Article Commentary

Gerard Lagasse, RCIS, Borgess Medical Center, Kalamazoo, Michigan
Gerard Lagasse, RCIS, Borgess Medical Center, Kalamazoo, Michigan
The article Moving into Interventional Cardiac Procedures: A Foundation for an Education Plan brought a neighboring city’s experience to mind. About fifteen years ago, their hospital decided to start a diagnostic lab. Under an agreement with my hospital, they sent new staff for training and soon hired our lab’s supervisor to finish getting the lab operational. The moral of this story is that knowing how to get a lab going knowing things like what supplies to get and from whom needs experience. Expecting it to be done by bean counters or in-house nursing staff (with the perspective that a ‘nurse is a nurse is a nurse’) is a mistake. These people most likely do not have the skills or knowledge necessary for this new sub-specialty. The Powers That Be may not have a sufficiently clear plan on how to get things done. They may either macro-manage (I don’t care how you do it. Let’s plan on doing our first case next month) or micro-manage (How much are those catheters going to cost apiece? Why can’t we use existing catheters?). I liked the authors’ plan for a training program, but I’m concerned about properly stressing the importance and potential difficulty of getting all these different departments in line for a training program. Departments involved should be determined by a committee that includes an experienced interventional cardiologist and hopefully, acquired experienced interventional staff who know what departments need to be included in the planning and training. Experienced people would catch problems early in an interventional program and correct them before they might become major issues. Physicians also need a strong sense of hospital support. The invasive cardiologist(s) who will be utilizing the lab should have his or her concerns fully addressed up front and be involved (or at the very least, informed and included) in the process from the beginning. One thing the authors do not make clear is who they are addressing as the person in charge of implementing this program. A hospital administrator who has no clue about patient care and therefore no reference point of what kind of staff education is needed? A committee made up of different department heads who have or have never had experience with interventional cardiac patients (but may have read a book on the subject) and now are expected to be experts on what needs to be done? The authors note: In today’s increasingly complex health care environment with staffing shortages and budget constraints it is difficult for institutions to approve non productive time for education. Hospitals can be successful by looking beyond the traditional classroom settings for opportunities that can be offered during unplanned down time in departments. The best example I can think of is requiring staff to acquire their Registered Cardiovascular Invasive Specialist (RCIS) credential. Offer the inducement of an increase in pay or perhaps the highest test score gets a weekend at a bed & breakfast, for example. This approach would have the staff studying on their own and on material that would prepare them for their new future. While the authors have presented a good plan, they should have highlighted the importance of choosing who will make up the committees involved in the educational process, and who will determine when the hospital departments are ready to accept their new duties (or if the departments involved have any say-so in their own sense of preparedness). The most important thing is to have staff trained and prepared to use the devices, medications and tools necessary to help keep a patient (a human being) alive. If the hospital can spend millions preparing their facility for a new procedure, then there needs to be money and time made available for serious and thorough staff education. It is responsibility of the hospital involved to make sure their staff is trained properly.