitral valve repair and transcatheter aortic valve replacement (TAVR) in the cath lab and in the hybrid operating room (OR), for both research trials and commercial patients. Innovation is a big part of who we are at Emory. We are always open to the idea of change and often do some complex and creative procedures, especially in our congenital heart patients. Pulmonary (Melody, Medtronic) valve implants, and pulmonary vein and artery interventions, are some of the more common procedures we do, but we do also perform some miscellaneous congenital heart interventions. Both vascular surgery and cardiology do a great deal of peripheral angiography and interventions including renal, mesenteric, carotid, and the upper and lower extremities, along with some miscellaneous procedures such as inferior vena cava (IVC) filter placement. 

Research is a huge part of what we do on a daily basis. Currently, we have carved out a niche for Emory through our expertise in intracoronary imaging and physiology, translational research in atherosclerosis science, and coronary biomechanics. We participate in many international, national, and Emory-based research trials. We have the same capability in all three of our biplane labs and anesthesia hook ups in two of the three biplane labs. The Impella left ventricular assist device (Abiomed) and the intra-aortic balloon pump (IABP) are modalities available for our more high-risk procedures.

Can you share your experience with TAVR?

Emory has carried on the tradition of cardiovascular excellence and historical firsts — currently, we are one of the top valve implant sites in the nation. Emory was the fourth TAVR valve research site to be activated in the U.S. (2007). Our TAVR program includes Emory University, Emory University Midtown, and Emory Saint Joseph’s, and to date, we have implanted over 950 valves. This is largely spearheaded on the interventional cardiology side by Dr. Vasilis Babaliaros (co-director of the Emory valve center), a protégé of Dr. Peter Block, pioneer in the world of structural intervention. Dr. Babaliaros also trained in France with Dr. Alain Cribier, the founder of TAVR. This invaluable training has helped to make our TAVR program well known for its success. We have a heart team approach that has dedication from nursing, cath lab staff, cardiothoracic surgeons (co-director of the valve center, Dr. Vinod Thourani), OR staff, anesthesia, echo cardiologists, echo sonographers, and most importantly, our exceptional valve coordinators and research teams. We were the first to utilize transcarotid access in North America, and we perform transfemoral TAVR in both the cath lab and hybrid OR. In our alternative access routes, we perform transapical and transaortic access, and have recently added transcaval to our expertise, all of which are done in the hybrid OR. We take pride in having the largest experience in North America with transfemoral TAVR in the cath lab under moderate sedation (>300 patients) with the majority transferring to a specially trained step down cardiovascular floor, rather than the intensive care unit (ICU). To date, >40 patients have gone home post implant day one with remarkable results. The collaboration has been a large undertaking with a lot of hard work, dedication, cooperation, and experience that appears as an effortless approach to TAVR here at Emory. We continue to excel doing multiple procedures weekly in both the cath lab and hybrid OR. We currently do not have plans for a hybrid room in the cath lab. We continue to push the boundaries of this procedure, finding ways to help those who have been turned away by other centers.

Do any of your centers perform primary angioplasty without surgical backup on site? 

Emory University Hospital, Emory University Hospital Midtown and Emory Saint Joseph’s all have cardiothoracic surgery on site with 24/7 coverage, Emory John’s Creek is in close proximity to Emory Saint Joseph’s.

What percentage of your diagnostic caths is normal?

Our normal cath rate is close to the national average, and this is largely due to our partnership with many transplant services within the Emory healthcare system. Many of the pre transplant evaluations involve cardiac angiography and these procedures are performed at Emory, with most resulting in normal coronary angiography. We also have a very active clinical and research program that evaluates patients with microvascular disease and endothelial dysfunction in patients with angiographically normal coronary arteries.

Do any of your physicians regularly gain access via the radial artery?

We are a radial-first lab, so our physicians do roughly 60% of their cases via radial access. We are also radial first for all ST-elevation myocardial infarction (STEMI) patients that are assessed to be appropriate radial candidates.

Who manages your cath lab? 

Jane Wilson, BSN, MSN, is our unit director. She oversees the administrative management of both cath labs at Emory University Hospital and Emory University Hospital Midtown. Lynn Whelan, PhD, is the associate chief nursing officer for both Emory University Hospital and Emory University Midtown cath labs. Nancy Sarpong, BSN, is the nurse manger for the Emory University Hospital cath lab, managing the daily procedural operations and workflow of the lab. 

Who scrubs, who circulates and who monitors? 

All staff members are fully trained to both scrub and monitor diagnostic cases and angioplasties. Some staff members have had advanced training to scrub structural and TAVR cases. Nurses administer all medication and moderate sedation in the lab.

Are there licensure laws in your state for fluoroscopy?

Currently, there are not any laws in the State of Georgia in regards to fluoroscopy.

Which personnel can operate the x-ray equipment (position the image intensifier [II], pan the table, change angles, step on the fluoro pedal) in your cath lab? 

Fluoroscopy is administered by the physician, whether it is the interventional cardiology attending or the fellow. Table positioning, panning of the table, and camera angles are all a shared responsibility, largely done by the fellows who are in training; however, all of our staff is trained to pan and position the table for basic angles. We do have some staff in the lab that have attended specialized equipment training and are fluent in all advanced equipment applications.

How does your cath lab handle radiation protection for the physicians and staff?

On an annual basis, mandatory radiation safety courses are completed by all physicians and staff. Physicians and staff are all suited with custom-fit lead aprons and thyroid shields. Monthly exposure is monitored with radiation dosimeter badges for all staff, physicians, and any auxiliary personnel that frequent cath lab cases regularly. Individual exposure reports are available monthly and timely updates are received if anyone has had exposure above the standard limits. Our staff and physicians are all very mindful of body shields, fluoroscopy equipment settings, and collimation during cases to help reduce scatter and exposure. Radiation scatter prevention pads are used in cases that are known to be lengthy; as well, many staff members and physicians wear radiation scatter hats and lead glasses. Considering that we have many complex and lengthy procedures, all attempts are made to reduce patient and staff radiation exposure. Protocols are in place for prolonged exposure. Personnel in the room keep the physicians notified of specific 30-minute, 60-minute, and above time stamps, along with Gy readings. Our procedural documentation includes fluoroscopy times and dosages for each case. Any out of range exposure is reported to the radiology quality control department and those patients are then followed for post exposure monitoring. 

What are some of the new equipment, devices and products introduced at your lab lately? 

Emory is very fortunate to have access to many of the modalities and devices that have helped to make interventional cardiology so innovative. All of our labs are fully integrated with intravascular ultrasound (IVUS)/ rotational IVUS/fractional flow reserve (FFR)/instantaneous wave-free radio (iFR) (Volcano) systems. We also have wireless FFR integration in all labs, along with the optical coherence tomography (OCT) Ilumien Optis (St. Jude) system. The near-infrared spectroscopy (NIRS) TVC imaging system (Infraredx) is a more recent modality in our lab. With all of our devices, we support the most up-to-date software and technology. We are often a launch and or test site, especially in the southeast part of the United States, for new equipment and new software for various devices. Our physicians have access to many of the devices, products, and modalities that are at the cutting edge of current technology. 

How does your lab communicate information to staff and physicians to stay organized and on top of change?

Emory does a great job of keeping employees well informed. We all receive inter-hospital email updates, and have an informative and up-to-date internal intranet website. Town hall meetings and information sessions are held for various topics as they arise, and this is something that is done across the health care system. 

Our unit director holds bi-weekly staff meetings. Often during this time, staff will be in-serviced on new products or devices, and any new changes or information pertinent to the lab. We have frequent inter-office email transmission and information bulletin boards in the staff room. With a staff of 16, often verbal transmission of information is an easy, personal, and effective method. 

Our physicians hold a daily early morning meeting to review the cases for the day, discuss interesting cases, films, topics, etc., and then round to see patients that are on our service. Weekly, all of the interventional fellows and attending physicians for both main campuses attend a journal club meeting and an interventional cardiology meeting, giving them time outside of the lab to present further learning opportunities and stay on top of current trends and information. 

How is coding and coding education handled in your lab? 

We have a dedicated coder who has years of valuable experience and knowledge, she stays up to date on all the current and incoming billing and coding changes especially those unique and specific to interventional cardiology and procedures performed in our cath lab. She oversees the billing and coding for both Emory University Hospital and Emory University Hospital Midtown cath labs.

Who pulls the sheaths post procedure, both post intervention and diagnostic? 

Hemostasis is usually achieved by way of closure device or radial compression band, due to the large number of radial cases performed in our lab. All staff members are trained to remove sheaths, and do whenever necessary, as it is a shared responsibility. However the interventional and cardiology fellows pull the majority of sheaths to be removed in the cath lab as part of their training. The nursing staff from the step-down telemetry unit pull a fair number of post intervention sheaths for patients that have been given a room assignment.  

Where are patients are prepped and recovered (post sheath removal)? 

Same-day patients are prepped and consented in the Cardiac Observation Area, which is staffed by great team of experienced critical care and cardiology nurses. Many of the patients that will be discharged return to this area post procedure for monitoring, bed rest, and discharge. In the cath lab, we do have a 4-bed recovery area staffed by a cath lab nurse, where sheaths are pulled and patients that will be admitted to either the telemetry unit or ICU are monitored until their room assignment is ready. Occasionally we will fully discharge patients from this area as well. 

How is inventory managed at your cath lab? Who handles the purchasing of equipment and supplies?

We have a dedicated inventory specialist who handles all purchasing and inventory management. Our computerized monitoring system is such that each case report gives a tally of supplies used for the case so that supplies can be reordered if needed. 

Has your cath lab recently expanded in size and patient volume, or will it be in the near future?

Atlanta is a very saturated market. We have noted that our cath lab volume has not changed, but the types of procedures we are performing have changed. We are doing a great number of structural heart cases, very complex CTOs, and high-risk complex percutaneous coronary interventions. Emory is the go-to place for complexity. We often receive many local, regional, and national patient referrals. Our unique cardiovascular research trials have also brought a large influx of referrals, especially women with coronary microvascular disease, which has become one of our unique areas of concentration.      

Can you share more about your clinical research program?

At Emory, we are heavily involved in research, and in fact, this has become one of our areas of expertise. Our medical director, Dr. Habib Samady, has spearheaded this focus, helping to make us world-renowned for some of the research we do within intracoronary imaging and physiology, translational research in atherosclerosis science, and coronary biomechanics. This research is helping to identify vulnerable coronary segments by evaluating vessel microvascular and endothelial function. Evaluation of our research is showing that arterial wall shear stress is a strong predictor of plaque progression and vulnerability. Currently, this is just one area of research and we are aiming to translate our findings into larger clinical trials. Emory is also the biomechanical core laboratory for the ABSORB III (bioresorbable stent, Abbott Vascular) imaging sub study and we are running the SHEAR STENT multi-center, multinational trial, among other studies. In addition, we do a lot of work with gene typing, its link to atherosclerosis, and cell therapy studies in collaborations with Dr. Arshed Quyyumi. This research is possible due to the hard work, vision and dedication of an exceptional research team. 

Do you use the American College of Cardiology National Cardiovascular Data Registry (ACC-NCDR) or any other outside data collection registry?

We participate in the ACC-NCDR and AHA: Mission Lifeline data registries. Emory University Hospital, Emory University Hospital Midtown, and Emory John’s Creek Hospital earned Silver Recognition from AHA Mission: Lifeline in 2013 for consistency in achieving the First Medical Contact to Balloon (FMC2B) time within the 90-minute target for four consecutive quarters in 2013. Emory University Hospital and Emory University Hospital Midtown also achieved AHA Mission: Lifeline Accreditation in December 2013 for excellence in comprehensive heart attack care, making them the first hospitals in the AHA’s Greater Southeast Affiliate (GA, AL, TN, FL, LA, MS, Puerto Rico) to earn this accreditation. 

Who transports the STEMI patient to the cath lab during regular and off hours?

During regular hours, an interventional cardiology fellow goes to the emergency department (ED) to quickly assess the patient. At times, the nurse manager or charge person goes as well. Then an ED RN and the fellow bring the patient to the lab. The duration of time that a patient spends in the ED during on hours is usually very short, so often we receive patients right off the EMS stretcher. During off hours, it is similar in that the interventional fellow or the interventional cardiologist quickly assesses the patient prior to bringing them to the lab. We have a unique partnership on this campus in which the ED staff will accompany the physician to the lab and assist in prepping the patient while awaiting for all team members to arrive. Having a geographical call schedule, often at least one to two staff members are here when the patient arrives in the lab. If an in-house STEMI occurs, the process is much the same. A physician always goes to see the patient and assesses the situation prior to bringing the patient to the lab.

How does your lab handle call time for staff members? 

We are Mission: Lifeline accredited and as such, we take our D2B and FMC2B times extremely seriously. All staff members are held to a 30-minute response time for all STEMI activations. If activated for an emergency cath, the time frame may vary and will be paged as such. For some reason, if a member of the call team cannot respond or additional help is needed, the back up person is activated and has 45 minutes or less to respond. When constructing a call schedule, we do make it as geographical as possible, meaning there is someone who lives extremely close, one person who lives a bit further out, and usually one person who actually stays in-house, as they are someone who lives further then the 30-minute time zone. We always have at least one nurse on call and the skill mix will vary by way of number of nurses or technologists on call. Newer personnel in the lab are always on call with a more experienced call team.

What do you do when the call team is already busy doing a procedure and a STEMI comes into the ED?

We maintain a four-person call team for weekday and weekend coverage. If a second STEMI occurs while we are still in a procedure, the back up or fourth person is activated. The ED medically manages the patient until the first case is completed. The CCU or ICU team comes to pick up the first patient while the call team starts in an alternate lab with the second case. In a very rare occurrence, a second physician and fellow covering another campus would be called in and the call team would break up into two teams. CCU and the ED both provide great assistance and if necessary, would send a nurse to help.

Are you recording fluoroscopy times/dosages? 

Fluoroscopy dosage and exposure time for each case is recorded within our computerized documentation system, with a calculated frontal and lateral dose for both Kerma (mGy) and Dap (cGycm2). Because we do many lengthy procedures, we do have a more in-depth documentation system that breaks down specific dosing and time intervals for both frontal and lateral if any patient has exposure over 60 minutes. These patients have preventative follow-up by the radiology quality control department.

Who documents medication administration during the case?

Medication documentation occurs in two places during the procedure: first in our cath lab-specific computer system, which integrates into the patient’s electronic medical record. The route and dose of the medications given are all recorded here, as well as the hemodynamics, equipment, and any other pertinent information during the case. Second, the circulating nurse physically documents on a clinical pathway document, which is initiated in the Cardiac Observation Area or nursing units. This document follows the patient through the procedure and to the recovery area or to the nursing unit to which they are admitted. The document is signed by the physician and will be scanned into the system as an official part of the patient’s medical record.

Are your physicians dictating their cath procedure reports, or do they use a structured reporting tool?

Our physicians and interventional fellows have a specialized, computerized cardiac cath and interventional documentation specific to the cath lab. This document is filled out with written narrative and specific drop-down and click answers, developed to capture all required NCDR documentation points.

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

Emory interventional cardiologists help to cover STEMI call for various smaller outlying programs that are a referral source. As well, they have collectively helped to launch a new STEMI program with Grady Memorial Hospital, a level-one trauma and stroke center in the heart of downtown Atlanta. Being the only adult congenital program in the southeastern U.S., we receive many referrals to our structural heart team. Having such a large health care system, Emory physicians across all specialties are a great referral source as well.

How are new employees oriented and trained at your facility? 

We have very hands-on approach to training new employees. Orientation schedules are tailored to their specific learning needs. Most new employees require at least 6 months to be oriented to all roles for routine diagnostic and intervention cases. Nurses orient with a nurse to learn the circulation role, and usually a technologist to learn the scrub role, while monitoring is usually then taught by their primary preceptor. New employees are sent to introductory cath lab courses that are offered locally or regionally, and cath lab-specific educational lectures and in-services. After a new employee is comfortable and competent in routine cases, and signed off on proper use of devices, they are taken off orientation, but remain supported by senior staff members. For more complex and advanced cases, additional orientation time is provided with a senior staff member to precept the new employee to a more advanced role. 

What continuing education opportunities are provided to staff members?

We have multiple in-services and continuing education courses in the lab offered by various sources throughout the year. Emory provides all nursing and certified personnel with CE Direct access, a website which has thousands of online continuing education opportunities. Often cath lab-specific courses are offered through various vendors in our city and state throughout the year. Emory is huge advocate for continuing education, so many staff members attend these local and statewide conferences. Annually, our facility hosts EPIC (the Emory Practical Intervention Course), which is a 3-day regional conference with live case broadcasts, panel discussions, and a lecture series. All staff members participate in and attend this conference with CE credit for attendance.

How do you handle vendor visits to your lab? 

All vendors must book time with our unit director or nurse manager prior to coming to the lab. Emory’s vendor policy requires that they check in via the vendor kiosk (RepTrax), and print off an adhesive visitor badge for that day. Vendors in the cath lab are only allowed in the recording booth or cath lab procedure room if invited. All vendors that participate in a procedure must wear a clean disposable suit to cover their scrubs and a color-identifying hat so they are easily recognized in the room as a vendor. Unsolicited vendors are politely asked to schedule time.

How is staff competency evaluated? 

All hospital staff receives an annual performance-based evaluation. In the cath lab, we have annual competency check-offs that require return demonstration and theoretical knowledge testing. If a new modality or device is introduced in the lab, all staff is in-serviced and must show competent return demonstration. Throughout the year, we have refreshers with vendors if a device has not been utilized in a while or if there is a software or mechanical change.

Does your lab have a clinical ladder? 

Emory as a health system currently has a clinical ladder for nursing professional advancement.

Do you have flextime or multiple shifts? 

Currently our lab uses a self-scheduling system. All staff members work four ten-hour shifts per week, and we do not have a large amount of flextime. In the rare occasion the lab is slow, a few staff members may be let off that day or we will help to staff other cath labs in the Emory system if they have staffing needs. 

Has your lab recently undergone a national accrediting agency inspection? 

Yes, we recently became the second lab in Georgia and Emory University Hospital Midtown the third lab to become ACE-accredited. We are thrilled with this honor and it was great to get credit for standards we already upheld. It is important before undertaking such credentialing to fully understand the standards that are being asked of your lab and make sure your documentation proves it. Taking an internal survey of your lab prior to initiating the credentialing process is a good way to gage where you stand and make adjustments to ensure you are meeting the standards that your lab will be asked to demonstrate.

Where is your cath lab located in relation to the OR and ED? 

The cath lab is located on the fourth floor of the hospital, one floor above the operating room and three floors above the emergency department. There is a red ceiling trail and many signs leading directly to the cath lab. EMS services and all of the ED staff are all aware of the quickest route to the cath lab.

What trends have you seen in your procedures and/or patient population?     

Our patient population is largely comprised of complex patients because of their comorbidities and required procedures. Our young adult, adult congenital, and structural volumes have largely increased with the expansion of the structural heart center. Emory has the only adult congenital heart center in Georgia. We also have a unique partnership with the Sibley Heart Center of Children’s Healthcare of Atlanta, making our program one of the largest in the nation. We are a large referral center for complex PCIs, CTOs, and TAVR. We do have a strong volume of diagnostic caths. This patient population usually consists of pre-operative diagnostic angiography, lung, liver, heart and renal transplant evaluation, as well as patients with non-invasive cardiology testing abnormalities.

What is unique or innovative about your cath lab and staff?    

Emory is proud to be coined as the birthplace of angioplasty in the USA. In 1977, pioneering cardiologist Andreas Gruentzig, MD, while living in Zurich, Switzerland, invented angioplasty and in 1980, Dr. Gruentzig chose to join Emory’s faculty to work with other Emory cardiologists to vigorously research and refine this intervention, known as angioplasty. Emory became the international training center for angioplasty. Hundreds of fellows have been trained here over the years, and many firsts and historical moments happened within our lab: 

  • Emory established the first cardiac catheterization lab in Georgia (established at EUH in 1942).
  • In 1982, cardiologists Andreas Gruentzig, MD, and Douglas Morris, MD, performed Georgia’s first injection of a thrombolytic agent into the coronary artery of a patient to stop a heart attack. 
  • In 1986, Dr. Morris led a team of cardiologists in Georgia’s first use of angioplasty to open the occluded coronary artery of a heart attack victim.
  • In 1987, John Douglas, MD, implanted a coronary stent for the first time in U.S. history.   
  • In 2001, Dr. Douglas and Ziyad Ghazzal, MD, continued to innovate improvements in interventional cardiology by implanting the first drug-eluting stents in Georgia as part of the landmark SIRIUS and DELIVER studies.

Our structural heart team continues to carry the historical torch; we were the first and currently are one of the only labs in North America performing conscious sedation TAVR implants. Many of these patients are then transitioned to a highly trained step down floor instead of ICU.

We continue to be a part of groundbreaking research in anatomical and biologic imaging, with a focus on identifying vulnerable coronary segments that could be potentially treated preemptively to avoid a sudden cardiac event. 

Many of our cardiologists are very passionate about woman’s heart disease, especially those with under-diagnosed coronary disease. We are one of the few centers in the nation studying the effects of microvascular disease in women. “Everyone who is part of Emory can take pride in the Emory Heart & Vascular Center. Our experience, history and teamwork enable us to provide the best care to our patients,” says Emory Heart & Vascular Center Director Douglas Morris, MD. “In fact, physicians all over the country routinely refer patients here for the multitude of resources, innovative options and procedures we can offer even  the most complex heart and vascular cases.”

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”?

Atlanta, Georgia is a large metropolitan area with over 5.6 million residents, making it the ninth-largest metropolitan area in the United States. It is well known that cardiovascular disease is the number-one cause of mortality in the nation, and in the state of Georgia, we share the same primary source of mortality. With such a high incidence of cardiovascular and heart disease, we have a cath lab market that is quite saturated in the greater Atlanta area. Emory is a standout, not only in its vast history and presence in Atlanta, but in the diversity of procedures offered. Our STEMI program has one of the lowest D2B times in the nation, and as a major cardiology center, we are the go-to place for complexity. Many of the patients that are treated here are those whose advanced cardiovascular disease is not easily treated by most centers. Being the only academic hospital center in the metro Atlanta area, overall we have a large footprint in this area.

A question from the American College of Cardiology’s National Cardiovascular Data Registry:   

How do you use the NCDR Outcome Reports to drive QI initiatives at your facility?

We use the NCDR Outcomes Reports to identify opportunities for improvement and to provide feedback to our physicians regarding:

  • D2B and FMC2B times
  • Mortality rates
  • Complications
  • PCI Appropriate Use

Questions from the Society of Invasive Cardiovascular Professionals (SICP):

Do you require your clinical staff members to take the registry exam for the Registered Cardiovascular Invasive Specialist (RCIS)? 

All of our technologists are RCIS-credentialed and it is a requirement for all cath labs across the Emory system. Emory does give a financial incentive to all employees annually who hold specified credentials.

Are your clinical and/or managerial team members involved with any professional organizations that support the invasive cardiology service line?

  • Dr. Spencer King is the current editor of JACC: Cardiovascular Interventions.
  • Dr. Habib Samady is the current associate editor of JACC: Cardiovascular Interventions.
  • Dr. John Douglas is an associate editor of JACC Cardiovascular Interventions.
  • Dr. Vasilis Babailaros is an associate editor of JACC Cardiovascular Interventions.
  • Dr. Tanveer Rab is a member of the leadership committee of the ACC interventional Scientific Council, as well as the Councilor of the ACC’s Georgia Chapter.
  • Dr. Peter Block an affiliate with the ACC CardioSource Network.
  • Dr. Kreton Mavromatis is the SCAI TAVR center editor.