Use of an Interim Cath Lab to Handle Increased Volume at Saint Elizabeth Regional Medical Center

Cath Lab Digest talks with Bruce Couillard, Director, Cardiac and Vascular Services, Saint Elizabeth Regional Medical Center; Lincoln, Nebraska

Cath Lab Digest talks with Bruce Couillard, Director, Cardiac and Vascular Services, Saint Elizabeth Regional Medical Center; Lincoln, Nebraska

These were older labs with older equipment and they were definitely in need of eventual replacement. We decided to get a modular lab because we saw a major shift in our market. Our volumes underwent an incredible increase as a result of a cardiology group coming over to our facility. In 2002, prior to the increase in volume, we performed 800 cath procedures and 245 electrophysiology procedures. After the cardiologists moved a significant portion of their business to our facility, we were performing approximately 1,500 cath and 750 electrophysiology procedures annually. Our labs were being used pretty much up to and even exceeding 8 to 9 hours a day. At present, post-interim lab, we remain with two (fully updated) labs. We just replaced our EP lab in October 2005. It’s a brand-new lab with a little more space, better workflow and new equipment. The cath lab was replaced while we were utilizing the modular lab. We replaced the equipment and remodeled it as well. Now we have Philips flat-panel cath labs and we are state-of-the-art, equipment-wise. We currently have approximately 14 staff, and they consist of RNs, RCISs, and RTs. We have approximately 23 physicians that may utilize our labs.

Was it only a volume increase that drove your decision to utilize a modular lab?

Yes, that was the initial reason. We saw more patients coming in as a result of the physician group which moved over to our facility. We needed that extra lab just to handle the volume. However, as time moved on, we realized we would also need this modular lab when we remodeled our in-house cath lab. During the remodel, the modular lab was essentially our main cath lab.

How did you originally decide to solve your volume problem with a modular lab?

Our labs were 100% utilized at times, and so we sat down with the physicians. They basically said, you need to get another lab. Well, you don’t just all of a sudden remodel and put in another lab, so we decided to use an interim lab. We looked at other companies. I went to the American College of Cardiovascular Administrators (ACCA) meeting and talked to the different vendors. We chose MDI (Modular Devices Incorporated, Carmel, IN). The owner of the company is originally from the Lincoln area, so there was also a local connection.

How did the modular lab attach to your facility and how long did it take to get going?

Once MDI pulled the lab in and set it down, it took about two weeks to get the lab up and running. We set it up at an entrance into the cardiology area. We created a temporary entrance into the lobby and we added another door. We attached the lab to the hospital with a heated corridor from the doors out to the modular lab. It can be pretty chilly in the wintertime in Nebraska, so we put a heater in there with a thermostat. A concrete ramp was also installed. It took about a week to pour the concrete ramp and build the corridor. If you were a patient, you didn’t really know that your cath lab was basically a trailer sitting outside the facility. We wheeled patients through the cardiology area, through some sliding glass doors, then down a hallway right into the lab. It worked really well for us, as far as the location; although it probably didn’t work so well for the patients wanting to come into the facility for other things. The original entrance was mostly for cardiology, but was also utilized by physical therapy patients.

How long did you have the modular lab in place?

We had it about a year and a half. Once we got our new cath lab, our throughput increased, so we tapered the usage of the modular lab to a point of doing maybe four cases a week. That was the time to say, okay, maybe we’re going to stop. We held onto it as long as we did because we were thinking about tearing the EP lab down and remodeling it. We kept the modular lab in order to still have two labs (one for backup), but decided against keeping it longer because we delayed our EP lab remodel. Regardless, the lab sat out there and worked great the whole time.

How did well did it support your caseload?

The lab worked very well. It had new Philips equipment and a Siemens hemodynamics system. It was certainly a little workhorse lab. We did everything from normal diagnostic caths to interventions, and I think we might have done a couple pacemakers in there as well. MDI took care of everything, which was nice. We did have a glitch which was our fault. There was a power issue which shut the lab down. We called MDI and they sent people out to fix it right away. We also had an air-conditioning failure at one point. MDI contacted someone to come out and replace the air conditioner and we were set to go. Really, it was one phone call over to MDI and it was done.

How did physicians and staff react to using the modular lab?

Physicians were kind of mixed on using the modular lab. I had some physicians used to our lab in the main building, which by most standards, is very large. When they got into this interim lab, obviously it felt more crowded. A lot of our physicians would hold off on their cases if possible and didn’t schedule in that lab. I did have one physician who said, put me in this modular lab, period. Just put me in this modular and that’s where I’ll do all my work. He enjoyed being out of the main flow of things and off doing his own work. He also thought the image quality was very good, as compared to our current labs at the time. The image quality was better than what we had in our older labs. The staff also liked it because they were out of the main flow, and were just out there doing caths all day.

Would you recommend tapering off your use of the lab, as you did, rather than stopping quickly?

You don’t just want to cut off your use and see if you can handle your caseload in the other lab(s). We felt we wanted to sit and watch our volumes. The market in Lincoln is pretty dynamic and we wanted to be certain that our volumes were going to stay at the level they were at before we got rid of the interim lab. We slowly put more and more cases in the other lab. Eventually, you have to cut the cord, and we did. We probably could have done it sooner, but we just felt more comfortable doing it that way. We are very proud of our door-to-vessel times for the acute MIs that come in (currently 74 minutes) and felt we needed to have an alternative for patients needing emergent work. The modular lab was helpful to have until we felt we could operationally handle our caseloads.

Any advice for other labs considering this option?

At the time, we did not hook the lab up to our image archival system because of interfacing issues. We were burning CDs out in the modular lab, then bringing them into the main lab and putting them into our system. From a workflow standpoint, that was probably the only issue. I would say that if other labs were to utilize an interim lab, they should really look at trying to network the lab into their archival system.

Bruce Couillard can be contacted at BCouillard@stez.org

Behind the Project: MDI, Inc. With over 18 years in the interim cath lab business, MDI has seen many changes. According to Greg Mink, Chief Operating Officer of MDI, one of the biggest changes has been the need for a larger interim lab. The capability of the standard cath lab has grown and as a result, our customers are doing more procedures than ever in the cath lab. They are also involved in building or expansion projects that require an interim lab for extended periods of time. As a result, the modular lab is an ideal solution to meet their needs. When compared to a mobile lab (which our company also offers), modular labs are larger and dispense with the clumsy patient lift. The size of the modular labs rival that of an in-house lab, said Greg. MDI, located in Carmel, Indiana, had its beginnings running the first mobile cath lab route in the country. Our company pioneered the mobile cath lab industry with a mobile route based in central Indiana, notes Greg. Recognizing a distinct need in the marketplace, MDI shifted its focus from running cath labs on a route to providing interim labs for monthly rental to hospitals during in-house renovations and upgrades. This remains the primary focus of the company. MDI’s product offering includes both mobile and modular labs. Greg comments, Our mobile labs are a great solution for customers who are replacing equipment and anticipate the total project taking less than three months. The mobile labs offer all the functionality of an in-house lab in a self-contained environment. They are compatible with most hospitals’ existing mobile services pad. MDI can help determine site feasibility if such a site does not exist. MDI’s second and industry-unique offering is the modular lab. The modular labs are very spacious, with some offering over 500 square feet in the procedure room. We have the capability, with our modular products, to meet the AIA guidelines for cath labs. This is very important in some states where the AIA guidelines are viewed as law, said Greg. Modular labs can be placed in the same location that their smaller cousin, the mobile lab, can be placed. Greg continues, Most of our customers construct a connecting corridor to the modular lab with the interior finished to match the hospital. From a patient perspective, they never know they have left the permanent facility. If your hospital is interested in finding out more information, feel free to contact Greg Mink at (800) 456-3369 or through MDI’s website, at www.modulardevices.com.