Issue Number

**Room Utilization**Does anyone have a cath lab room utilization formula to calculate to what percentage a room is utilized? I am looking for the amount of time the room is in use.

*Andrew J. Graves, RCIS,FSICP Centennial Medical Center Clinical Coordinator, Cardiovascular Lab Nashville, Tennesee*

**Sedation of Patients Undergoing Biventricular PPM &/or AICD**1. Who is responsible for the sedation/ analgesia of patients undergoing a biventricular PPM &/or AICD? 2. Are labs using CRNAs, anesthesiologists or is the circulating nurse enough? 3. If using a circulating nurse, how many circulators do you have in the room? 4. Is this different from other procedures done in your lab? Thank you very much for any response.

*Dianna Johnson, RN Heart Institute Manager St. Francis Medical Center Cape Girardeau, MO*Do you have a question you’d like to ask the Cath Lab Digest Email Discussion Group? Send it to: cathlabdigest@hotmail.com

**Quick formula When I need this I calculate as follows: the number of slots used, divided by the number of slots available.**I exclude after-hours emergencies.

*Carletta Williams carletta@weirtonmedical.com*

**Certificate of Need process If Tennessee has a CON process, then they have utilization numbers you can use.**For Georgia, I believe that capacity for one lab is is set at 1300 cardiac procedure equivalents: diagnostic caths are counted as 1, angioplasties/stent implants are counted as 1.5 and EP studies are counted as 2. A procedure is defined as a cardiac catheterization study or treatment or combination of studies and/or treatments performed in a single session on a single patient who appears for cardiac catheterization. This means that your caths that turn in the same session to angioplasty can only be counted as one, which I think is completely unreasonable. Also, Georgia apparently does not allow you to count pacemakers or ICD's done in the cath lab at all (as opposed to being done in a dedicated EP lab), so I would be interested in hearing from anyone else in Georgia who might be able to confirm/deny either of these questions (cath/PTCA same session and pm/ICD in the cath lab). Thanks.

*Judy S. Parham jparham@armc.org*

**Review answers to variables I do not have a formula, but there are some variables that need to be considered.**What types of procedures does your lab perform? What is the average time per procedure per physician? Do you have a holding area or do you recover patients in the procedure room or elsewhere? What is your staffing per procedure? (Do you staff for 8 hour days, 10 hour days, etc.) What kind of equipment do you have, and do you know how much down time you have with that equipment?

*Dale Hansen dhansen2@yahoo.com*

**One professional’s proven formula Introduction: This writer used these formulas to reorganize a cath lab system in the early 1980s. After five years, the department was functioning with a 54% gross profit margin. The same methods were applied to a new cardiac cath system in the late 1980’s. This system continues to function with a 60“65% gross profit margin. I. The formula for calculating the percentage of utilization for a procedure room is 100 (Number of daily uses)/365. If more than one room is used, then multiply 365 by that number of rooms. II. The length of use is determined by a quotient between the number of daily uses per year and the number of setups per year.**A. The formula for setup costs of a room is: Hourly Rate (Setup Time)/60

^{1}III. The time needed to turnover a room has six necessary cost factors that will determine the total cost per diem.^{ 2,3}B. The cleanup costs per patient is derived from the same formula as the setup costs.

^{ 2 ,3}C. The daily inspection/QA of equipment such as ACT units, defibrillators, inventory of on-hand patient chargeable supplies, etc. is calculated with the same formula for setup and cleanup costs.

^{2,3}D. Analysis of cost of capital equipment for a cardiac cath. 1. Make an inventory of all capital equipment that is used for each procedure room. 2. Determine the cost of each item and its frequency of use per patient. 3. Determine the cost per unit, which is the product of the cost of the item and the frequency of use. 4. Determine the rate of depreciation. Three years? Four years? Five years? 5. Calculate the annual cost, which is the product of the cost per unit and the number of units inventoried for each capital expense device/the rate of depreciation (Time of Replacement) 6. Calculate the cost per replacement as a quotient between the annual cost and the number of daily uses per year. This value will be included in the total cost per diem for cost of capital equipment used. 7. Derive the cost of service contracts and repair parts.

^{4}a. Determine the cost per unit as a product of the cost per contract as the product of the cost of the service contract and unity. b. Calculate the cost per replacement as a quotient between the annual cost and the number of uses per year. c. This value is included in the total cost for per diem for reusables. E. Calculate disposable item costs such as electrodes, oxygen saturation cuvettes, pulse ox finger probes, cardiac cath trays, etc., if the items are included as part of the procedures. 1. Calculate the cost per item and the frequency of the item per patient as a product, which derives the cost per use. 2. The total cost for disposable items is then placed in the summary of per diem costs F. Determine the labor costs for daily inspection and quality assurance with the formula: Inspection Time in minutes + 1.5 / 60 x hourly rate.

^{2}This value is then placed under total cost for labor.

**IV. Summary of Per Diem Costs**A. Total cost of capital equipment used for direct patient care. B. Total cost for disposable items C. Total cost for labor D. Total cost per diem (Total cost per daily use.) E. This summary is termed the total cost per daily use. 1. This value can denote the actual cost per hour. Expressed in minutes, it can be used to demonstrate the cost of slow turnovers by the support staff and physicians. 2. Using a quotient between the total cost per daily use and 24 hours per day becomes a very useful factor in calculating productive time (revenue generation) and non-productivity. 3. The cost to a patient is the sum of the per diem costs divided by 1.00 - overhead costs in percent.

^{5 }

**V. Summary of Set-up Costs**A. Total setup B. Total cleanup C. Quality Assurance D. This data is termed the total cost per setup

^{6}(1) The length of use for any procedure room begins when a patient enters the room and ends when he (she) leaves the room. This is true productive time of the room. Non-productive time refers to the idleness of a room. (2) The hourly rate of an employee is the base rate + the percentage an employer contributes. Example: $10.00 per hour is 10.00 x 1.35 or $ 13.50 per hour; whereas 20.00 x 1.35 becomes $27.00 per hour, etc. (3) Time is expressed in minutes. (4) Service contracts are done annually. The contract should cover all glass and parts. Any changes in costs should be reflected to the patient. Many facilities skimp on service contracts in the belief it will lower costs. Such actions cause budgets to be overrun. (5) Departmental overhead is usually 35%. This technologist always uses 1.00 - 0.35 to determine the charge to a patient for per diem costs. (6) The overhead in percent is the same as per diem costs.

*Chuck Williams, BS, RPA, RT, RCIS Cardiovascular Lab C-430 Emory University Hospital Atlanta, GA codywms@msn.com*

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