Where is there the most room to improve efficiency in the lab? I believe it is in communication. Better communication will improve efficiency between and among all team members. Let’s look inward first. Communication within oneself is not always appreciated as important. Inner communication means that the individual technologist, nurse and physician alike is thinking ahead (i.e., communicating with oneself) about the procedure. Failure to have good inner communication can be seen in the wide variety of behaviors in the cath lab operators and staff. We have all had colleagues that appear to work slowly or inconsistently, or even unreliably. Sometimes they do not give appropriate forethought to the needs of their colleagues or to the procedure at hand, resulting in a slow and inefficient series of events, prolonging the procedure (and perhaps the day) for everyone, especially the patient. Historically, procedure speed was considered important, as there was a correlation between arterial time and procedural complications. Although the days of this relationship have passed, there is a relationship between quality and a procedure performed in a timely and accurate manner. Similarly, the operator who moves to too fast may miss important observations. A prolonged procedure due to operator or staff delay impairs the quality of the lab by limiting the throughput of cases or producing excess overtime expense. Communication at the beginning of the day with team members will likewise improve efficiency. Keeping the physician informed as to the status of his/her procedure will enhance his/her ability to manage time and minimize delays in arriving to the lab. Likewise, communication from the physician to the staff will assist their ability to move patients in and out of the lab to satisfy the needs of the numerous operators, types of procedures and the availability of special equipment. Although it is not always possible, better communication can move cases earlier in the day, something I believe most everyone would favor. Communication at the table during the procedure will also improve efficiency. The informed team can prepare the equipment, anticipate catheter and pharmacologic needs, and shorten the time to set-up. By letting the team know where the operator is in the procedure, the next steps can be anticipated. The recording technologists appreciate these announcements for documentation. The staff should be in the game, watching and listening to be ready to get the needed supplies without undue delay. On the other hand, communication from the room back to the table improves efficiency by clearly acknowledging requests from the operating table, reducing redundant and unnecessary repetition of orders. Clear and open two-way communication, especially under critical portions of procedures, also leads to improved safety through error reduction and timely performance of the catheterization. Here are a few final thoughts to improve communication in the lab: 1. The physician as well as the staff sets a tone of communication in the lab. I suggest that tone be that of a pilot with the right stuff: cool, clear and confident. 2. Orders from the table should be acknowledged clearly by those designated to carry out the order. Just as military efficiency is built on this dictum, so should that of the well-run lab. It is disturbing to request epinephrine and not know if someone heard or is getting the medicine. 3. Repeat orders to reduce errors. 4. When at the table, announce what the table is doing. For example, Left Jud going up... Start with better communication and see whether lab efficiency does not improve immediately!