Letter from the Editor

Cardiac Cath Lab Clutter or, Spring into Action!

Marshall W. Ritchey, MS, MBA, Presbyterian Hospital, U.P.M.C., Pittsburgh, Pennsylvania
Marshall W. Ritchey, MS, MBA, Presbyterian Hospital, U.P.M.C., Pittsburgh, Pennsylvania

You’ve heard about the spring cleaning. You have heard about organization. But have you heard about cleaning up your act? In the cardiac catheterization laboratory, a great deal of clutter seems to accumulate. Unnecessary items, duplicate, triplicate, or more, of supplies, instruments that can not be stored elsewhere or they will disappear, and what do we do with all this…other than try to work around it?
In the cath lab, it seems every room has its cabinets, closets, drawers, shelves, and nooks and crannies. These hold essential items for easy access and then some not-so-essential items, but things it would be nice to have rather than go to the storage room. Then there are those secret hidden items for emergency loss of supplies! The unfortunate part is that at the end of the day, more and more things are put away in the room and soon they expire from memory and sterilization.
I am here to report that too many products are not used and thrown away because they are not used in a timely fashion. When there is more than one cath lab room, this problem is exponential, as each room has a different configuration and different storage areas. The end result is inefficiency, loss of inventory, frustration and loss of revenue.
There is no easy answer to this problem. It has taken years for this system of acquiring supplies and stocking the cath lab to develop in full. It may take years to resolve the situation. There needs to be a change in thinking and planning for the cardiac cath lab of the 21st century. Many facilities now do peripherals, carotids, atrial septal defect (ASD), patent foramen ovale (PFO) and electrophysiology procedures, and we need to be able to quickly adapt to an ever-changing playing field. Adaptability and conversion should be efficiently done.

I would suggest a laconic approach. The KISS (keep it simple, stupid) system is my recommendation. When designing your next cath lab, do not put any cabinets, closets, drawers, shelves, or nooks and crannies in the cath lab. Keep it barren and clean to the walls. Clear the decks for action. At a minimum, have a sink and a countertop. Drug-dispensing equipment may be in the control room area.
Design the room so no supplies can be stored in the cath lab. Dedicate or design a large central storage area and develop a cart system. When there is a procedure is assigned to the cardiac cath room, select the appropriate carts and whisk them into the cath lab. At the end of the case, take the cart out and clean the room easily. No continual source of contamination.
With basic supplies on one cardiac cath cart, a crash cart, a basic interventional cart, a peripheral cart, a carotid cart, an a ASD cart, a PFO cart, you are ready to rock and roll. The key to the system is to have enough carts to keep you supplied throughout the day.

Cleanup is quick and complete. The whole lab can be wiped down and the chances of cross-contamination are reduced. The staff restocking the cart do not require RN or technical training, and costs are reduced. Time is saved by not having to check the room for stock, and restocking by RN or technologists is not required. Now every room is standard, because every cart should be standard. There is more room in the cardiac cath lab to get around. Finally, the wipe-down and cleaning of the room should be quicker, easier and more effective in fighting infection. This is a winning situation!
Staffing costs are reduced, inventory is better controlled, there is standardization of labs, lab efficiency is improved, and if the system works for you, staff morale is improved! These are big promises.

But, you may be saying, what can I do? Our labs are already built.

Start now by centralizing your supplies. This may require administration to allocate another area for storage. Limit the stock in the room for the case at hand. Train an ancillary staff to pack a box with the basics for a room setup. Then just bring a box of supplies into the lab for each case. Use your imagination to expedite and streamline the turnover process by using less expensive staff. Have a housekeeper wipe and mop the room, rather than a nurse or technologist. There are always options. Try one for a week and evaluate the outcome before making a year-long commitment.
This is your lab. This is your job. These are your physicians. These are your patients. Take pride in what you do. You are saving lives. Now take time to think about doing your job better. When you look around, perhaps you, too, will find that it is time for spring cleaning. Is it time to clean up your act?