Tracking issues in the cath lab for quarterly meetings

(Thank you to Don Sanders, Director. CVS, in Cullman, Alabama, for last month's discussion group question, below).
(Thank you to Don Sanders, Director. CVS, in Cullman, Alabama, for last month's discussion group question, below).
17 cath labs responded to the question above. If you’d like to join our group, please send an email to cathlabdigest@hotmail.com Group Members’ Responses: lunch case reviews We do lunch case reviews about interesting procedures. The cathing physician presents the case and it is discussed among us. Our medical director will also attend staff meetings from time to time and the techs will discuss problems that have developed over the past few months. It’s a good time for everyone to talk about things bothering them along with sharing new ideas. Denise Foto RCIS, RT, University Community Hospital, Tampa, Florida Tootie813@msn.com good luck! We been unsuccessful at getting our cardiologists as a whole to participate in any discussion group. Anonymous alternate points of view I’m sure your doctors and staff should be the first to offer up meeting topics it is their program there is never a shortage of credible and meaningful topics and going to them first will be much appreciated. Perhaps if I can make a suggestion: you might alter meetings to include physician-requested topics one meeting and staff-requested topics at the next so that you avoid wasting time on minutia. Also, you might consider sending out outlines of each topic prior to the meeting so members can be more prepared and keep the discussion relative to the topic. JCha602066@aol.com an educational focus We have had similar meetings of staff with cardiologists. The staff were asked what they would like to have discussed at these meetings and the cardiologists were also asked what they would like to include in these get-togethers. In our case, the focus was almost always educational; occasionally operational questions were discussed, like room turn-around time, or other items of that nature. Sadly, we have gotten away from this practice. Our new folks would really learn a lot from film review of interesting patients, along with the patient history and presentation. M. Todkill, RN Tennessee Todkill@worldnet.att.net poll participants There are many topics which can be brought to the table. I will list some suggestions, but the best place to start is at your meeting, by asking what topics the staff would like to cover. We are an emergency center. There is a definite need between docs and staff for emergency call-in response time. One part which you have control over is the response time of your staff from initial call-in to first inflation. Our average started out at 71 minutes even though the staff has to be here within a half hour. Through monitoring and with staff and physician interaction, we reduced that time down to 43 minutes. (Just an example.) Groin care and complications is an other topic idea. Here are some more: “ Every specific accountability, from how x-rays are generated to drug interactions to cardiogenic shock and treatment. “ In terms of group integration, what each staff member’s expectation of your leadership might be. “ Controlling inventory with the continual rise in cost. “ The new privacy guidelines. Roberta Sparks, Good Samaritan Hospital, Downers Grove Il. Roberta.Sparks@advocatehealth.com a great idea As a staff member, I can see a huge benefit for the staff and the MDs in verbalizing their expectations. I will be extremely interested in the response you receive from this and will be watching to see the ideas I can bring back to my lab. I will definitely make this suggestion to my supervisor. One question: How will you get the cardiologists to participate in this meeting with the busy schedules we all have to contend with?!? cvgal5000@yahoo.com routinely tracked topics Some of the things that we have routinely tracked in our lab are: Physician tardiness, contrast usage, hematoma rates, any complications, compliance with conscious sedation, pt satisfaction, new device tracking, overtime hours, quality tracking issues like act controls and documentation, crash cart checks, competencies for employees annual basis, radiation quality controls, inservices and education for staff. Annie.Ruppert@sharp.com fines for tardiness Tardiness of physicians is a chronic problem in most places. Can you imagine how a patient feels when they are scheduled at 8am and they do not have their procedure started until 12pm, 4pm, 8pm at night? How do you curtail the situation? It’s very difficult. Several years in NC, we had a policy drafted that was signed by our medical director and hospital administration. The policy stated, If any patient has to wait in a ready state for a procedure and the attending physician has not made his or her presence, the patient is removed from the table and placed in the holding area. The next patient of another physician is then moved up. The first to violate the policy was the medical director, and his patient was placed in the holding area. After that, he was never late for a case. There is one private hospital in Atlanta where partners fine other associates for their tardiness. The funds are taken out of the MDs' salary every month and given to the cath lab staff for educational purposes. There is also a hospital in Denver that pays their own call staff $75.00 per 15 minutes for every elective patient that is done after 6pm due to physician tardiness. If I am correct, the cardiology group gets billed for the funds. At my facility, our whole staff was placed on 10 hour shifts three years ago. The purpose was to keep three labs open until 6pm with full staff. It gave physicians more reason to start later. Trying to solve the late physician is truly a catch-22. If anyone solves this serious matter that truly affects patient care, let me know. What is worse is that the staff becomes dishonest with the patients because we have developed excuses for the tardiness of professionals, who have developed an impression that the patient’s time is not important to them. Just some enlightenment on your situation. Be grateful your staff is happy. It’s a plus when a cath lab has some form of harmony. Chuck Williams, RPA Student, Weber State University, Ogden, UT CharlesWilliams@mail.WEBER.EDU painful beginnings can lead to cohesiveness The topics you bring to the table will usually be painful in the beginning, but lead to a more cohesive group. TAT and productivity issues. Not only MD lateness; it could also be system problems like staffing, or it could be that one of the secretaries in the office tells the patients to arrive one hour before the procedure instead of two. What about multi-disciplinary PI inventory issues? This is where the ground rules are set for how many $$ sit on the shelf. Discuss how the one out/one in rule works so that the old stuff doesn’t sit until it expires. These are just a few ideas. The only thing is that the subjects you discuss must be multi-disciplinary. This is not a good place to discuss something that pertains only to part of the team. There could be some time set aside from each meeting for a cine review open forum. Review cines and allow for a question and answer period. Educating everyone about what you did and why you did it will only form a better team. Review standards and order sets, as well as policy. How about statistics? Volume of patients, equipment usage per patient, etc. Look at what the burning issues are in the cath lab today and pick two or three to work on. Use these standards for the meeting: Set a time; Have an itinerary with time frames set up; Stick to the itinerary and finish the meeting on time; Set a follow-up meeting to complete any unfinished business; Critique the meeting: what went well, what didn’t. Anna, annasmith@chi-east.org tracking ideas You should have a way of tracking the following: Cost as it relates to each cardiologist, such as how many stents per vessel, guide wires per procedure, balloons, etc. You will want to track closure devices, if you will be using them. Cindy Fielders Cynthia.Fielders@HCAHealthcare.com groin complications I can give you one topic that our physicians discuss: closure devices with groin complications. Also, should closure devices be used in diagnostic cases? Which ones should you carry, or should you have them all on hand for different physicians to use? We discuss the tracking and documenting of groin complications. All out of the ordinary events that may occur in the cath lab are discussed: for example, excessive fluoro time, dissections. Staff meetings are held every month and we talk about issues regarding documentation of cases, new products, and inservices. charlene@shentel.net operations affecting staff well-being Helpful topics to track are overtime, physician tardiness, amount of overtime, complications, costs and equipment usage. Anything that affects how the lab is operating and any topic that affects the well-being of staff is worth tracking. Our lab has made many adjustments to improve working conditions. Our turnover is very low and a happy staff is one reason. We have a few chronically late physicians. Even though there isn't much we can really do about it, it helps the staff to be able to vent in an open forum. rhood@communitymedical.org stress improvement Together, examine ways to improve from all standpoints. I feel the ideal is nice, but I am curious to see your cardiologist follow-through. MelodyBelaire@aol.com monthly meetings We have a similar meeting once a month, not with all the staff, but with representatives from various disciplines (CVT, RTR, RN, Coordinator, Material Management Coordinator, etc.) Some standing topics are as follows: 1. Any QA reports; 2. Product evaluation and consent to discard or bring in new; 3. Staffing issues, call team response, staffing, recruitment efforts; 4. Staff concerns; 5. Review of volumes; 6. Strategic plans that are applicable; 7. New lab construction; 8. Capital requests and grants are reviewed. Hope this helps. Dan Witt, Manager, Cardiovascular Diagnostics, SwedishAmerican Health System, Rockford, Illinois, dwitt@swedishamerican.org problem areas We look at problem-prone areas like infection rates, hematoma rates, scheduling back-ups, etc... You will soon get an idea what you need to discuss and have to limit your agenda to a few things. Marketing and community relations might be a good area to start with if you aren’t currently having a problem-prone area; ie, what can your staff do or the doctors do to get your services known in the community both at home and in referral areas. As you probably have already figured out, bring food and everyone will show up! Sherri.DeLashmit@BMHCC.org some suggestions I would suggest the following: a) Patient care quality issues: how-tos, efficiency of turnover, etc. b) Technical/knowledge level issues: at what level do the MDs want the staff to perform? What can staff do and not do? c) Direction of growth: where and how far do you and the physicians want to go? d) Education/inservices: drugs, new technology, etc. The MDs usually get the info first and more often than we do via their national-level meetings, journals, etc. e) Case reviews: exceptional findings, technically difficult, poor outcomes, etc. f) Other general areas of operation: how many staff per procedure, how to cover call, etc. Leave the more detailed operational discussions to staff only: department finances, staff problems, discipline, rules, etc PAM_RAGLAND@bshsi.com invasive committee Our facility does not have a group of this type. We do have an Invasive Committee that meets monthly, which includes invasive cardiologists, administrators, and management staff of our prep and recovery area, cath lab, non invasive cardiology, procurement, and clinical analysis. Topics include operational issues, quality improvement, introduction of new products, and concerns the cardiologists might express. Sheila DeBastiani, RT(R) Supervisor/Educator, WakeMed Invasive Cardiology SDebastiani@wakemed.org