Questions for...Richard J. Gray, MD, FACC, Medical Director, Sutter Pacific Heart Centers San Francisco, California How has your role evolved as the center was being built and then opened to patients? My background is that of a clinical cardiologist. Up until coming to Sutter Health and Sutter Pacific Heart Centers, I’ve been in academic medicine, most recently as the Director of Cardiology at Regions Hospital in St. Paul, Minnesota, and Director of Cardiovascular Services at HealthPartners, a managed care organization. I’ve been with Sutter Health since February 2002. I am currently the Medical Director of the Sutter Pacific Heart Centers, overseeing the cardiac programs of both California Pacific Medical Center (CPMC) and Marin General Hospital in Marin County, California. My role here has evolved. At the very beginning, it was about helping Sutter Health conceptualize what direction its newly-formed cardiovascular center should take. The original plan had been to rebuild two cath labs on the second floor of the hospital and leave noninvasive testing as it had been. I attempted to create a vision for a marquee heart center that would provide the physical place for all cardiovascular programs for CPMC a physical embodiment of the institution’s commitment to cardiovascular health, and also to inspire nurses, doctors and staff to provide the very best care and working environment. At one point in planning, we realized that to truly manage the patients well, we would need to rebuild everything. For instance, we realized we needed a holding recovery room and more sophisticated ultrasound equipment, which we didn’t have in our old space. Top management at California Pacific took a very hard look at existing space and made the difficult decision to convert existing administrative facilities, conference room and board room space into an area large enough to fit our vision for a true cardiac center. Our CEO, Dr. Martin Brotman, has always had the philosophy that clinical programs take precedence over administrative needs. That meant his office, as well as the offices of our COO and CFO, all recently remodeled, would have to move as well. My role as Medical Director of Sutter Pacific Heart Centers evolved from one of defining the needs of the institution, to helping to create the vision for what would best serve our needs for the coming decade, and then helping design specific floor plans for the center. We were fortunate to have a team of architects, designers and interior planners who shared our vision and were able to translate that vision into a very successful end product our new center. My role now is to work with the staff to maximize their efficiency, the flow of patients, and to maximize our efficiency in patient service. Can you describe how the center’s new technology was planned to aid in better patient care? The single largest addition of new technology is a comprehensive electrophysiology lab. Formerly, patients who needed electrophysiology services would require transfer to another medical facility. This can now be done in the hospital they’re familiar with and under the care of their own physician. Our electrophysiology mapping system enables us to diagnose and treat the most complex of arrthymias. Intracardiac echo was introduced to help support electrophysiology ablations, and we are now performing 3-D echo, which assists in diagnosis of certain mitral valve conditions and complex congenital heart disease, in addition to our traditional state-of-the-art ultrasound equipment. How many staff members does the center have and what is the mix of credentials? We have a total of 23 staff members in the Kanbar Cardiac Center, including RNs, radiology techs, and recovery room nurses trained in traditional recovery room techniques. We have two electrophysiologists, Drs. Steven Hao and Richard Hongo, totally trained in all modalities of electrophysiology treatment. We also recently added a pediatric cardiovascular surgeon to our staff, Dr. Michael Black, who specializes in treating the most complex heart disease in the smallest of infants. Dr. Michael Colson is our interventional pediatric cardiologist and the new lab imaging is designed around our needs to support his practice of pediatric intervention. How many physicians do you serve? Fifteen cardiologists who are using CPMC as their principal practice site, and another 10 or so use it as part of their practice. There are also four pediatric cardiologists and one pediatric cardiac surgeon, as well as ten cardiovascular and thoracic surgeons who are using the services of the center. Will the center be involved in any research trials? Yes, we’re currently involved in research trials, and our Director, Richard Shaw, is making plans to significantly increase that activity. What do you expect as your annual procedure volume? We currently do 25,000 EKGS a year, and we expect to exceed 30,000 soon. In echocardiology, we currently perform 5,000 every year and expect that to top 6,000 in the coming year. Our interventional cardiology volume is expected to approach 800 cases in the coming year. How was industry involved? We chose Philips imaging equipment, and they trained the staff. They have been responsive in adjustments in initial phases of our operations. We are also using the Heartlab Encompass to archive and manage cardiology images and information. Heartlab will partner with us over the long-term on large-scale imaging and information integration projects. Did you have the chance to give input into the architectural/structural details of the center? Absolutely. We helped set the tone for the design. We wanted both outstanding aesthetics and a strong sense of healing and patient and family comfort. We believe that this has been largely achieved through specially-designed healing architecture, programmed LED lighting highlights, and architectural glass with quotes from well-known philosophers and poets that attest to the strength of the human spirit. Has the development and building of this new center given you any insight into future trends in invasive cardiology? It’s widely expected that various types of invasive cardiac treatment will continue to be developed and will grow. However, I foresee a time when the growth of the most common of our conditions, namely coronary artery disease, will level off because of ever-more successful prevention efforts. Our cardiology growth will then be in other areas, such as valvular heart disease, arrthymias and new treatments for congestive heart failure. What are some of the challenges you faced in opening the Kanbar Cardiac Center? First of all, to have the center construction project come in on budget and on time we succeeded in that. Other challenges include making sure that all the complex technology works as intended, and to integrate the newly-trained staff into our program. What are you most proud of in the new center and why? I’m most proud of the initial broad acceptance by the public the initial impression of the unit’s appearance and tastefulness as expressed in comments heard from our patients and community members attending our grand opening events. Most importantly, the staff is very pleased with the new working environment. Cath Lab Digest also had a brief chance to catch up with the busy Interim Cath Lab Manager at Kanbar Cardiac Center, Scott Wendricks, RN: How will inventory management be handled? We have implemented total automated supply/drug distribution in each room and have hired a purchasing technician to manage this new system. It is our plan to maintain total automated supply/drug distribution with just in time delivery for each room and the center. Can you describe your post procedure hemostasis process? We do use closure devices here at CPMC, if the patient is suitable for a closure device. If the patient is not able to have a closure device for any reason, manual compression is our process. The patient will either go to our inpatient interventional unit, and have the sheath remove using a FemoStop if on IIb/IIIa inhibitors or if ACT is still elevated after PCI. If the sheath is removed in the cath lab with manual compression, we have a 6 bed pre/post holding room staffed with 2-3 RNs who will remove the sheath.