Cath Lab Spotlight

Borgess Medical Center

Ron Zellers, RCIS, Gerry Lagasse, RCIS, Terry Adlam, RCIS and Tonya Rogers, RN, Kalamazoo, Michigan
Ron Zellers, RCIS, Gerry Lagasse, RCIS, Terry Adlam, RCIS and Tonya Rogers, RN, Kalamazoo, Michigan
What is the size of your cath lab facility and number of staff members? Borgess Medical Center’s cardiac catheterization laboratory in Kalamazoo, Michigan consists of 6 labs, 4 single-plane digital labs, 1 dual cardiac/peripheral lab, 1 bi-plane electrophysiology lab, a 3-bed holding room, and a 35-bed prep/recovery area. Staff consists of: • 1 medical director • 1 cath lab director • 1 cardiac information systems director • 43 professional registered nurses (RNs) • 5 registered invasive cardiac specialists (RCISs) • 3 registered radiology technologists (RT[R]s) • 3 exercise physiologists Staff consists of: • 1 medical director • 1 cath lab director • 1 cardiac information systems director • 43 professional registered nurses (RNs) • 5 registered invasive cardiac specialists (RCISs) • 3 registered radiology technologists (RT[R]s) • 3 exercise physiologists • 2 cardiovascular technologists (CVTs) • 1 supply coordinator • 11 patient care associates • 13 care center coordinators • 2 cardiac information specialists • 2 clinical documentation analysts Staff experience averages 11 years in the cath lab. What types of procedures are performed at your facility? We performed approximately 6,270 procedures in 2007, including: • Diagnostic cardiac catheterizations • Coronary interventions: stents, percutaneous transluminal coronary angioplasty (PTCA), intravascular ultrasound (IVUS), AngioJet (Possis Medical, Inc., Minneapolis, MN), Rotablator (Boston Scientific, Natick, MA), septal alcohol ablation • Complicated lesions, such as unprotected left main disease, along with protected left main disease • Diagnostic and interventional peripheral studies • Electrophysiology (EP) studies/ ablations Borgess Health Alliance is privileged to be a Top 100 Cardiac Hospital, as designated by Solucient in 2006 and renewed in 2007. Does your cath lab perform primary angioplasty with surgical backup on-site? Yes. The surgical team is available on callback within 30 minutes if needed in an emergency. What procedures do you perform on an outpatient basis? Approximately 15 percent of all procedures done in the cath lab are done on an outpatient basis. What percentage of your patients is female? Approximately 40 percent of our patients are female. What percentage of your diagnostic patients go on to have an interventional procedure? Approximately 80 percent of our diagnostic cases receive interventional procedures in the same setting. Who manages your cath lab? Lynn Smith, RN, is Clinical Director of the cath lab. She reports to Vice President of Operations, Linda Lawton, MSN, RN. Our Medical Director, Dr. Stephen Peck, is a board-certified interventional cardiologist. Do you have cross training? Who scrubs, who circulates, and who monitors? Management supports cross-training. Technologists are primarily responsible for scrubbing and monitoring. Circulating is done by the nurses. Monitoring can be done by either a nurse or tech, and nurses may also choose to cross-train to the scrub role. Does an RT (radiologic technologist) have to be present in the room for all fluoroscopic procedures in your lab? No, we do not require an RT to be in the room during cases. Which personnel can operate the x-ray equipment (position the II, pan the table, change angles, step on the fluoro pedal) in your lab? The cardiologists and staff are trained to operate the Toshiba x-ray system (Tustin, CA). How does your cath lab handle radiation protection for the physicians and staff that are in the lab day after day? We provide x-ray aprons, lead glasses, table shields, personal dosimeters which are monitored monthly, and quarterly radiation safety meetings. How did you begin performing peripheral cases? We actually began performing peripheral interventions in the mid-1980’s. Peripheral procedures were done in the cath lab by an interventional cardiologist. Presently, peripheral procedures are performed at Borgess Medical Center in a variety of venues, including the cath lab, radiology, surgery and the neuro interventional lab, by physicians in those respective specialties. Only cardiologists perform peripheral interventions in the cath lab setting. We have one dual-purpose lab with a 16-inch image intensifier for peripheral studies, along with a step table for DSA runoff. Does your lab have a clinical ladder? Our lab has a career ladder for technologists that has four levels (see Figure 1). In order to advance up the career ladder, staff obtain evaluations from peers and physicians. The evaluations are reviewed by the career ladder committee and the director of the lab to determine the employee’s advancement. What are some of the new equipment, devices and products introduced at your lab? Our most recent is the Medtronic Endeavor Stent (Minneapolis, MN). Can you describe the system(s) you utilize? We use Toshiba for our x-ray systems, the OptiMed archiving system (Fairfield, NJ) and Mennen Medical hemodynamic monitoring equipment (Horsham, PA) that includes daily inventory. Our Apollo system (Lumedx, Oakland, CA) collects data for Bluc Cross and the American Heart Association, as well as the American College of Cardiology National Cardiovascular Data Registry (ACC-NCDR). How does your lab handle call time for staff members? We have a call team that is on from 6pm daily, weekends and also holidays. The call team covers all scheduled, unscheduled and emergency cases that come into the hospital. All cath lab members are responsible for taking call. The call team consists of 3 team members, with at least one RN and one scrub tech, with the third member being either. Do you have flex time or multiple shifts? Yes, we have multiple shifts of 8 hours and 10 hours. How is coding handled in your lab? We have a coding specialist who audits charts for accuracy and works closely with two of the techs to verify the components of the bill. We have our own billing for the cath lab/EP department. They work closely with staff to ensure accurate charting and billing. How does your lab handle hemostasis? Our patients return to their rooms, where their RNs use manual pressure and Neptune pads for hemostasis (TZ Medical, Portland, OR). Does your lab have a hematoma management policy? A quality improvement process is in place. We also do monthly tracking. How is inventory managed at your cath lab? Who handles purchasing of equipment and supplies? We have a dedicated supply coordinator responsible for all areas of inventory. Equipment is purchased using the expertise of staff, physicians, in-house med-electronics and purchasing. We are currently switching over to the Mennen Medical Clinibase system for daily inventory management. Cardiology maintains an independent peripheral inventory. We have a dedicated supply person who maintains stock levels. Has your cath lab recently expanded in size and patient volume, or will it be doing so in the near future? In October of 2005, we moved into a state-of-the-art facility. We upgraded from five labs to six flat-panel labs. We have a dual peripheral/ coronary lab and a biplane electrophysiology lab. Toshiba x-ray equipment is in all of the labs. All monitoring systems (Mennen) and injectors are all new. One benefit of moving into this new facility has been a reduction in staff overtime. Is your lab involved in clinical research? Yes, we participated/are participating in the following trials: 1. SPIRIT III and IV: evaluating the Abbott Vascular Xience™ V everolimus-eluting stent 2. The CAPTURE trial: Carotid Acculink/Accunet Post Approval Trial to Uncover Rare Events 3. Internal-nicardipine use versus distal protection in graft stenting 4. Angel Medical Systems DETECT Feasibility Study: The Angel Med Guardian is an implanted diagnostic device. If the monitor detects an abnormality, it alerts the patient to seek medical attention. 5. 3D coronary reanalysis versus IVUS Have you had any cath lab-related complications in the past year requiring emergent cardiac surgery? For calendar year 2006, our emergency open heart rate was .002%. For 2007, our emergency open heart rate was .008%. Can you share your lab’s average door-to-balloon (DTB) times? Our current average DTB is 55 minutes. All employees live within 30 minutes of the hospital. We are members of the D2B Alliance. As of April 2008, we have 100%