Cath Lab Management

The Process of iPad Integration into the Cardiac Diagnostic Interventional Unit (CDIU) at The Hospital for Sick Children

John H. Balcom, RN, BScN, BHA, Staff Nurse, Team Leader for the iPad trial in the Cardiac Diagnostic Interventional Unit, The Hospital for Sick Children, Toronto, Ontario, Canada
John H. Balcom, RN, BScN, BHA, Staff Nurse, Team Leader for the iPad trial in the Cardiac Diagnostic Interventional Unit, The Hospital for Sick Children, Toronto, Ontario, Canada

 John Balcom, RN, BScN, BHA, can be contacted at

The Hospital for Sick Children (SickKids), affiliated with the University of Toronto, is Canada’s most research-intensive hospital and the largest center dedicated to improving children’s health in Canada. SickKids is an innovator in child health, integrating care, research and teaching. In this article, we will share the path of iPad integration into a clinical setting, in this case, the Cardiac Diagnostic Interventional Unit (CDIU) at SickKids. This integration was a goal conceived and implemented under the hospital’s vision of “Healthier Children. A Better World.” 

Currently the iPad is utilized on the sterile field to allow physicians to access images, equipment and resources needed throughout catheterization procedures, without removing themselves from the sterile field.  The process for integrating the iPad into the CDIU began in 2013. A proposal for funding for the iPad and related software was submitted and approved by the hospital’s Cardiac Advisory Committee (CAC), which allowed the iPad to be trialed in the CDIU. 

The idea was instigated based on research from Dr. Itaru Endo, Director of Digestive Surgery and Liver Transplantation, Yokohama City University, who introduced the iPad into his operating room. He has also developed an iPad app that displays interactive patient data during surgery to save time and lives. Research also indicated that The Ottawa Hospital, Ottawa, Ontario, Canada, had integrated the iPad at the bedside. We asked how their iPad implementation was successful, what obstacles they came across and their plans for the future. The feedback we received outlined many benefits, including instantaneous information at the fingertips, less paper being printed, and time savings due to increased efficiency by not having to access information on a local computer.

Once funding was approved, one 32GB iPad with retina display and WiFi was purchased, along with disposable, tablet-sized sterile covers. We use Dropbox to transfer information and images from the desktop computer to the iPad over a secure wireless network. The different programs we use to organize and view information include Adobe Reader, Pages, Numbers, iBooks and Notes Plus. 

The development and implementation phase took place with the collaboration of medical engineering, infection control, management, nursing staff, and the interventional staff physicians’ input and support. The Ottawa Hospital and Health Canada were also contacted prior to the iPad being implemented on the sterile field to ensure all safety standards were being met. 

Thus far, our physicians use the iPad for the following:

  1. Reference specific devices (sizes and delivery systems);
  2. Reference balloons (types and sizes);
  3. Reference stents (types and sizes);
  4. Reference catheters (types and uses). 

Nursing staff use the iPad for the for the following:

  1. Review setup guidelines for specific procedures;
  2. Review different protocols (e.g., coronary setup or thermodilution);
  3. Review standard unit guidelines. 

Evaluation of the iPad implementation is continuous through regular surveys and direct feedback from frontline staff to improve the utilization of its functioning capabilities in the CDIU. Dr. Lee Benson, director of the Cardiac Diagnostic and Interventional Unit at the Hospital for Sick Children, notes, “It’s a great idea, has everything at our fingertips, and can be updated instantly.”

 “Innovation creates change to improve the care we provide to cardiac catheterization patients everyday” - CDIU staff nurse.  This innovative idea provides continues momentum for practice changes at the Hospital for Sick Children that will add to generating “Healthier Children.  A Better World”.

iPad implementation: What could the future hold?

The possibilities are endless regarding what the iPad can potentially bring to catheterization procedures. There is a need for development of an application specific to cardiac interventional catheterizations that will allow access to echocardiogram reports, x-rays, electrocardiograms, patients’ health records, internet browsing, 3D images of procedures, videos, medication reconciling, and enhance teaching and educating families and staff. It would greatly advance day-to-day functioning in the CDIU.

The iPad could possibly stream information and images to cardiologists, cardiac surgeons for consult, physicians to update family members after their child’s procedures, or nursing staff to educate and teach families in the pre-cath clinic. Reviewing relevant anatomy at the point of care would also enhance communication and teaching. Efficiency could be increased through transferring patient information from outpatient or inpatient units to facilitate patient and work flow. The iPad could be introduced into many other clinical practice settings, such as image-guided therapy, the cardiac critical care unit, and cardiac operating room settings to potentially enhance patient care, decrease costs and time, and enrich the delivery of family-centered care.