Cath Lab Spotlight

Henry Ford Heart and Vascular Institute

Kathleen Arnold, RN, BSN, RCIS, Detroit, Michigan
Kathleen Arnold, RN, BSN, RCIS, Detroit, Michigan
What is the size of your cath lab facility and number of staff members? The Henry Ford Heart and Vascular Institute boasts one of the nation’s largest cardiology groups. Our cath lab consists of three lab suites supported by 38 staff members. Our cath lab consists of 1 Siemens swing lab (Malvern, PA), 1 Siemens Angiostar, dedicated to our peripheral program, a Siemens Axiom Artis single suite, and a shared Philips lab (Bothell, WA) that is utilized for coronary and electrophysiology procedures. In the fall of 2005, the completion of a new wing brought three additional electrophysiology suites and new state-of-the-art equipment featuring computerized magnetic navigation and control technology dedicated to our electrophysiology program. Our holding and recovery area consists of twelve beds, including two private isolation rooms. Our cath/electrophysiology lab team is staffed by 42 full-time employees (FTEs) with the following credentials: 26 registered nurses (RNs) 1 registered cardiovascular invasive specialist (RCIS) 7 cardiovascular technologists (CVTs) 1 nurse practitioner (NP) 1 nurse coordinator 2 cardiac research RNs 1 materials management coordinator 7 administrative support staff 1 transporter 2 full-time environmental specialists. We have a balanced mix of highly experienced nurses and technologists. All our nurses and technologists are advanced cardiac life support (ACLS) certified. The average length of time staff members have been employed in this department is 9 years. We have a total of 225 years of experience in our cath lab, with our longest employed staff member at 20 years. What type of procedures are performed at your facility? We provide various cardiac and peripheral interventions, including adult diagnostic studies, percutaneous transluminal coronary angioplasty (PTCA), coronary stenting, intra aortic balloon pump (IABP) insertions, coronary rotoblator atherectomy, coronary AngioJet (Possis Medical Inc., Minneapolis, MN), excimer laser, use of fractional flow reserve (FFR) and coronary flow reserve (CFR) technologies, septal closure procedures for atrial septal defect (ASD) and patent foramen ovale (PFO), intracardiac ultrasound (ICE), intravascular ultrasound (IVUS), extraction thrombectomy, peripheral atherectomy, stenting, cryoplasty and coil embolizations. We utilize a variety of embolic protection devices, including FilterWire (Boston Scientific, Maple Grove, MN), Spider (ev3, Plymouth, MN) and Proxis (St. Jude Medical, Minnetonka, MN). Electrophysiology (EP) studies, ablations and device implantations are also performed in our dedicated suites under cardiology services and are supported by dedicated staff. Annually, we perform over 6200 procedures, approximately 120 procedures each week, which breaks down as follows: 65-70 coronary diagnostic and interventional cases per week; Over 250 peripheral vascular cases annually; Approximately 1200 EP procedures performed annually. Heart transplantation is an everyday miracle at Henry Ford Hospital. We have placed more than 370 new hearts in patients from all over the midwestern United States, with survival rates significantly higher than national norms. As a result, our cath lab performs over 400 cardiac biopsies annually. Does your cath lab perform primary angioplasty with surgical backup on-site? We perform primary angioplasty 24 hours per day, 7 days per week. We have surgical backup on-site 24/7, with the OR team available within 30 minutes for emergencies during off shifts and weekends. On occasion, high-risk procedures are discussed on an individual basis with a cardiothoracic surgeon prior to intervention and an OR suite is open and available if needed immediately. What procedures do you perform on an outpatient basis? We perform diagnostic right and left cardiac catheterizations, cardiac biopsy and diagnostic peripheral procedures on an outpatient basis. What percentage of your patients is female? Forty-one percent of our patients are female. What percentage of your diagnostic cath patients go on to have an interventional procedure? Anywhere from 25-30 percent of our diagnostic cases become interventions. Who manages your lab? We have one manager and two assistant managers under the medical directors of the cath and EP labs: Daniel Cutcher, RN, Manager, Cardiac Catheterization/Electrophysiology Laboratories; Patti Renaud, RN, Assistant Manager, Cardiac Catheterization Laboratory; Edward Muxlow RN, Assistant Manager, Electrophysiology Lab; Aaron Kugelmass, MD, Director, Cardiac Cath Lab, Associate Chief Cardiovascular Medicine Claudio Schuger, MD, Director, Electrophysiology Laboratory. The cath lab is designed as part of the cardiology department, managed by: W. Douglas Weaver, MD, Division Head of Cardiovascular Medicine, Co-Director, Heart & Vascular Institute at Henry Ford Hospital, President, American College of Cardiology Kevin Yee, Administrator of Cardiology Do you have cross-training? Who scrubs, who circulates and who monitors? We are a teaching institution and we have first-, second- and third-year diagnostic fellows and two fourth-year interventional fellows. Generally, the cardiology fellows scrub, the nurses circulate and the technologists monitor. However, we currently have 4 RNs and 1 RCIS that are able to scrub or monitor when needed. Our goal is to train all nurses in the lab to be able to monitor cases. Does an RT (radiologic technologist) have to be present in the room for all fluoroscopic procedures in your cath lab? No, an RT does not need to be present in the room during procedures. Which personnel can operate the x-ray equipment (position the II, pan the table, change angles, step on the flouro pedal) in your cath lab? The cardiac fellow and staff-attending cardiologist operate the x-ray equipment. The physicians primarily control the positioning of the II, table panning and stepping on flouro. Do interventional radiologists and cardiologists perform procedures in the same area? Dr. Adam Greenbaum pioneered our peripheral program in the cath lab at Henry Ford Hospital. Today, both attending cardiologists and vascular surgeons perform peripheral interventions in a lab suite dedicated to peripheral procedures. Vascular surgeons have dedicated lab time on Tuesday and Thursday, and our cardiologists, Monday, Wednesday and Friday. Our cardiology staff has been performing peripheral diagnostic and interventional procedures for over 6 years. In the planning stages, Siemens installed its state-of-the-art Angiostar x-ray system, equipped with desired features like digital subtraction angiography (DSA), and table stepping for performing diagnostic aorto-iliac run-offs. What are some of the new equipment, devices and products introduced at your lab lately? We are currently using drug-eluting stents (DES) and bare metal stent platforms when clinically appropriate. We offer Driver (Medtronic, Inc.) and Cypher (Cordis Corporation, Miami Lakes, FL) as our front-line stents. The Taxus Express stent (Boston Scientific) and the Multi-Link Mini Vision and Multi-Link Ultra stent (Abbott Vascular, Redwood City, CA) are also available. A full array of interventional guidewires is available to the cardiologists, including the recently added Steer-it deflecting tip guidewire (Cordis Corp.). The Tornus Specialty Catheter (Abbott Vascular) is being used for chronic total occlusion (CTO) interventions. The Starclose vascular closure device (Abbott Vascular) has been a recent addition to our groin management options. Most of the new equipment that we have introduced into our lab has been related to peripheral procedures. For peripheral cases, the new devices we are using are the SilverHawk (Foxhollow Technologies, Inc., Redwood City, CA), a linear plaque excision deice, the PolarCath cryoplasty balloon device (Boston Scientific) and the FrontRunner catheter (Lumend, Inc., Redwood City, CA) that facilitates lumen through a chronically occluded vessel. Can you describe the system(s) you utilize and how they work in cath lab daily life? We have been filmless since 2001. Today, the systems we utilize in our daily operations consist of the Siemens Axiom Artis cardiac cath labs, Siemens Axiom Sensis hemodynamic recorders, and Siemens ACOM network, a digital mass storage system for image archive and diagnostic quality image distribution. This storage network has allowed our physicians to be able to retrieve patient films quickly and by themselves. Siemens Sensis technology also allows all reports to be accessible via a hospital-wide electronic medical record within 24 hours. There is a viewing station in the OR where vascular operations are performed, allowing surgeons to immediately recall their patient’s procedure images. We also are capable via the web to enable our physicians to view studies from anywhere in the hospital, their offices or even their home. How is coding and coding education handled in your lab? We are very fortunate to have one dedicated coder in our department who handles all coding issues. Separate EP, peripheral or coronary catheterization billing forms are given to our attending physicians following procedures to document the performed procedure and codes. Billing forms are forwarded to the coder. Our coding specialist reviews procedural reports, and physician indications and codes reports. Final reports are then further processed directly through electronic sessions to insurance companies. Certified Professional Coder conferences are offered throughout the year to constantly update our charge master and amend our billing practices to adhere to all regulatory demands. How does your lab handle hemostasis? Hemostasis is usually a matter of physician preference. The majority of our diagnostic catheterization and peripheral procedures are performed using 4 and 5 French catheters and as a result, manual compression is a preference. Following visual verification with femoral angiography, physicians use vascular closure devices such as Perclose (Abbott Vascular) and Angio-Seal (St. Jude Medical, Minnetonka, MN) in the lab. The SyvekPatch (Marine Polymer Technologies, Danvers, MA) is used with manual compression hemostasis in our recovery area. The nurse who circulates the patient’s diagnostic procedure is responsible for removing the sheath and providing hemostasis post procedure. Following percutaneous coronary interventions, we have 2 multi-disciplinary RNs who are responsible for removing sheaths following interventions when ACTs are less than 175 seconds once patient reaches their overnight destination in the hospital. What is your lab’s hematoma management policy? We do not have a hematoma management policy per se, but we do have arterial sheath management and hemostasis guidelines for post procedural cases. Incidence of hematomas is routinely collected and monitored by a data collection nurse for quality assurance purposes. Hematomas are handled immediately with either manual pressure or a FemoStop (Radi Medical Systems, Wilmington, MA). Any site indication of potential hematoma is marked, measured, timed and dated for further evaluation. Cardiac fellows are responsible for seeing inpatients at the end of each day to evaluate vascular access sites and monitor patients for potential post catheterization complications. How is inventory managed at your cath lab? Who handles the purchasing of equipment and supplies? We have one expert materials management coordinator that is responsible for all coronary, peripheral and EP inventory. Kelly Campau oversees over 10,000 products and over 4 million dollars in inventory. Ninety percent of our inventory is purchased via consignment contracts. Our software system is Cardio.Connect (Alinium, Austin, TX), which assists in managing overstock and consignment contracts. Utilizing a bar code system with pre determined par levels, items are scanned per case and uploaded on PalmPilots. Updated information is then downloaded every morning. As items fall below par levels, orders are automatically created and sent using PeopleSoft software to our purchasing department. Has your cath lab recently expanded in size and patient volume, or will it be in the near future? Our cath volumes have increased secondary to our EP and peripheral procedure numbers, which have grown significantly over the last two years. We also see many transfers from affiliated Henry Ford clinics and emergency rooms, including Henry Ford Fairlane, Sterling Heights, West Bloomfield, Bi-County Hospital, Wyandotte Hospital and Windsor, Ontario, Canada. Is your lab involved in clinical research? Yes. Combining over 30 years of experience in clinical trials research, Julianne Longlade, RN and Rachael Pangilinan, RN are experts in their field. They maintain and are responsible for 12 current enrolling trials in collaboration with 6 main investigators: Dr. Mayra Guerrero, Dr. Abdulrahman Arabi, Dr. Aaron Kugelmass, Dr. Henry Kim, Dr. Adam Greenbaum and Dr. Michael Hudson. We are currently participating in the following clinical trials: Enrolling: TRACER. A multi-center, randomized, double-blind, placebo-controlled study to evaluate the safety and efficacy of SCH 530348 (a thrombin inhibitor) in addition to standard of care in acute coronary syndrome (ACS). Primary Investigator: Henry Kim, MD ERASE. Early Rapid Reversal of platelet thrombosis with IV PRT060128 (an anti-platelet) before percutaneous coronary intervention (PCI) to optimize reperfusion in acute myocardial infarction (AMI). Principal Investigator: Adam Greenbaum, MD EVENT REGISTRY. A multi-center registry for the evaluation of drug-eluting stents and ischemic events. Primary Investigator: Adam Greenbaum, MD ENDOPAT: ACEDE. Assessment of chest pain in the emergency department using Endo-PAT (Peripheral Arterial Tonometry). Endo-PAT is a diagnostic device for assessing coronary artery disease (CAD) risk through endothelial function testing, using PAT combined with reactive hyperemia. Primary Investigator: James Mccord, MD CHAMPION PLATFORM. A clinical trial comparing treatment with Cangrelor, an IV anti-platelet agent, (in combination with usual care), to usual care, in subjects who require percutaneous intervention. Primary Investigator: Adam Greenbaum, MD CHAMPION PCI. A clinical trial comparing treatment with Cangrelor (an IV anti-platelet agent) to clopidogrel in subjects who require percutaneous intervention. Primary Investigator: Adam Greenbaum, MD REVEAL: Erythropoietin for AMI NIH. Randomized, multi-center, double-blind, and placebo-controlled trial of the effects of erythropoietin on infarct size and left ventricular remodeling in survivors of acute myocardial infarction. The primary objective of this study is to determine whether erythropoietin administration affects infarct size, left ventricular remodeling and circulating endothelial progenitor cells in patients with large MIs. The size of the infarction and the dimensions of the heart will be assessed by cardiac magnetic resonance imaging within 2-6 days of the infusion and again approximately 3 months later. Primary Investigator: Adam Greenbaum, MD TRIUMPH REGISTRY. Translational research investigating underlying disparities in AMI patient’s health status. Primary Investigator: Aaron Kugelmass, MD Trials in Follow-Up: AMIHOT II. A prospective, multi-center, randomized study of aqueous oxygen (AO) therapy for 90 minutes in anterior AMI patients with successful reperfusion (via PCI) BARI 2 D. Bypass Angioplasty Revascularization Investigation in type 2 Diabetics. Primary Investigator: Adam Greenbaum, MD ENDEAVOR III. Randomized, controlled trial of the Medtronic endeavor drug-eluting (ABT-578) coronary stent system versus the Cypher sirolimus-eluting coronary stent system in de novo native coronary artery lesions. Primary Investigator: Aaron Kugelmass, MD ENDEAVOR IV. A randomized, controlled trial of the Medtronic Endeavor drug-eluting (ABT-578) stent system versus the Taxus paclitaxel-eluting coronary stent system in de novo native coronary artery lesions. This study is investigating the utility of a new drug-eluting stent of the treatment of de novo or restenotic coronary artery lesions or vessels experiencing abrupt or threatened closure. Primary Investigator: Aaron Kugelmass, MD TIMI-38. A comparison of CS-747 and clopidogrel in acute coronary syndrome subjects who are to undergo percutaneous coronary interventions. Primary Investigator: Aaron Kugelmass, MD TAXUS-ATLAS. Treatment of de novo coronary disease using the TAXUS Liberte-SR paclitaxel-eluting stent. The purpose of this study is to evaluate the safety and efficacy of the TAXUS Liberte-SR stent in the treatment of de novo lesions compared with the TAXUS express paclitaxel-eluting coronary stent system. Primary Investigator: Henry Kim, MD Have you had any cath lab-related complications in the past year requiring emergent cardiac surgery? We have had one case in the past two years. What other modalities do you use to verify stenosis? Are you using physiology for lesion assessment? We primarily use FFR, fractional flow reserve, to determine stenosis severity in intermediate lesions. The PressureWire (Radi Medical Systems, Wilmington, MA) measures a gradient during adenosine-induced hyperemia reflecting the blood flow through the artery. The distal pressure/proximal pressure ratio during hyperemia is called the fractional flow reserve (FFR). We utilize intravascular ultrasound (IVUS) in special situations (i.e., left main coronary artery disease). We occasionally perform CFR, coronary flow reserve, using the Doppler FloWire (Volcano Corporation, Rancho Cordova, CA) to measure coronary flow through the use of pulsed sound waves and measurement of the returning signal reflecting off moving red blood cells. Quantitative angiographic measurements are also available quickly using our Siemens Axiom or Angiostar Systems. What measures has your cath lab implemented in order to cut or contain costs? One substantial move that has helped cut costs has been having a dedicated materials management coordinator to manage all inventories with in our cath lab. Twice annually, physical inventory is performed to evaluate no movement and expired products. Aggressive contracting with our vendors is also implemented annually in order to cut or contain costs. What type of quality control/quality assurance measures are practiced in your cath lab? Daily quality controls are performed on specific equipment including the Avoximeter, Accucheck, ACT and temperature-controlled equipment, as well as our crash carts and defibrillators in the cath lab. We also monitor room utilization, finish times, contrast usage, patient procedure flouro times, final time out, patient occurrences such as contrast allergy, contrast-induced nephropathy and documentation compliance. We track all complications and outcomes as identified by the American College of Cardiology (ACC) guidelines. We also participate in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2). BMC2 is a collaborative consortium of health care providers in Michigan, created in 1997. The goals of the consortium are to maintain a prospective, longitudinal multi-center registry of consecutive percutaneous coronary interventions (PCI), to develop and validate risk-adjustment models for fatal and non-fatal outcomes of PCI, to identify risk factors and process of care variables related to adverse outcomes of PCI and to improve the quality of care for patients undergoing PCI through the development of a continuous quality improvement program. This program involves information sharing, the use of risk-adjusted data and benchmarking. In 2003, Henry Ford, in a collaborative effort between the cardiac catheterization lab, the emergency department and the cardiac intensive care units, developed a process where every patient presenting to the ER and an outlying hospital ER with an acute MI would receive PTCA within 90 minutes of presentation, thereby minimizing heart damage and improving patient prognosis. As a result, we monitor and track our door-to-balloon times and participate in an interdepartmental AMI committee. Our systems administrator, Joann Alfonsi, gathers data and is very helpful in assessing and assuring that the quality of care is above standard. The data is analyzed by Christine Swanson MSN, NP and presented at interdepartmental meetings. Patient satisfaction is measured through Press Ganey Surveys. Today, the cath lab distributes patient/family education folders which include a cardiac catheterization or electrophysiology survey along with a self-addressed stamped envelope, general hospital instructions and information, pre and post catheterization instructions including discharge information, a self-care guide, including medical information sheet, appointment and questions for your doctor manual, and a referral form for cardiac rehabilitation, Working on Wellness, and weight management programs. As well as education folders, Henry Ford Heart and Vascular (HFH) gift bags containing heart-healthy popcorn, sugar-free mints, playing cards, a notepad and pencil, and pill box are given at discharge. These gift bags have become quite popular with our patients and their families. At Henry Ford Health System, we put EACH PATIENT FIRST… A focus on service and performance excellence has become a Henry Ford Hospital-wide initiative. Creating The Henry Ford Experience is the foundation of all that we do, bringing together the seven pillars that represent our system’s priorities: People, Service, Quality & Safety, Growth, Research & Education, Community and Finance. How does your cath lab compete for patients? Has your institution formed an alliance with others in the area? We have cultivated a strong connection with many of the outlying facilities and do receive many of our patients from these facilities. A majority of our ST-elevation myocardial infarct (STEMI) patients are transferred to our facility. We market our health system by letting the community know that we are the hospital that specializes in cardiac care. Our outstanding performance in our treatment of STEMI patients has been a useful marketing tool. Our motto is: We’re Henry Ford when others can’t, WE CAN! How are new employees oriented and trained at your facility? New employees are assigned to a preceptor. We have an orientation manual containing a checklist for multiple competencies that must be completed for each new employee. Orientation length is usually 3 months and evaluated on an individual basis with consideration of previous employment experience. Nurses are required to have RN licensure. Cardiovascular technologists (CVTs) do not have specific licensure but must have an extensive cardiac background. All of our staff technologists and nurses are required to maintain ACLS and Basic Life Support (BLS) certification. What type of continuing education opportunities are provided to staff members? Educational opportunities are fortunately abundant within our department. BLS and ACLS courses are provided by Henry Ford Health System (HFHS). HFHS also offers classes and seminars available to staff hospital-wide. We have scheduled in-services every Tuesday morning for a full hour. This time is also utilized to cover departmental updates and concerns that arise. Every January, a sign-up list for new or review topics is posted. Topics are then assigned to every staff member to research and present on a scheduled Tuesday throughout the year. Our vendors also offer CEU programs, and are invited to join us in our lounge to introduce or demonstrate the use of a new device or product. Our staff also benefits from opportunities to attend out-of-town conferences, meetings, various seminars, workshops and lectures. How do you handle vendor visits to your lab? All formal visits to the cardiac catheterization laboratory are scheduled in advance. Our materials management coordinator, Kelly Campau, is responsible for vendor visits in accordance with specific hospital policy guidelines. A primary vendor is allowed one visit per week. A non-primary vendor may schedule only one day per month. Vendors are encouraged to schedule appointments with the individual physicians or cardiac catheterization management. To protect patient privacy, visitation by vendors is limited to the cardiac catheterization laboratory lounge or conference room. Only at the request of a specific physician is a vendor able to proceed to a patient care area. HFHS policy requires vendors to wear plain black scrubs, minus any logos or names, so that vendors are easily identifiable by our staff. HFHS also requires vendors to attend a class where they learn and receive copies of our policies regarding the Code of Conduct, patient information privacy rules (HIPPA), pharmacy, supply chain management, and prevention and detection of fraud and abuse. Certification is an annual process, much like what is required for our staff and volunteers to go through for compliance training. After the class the vendor is given a badge, valid for one year. How is staff competency evaluated? Staff competency is evaluated on an ongoing basis. Our staff takes written competency quizzes at our Tuesday morning inservices. These competencies are designed to help maintain and strengthen our staff’s proficiency in the multifunctional modalities that we engage on a day-to-day basis. Competency is evaluated as part of the employee’s annual performance appraisal. Henry Ford Health System University also requires every employee to complete a computer-based learning program to review and update hospital competencies involving fire, chemical and personal safety, infection control policies, ergonomics, HIPPA regulations and emergency preparedness. Does your lab have a clinical ladder? Currently, we do not have a clinical ladder. Does your lab utilize any alternative therapies (such as guided imagery, etc.)? Our patients are offered warm blankets pre and post procedure for comfort. In the cath lab suites, we have Bair Hugger Blankets (Arizant Healthcare Inc., Eden Prairie, MN). Televisions are available at each patient’s bedside pre-and post-procedure. How does your lab handle call time for staff members? We are provided guidelines for self-scheduling every month with rotational weekend call, vacation and time off requests added prior to distribution by management. We currently have one call team that consists of 2 RNs to circulate and 1 technologist to perform hemodynamic monitoring and provide documentation for final procedural report. All cath lab staff is expected to take call. Weekday call begins at 6:00pm and continues until 6:00am the following morning. Those who are on call are considered post call or the late shift the following day and are not required to report to work until 10:00am. This post call or late shift is scheduled to stay from 10:00am until the work is complete. Weekends start at 6:00pm Friday and end at 6:00am Monday morning. Call averages 1 day per week and every fourth weekend for technologists. Nurses average 1 day per week and every fifth weekend. Within what time period are call team members expected to arrive to the lab after being paged? All call team members are expected to arrive within 45 minutes, with most arriving sooner. We have collaborated practice with our coronary intensive care unit (CICU) so that five multidisciplinary RNs are specifically trained, in the event of an acute MI, to respond immediately to the cath lab along with our cardiology fellow. They have become proficient at setting up and positioning the patient, so that when the cath lab team arrives we are immediately able to continue the process. These nurses have also become familiar with streamlining this process through one single hotline phone between our ER, admitting department, ambulance service, cath lab member call team, attending cardiologist and fellow staff. Our door-to-balloon times for our Detroit campus average within 70 minutes. Even more impressive, our cath lab door-to-balloon time average has been within 22 minutes. We have expanded the process to include non-Henry Ford Health System institutions, including local Canadian facilities, have provided community education and maintained a commitment whereby every patient with an acute MI arriving to our emergency room (ER) from an outlying hospital ER will receive PTCA within 90 minutes of presentation. Does your cath lab do electives on weekends and or holidays? We do not perform electives on weekends and holidays. Only urgent and emergent cases are performed. Has your lab has undergone a Joint Commission on Accreditation of Healthcare Organizations (JCAHO) inspection in the past three years? Staff should plan vacation time accordingly. Just kidding! I would recommend that you maintain a constant state of readiness. Maintain quality documentation, and continually strive to improve standard of quality. The focus was on patient identifiers including final time out, and incorporating patient safety goals to everyday practice. We also participate in unscheduled in-house surveys similar to JCAHO to ensure continual compliance. Where is your cath lab located in relation to the operating room (OR), emergency room (ER), and radiology departments? The cardiac cath lab is located on the second floor, the emergency room is on the ground floor, and the OR is on the 4th floor. Radiology departments have different locations throughout the hospital, but the main radiology department is located on the 3rd floor. Computed axial tomography (CAT) scan and ultrasound are located on the second floor, next to the cath lab. How do you see your cardiac catheterization laboratory changing over the next decade? Various members of the HFHS cath lab contributed their thoughts in response to this question (see also the large quotations from Dr. Kim and Dr. Greenbaum): We will continue to improve efficiency. We have seen the treatment of STEMI patients improve greatly. We continue to strive to streamline the process of getting those patients to the lab as soon as possible. In the future, to save additional minutes, we hope to initiate protocols for electrocardiograms to be performed in the field by our ambulance service en route to the cath lab at HFHS. Christina Swanson MSN, NP Advancements in the use of stents coated with bioabsorbable polymers, reducing the risk of stent thrombosis, have been promising. Amjad Farha, MD Please tell the readers what you consider unique or innovative about your cath lab and its staff. For us, having a diverse workforce has resulted in a strong cath lab culture and values. When Patti Renaud, RN, Assistant Clinical Management, was posed this question, she responded, Our cath lab is truly a melting pot of cultural differences, personality and professional backgrounds. When faced with a crisis or personal tragedy, every one of us rally together and support each other. Our focus on diversity goes beyond social and moral responsibility. Despite a variety of backgrounds, we are a team, building on collective strengths to provide our patients with the best possible care we can deliver. In our cath lab at Henry Ford, diversity is not just the right thing to do, it’s what makes us a leader in the industry. What’s special about your city or general regional area in comparison to the rest of the U.S.? A benefit of living in Michigan (particularly the Detroit area) is its proximity to Canada. You’re a bridge or tunnel away from another country. Detroit is home to one of the largest theatre districts west of New York. The Detroit Institute of Arts is the fifth largest art museum in the country, known for its world-class collections, and the Museum of African American History is the largest of its kind in the world. Alternately, Detroit has been known as the Motor City or Motown, and has developed a reputation during its history as a haven for automobiles and music. The city of Detroit makes the ideal place for the North American International Auto Show, an annual event held in January. Detroit was also the site of a modern musical renaissance in the 1960’s when Hitsville USA produced artists such as Smokey Robinson, Marvin Gaye and others. Hitsville USA is a tourist attraction located on West Grand Boulevard, just across the street from Henry Ford Hospital. Detroit and our Canadian neighbors also enjoy exciting casinos on both riverfronts. We have the best professional sports (and fans) in the country for our Detroit Tigers, Detroit Red Wings, Detroit Pistons and our Detroit Lions. Detroit is linked to Windsor by the Ambassador Bridge, making it an important port of trade with Canada. How is the culture of the cath lab affected? American blood laboratories use a different version of the metric system than does most of the rest of the world, which uses the System International Unit (SI units).The SI is a standard recognized around the world except by the United States of America, which will probably adopt it in due time. In some cases, transition between the two systems is easy, but the difference between the two is most pronounced in the measurement of chemical concentration (see Table 1). The American System: mg/dl The American system generally uses mass per unit volume (milligrams per deciliter of blood). By considering the weight of a substance in the blood, it is less accurate. The term mg/dl then is the abbreviation for milligrams (mg) per deciliter (dl) and describes how much lipid is present in a specific amount of blood. A deciliter is on tenth (1/10) of a liter (a liter being just over a quart) or about 1/4 of a pint. The SI System: mmol/L The SI system (Systeme International) in Canada, Europe, and other countries, uses moles per unit volume (millimoles per liter of blood). By considering the number of molecules of a substance in the blood, it is more accurate. Since mass per mole varies with the molecular weight of the substance being analyzed, conversion between the American and SI unites requires many different conversion factors. As a result, when patients are transferred from Windsor, Ontario, Canada conversion tables are used to convert many of the SI system lab units used in Canada to the American system. Thirty-seven percent of Henry Ford Hospital employees are Canadian. Six of our RNs in the cath lab live in Windsor. Visa screen, homeland security procedures and the close gap between the U.S. and Canadian dollar have now become challenges for recruitment of RNs and other allied health professionals from our Canadian neighbors.

The Society of Invasive Cardiovascular Professionals (SICP) has added two questions:

1. Do you require your clinical staff to take the registry exam for Registered Cardiovascular Invasive Specialist (RCIS)? Do staff receive an incentive bonus or raise upon passing the exam? No, there is no incentive or requirement currently in place to take the registry exam for RCIS. 2. Are your clinical and/or managerial team members involved with any professional organizations that support the invasive cardiology service line, such as the SICP, ACVP, or regional organizations? Yes, some members are involved with the Alliance of Cardiovascular Professionals (ACVP) and/or are members of the American Heart Association (AHA). Kathleen Arnold can be contacted at