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Call for Vasc/Cardiac Emergencies
A reader asks: “Do you have more then one call team? If only one, what happens if you have a AMI while doing a vascular/IR case?”
John: This very scenario might just occur this evening in the lab that I work in, based on our schedule. So I ask, what if? I was informed that it would be administration’s decision if it were to happen.
Jane: We have a cath call team and an IR call team. There's just too much of a chance that it would happen. As a matter of fact, we quit doing emergency PPMs at another hospital, because the team got caught doing a PPM when a STEMI came in.
Angela: We have a primary call team and a back up call team, so if the primary team is still there, the back up team comes in. If two STEMIs come in, the peripheral is taken off the table.
Kathleen: We have an IR call team and the cath lab call team doesn't do vascular cases.
John P.: Off the table they go. We don't have a second team, but usually we can call around for another RN or tech in a pinch.
Brenda: Currently we have three call teams: IR, Cards and Neuro, with an administrator on call, too.
L: We take them off the table and do the emergency. If we have two STEMIs, we either do them in order, or do the more critical patient first (this has happened only a handful of times). If we have three, like we did on Friday, the nursing supervisor nearly has a heart attack herself, goes into disaster mode and starts calling everyone in the lab. Then it turned out that only one was a real STEMI and life returned to normal.
Cassidy: IR is separate from Cath. We currently have only one call team and not a very big vasc program, so we only do a couple vasc emergencies a year. But in any case, AMIs take precedence. Sometimes docs want to perm pacers too. In that case, we call the manager to let them know what's going on and do the pacer anyway. However, it would be awful if we ever had to leave the EP doc with an open pocket while the team had to do an AMI.
Williams: I’m sure that everyone’s policy is to pull the patient and do the STEMI, and rightly so. Some tact will nonetheless be required when broaching this to the operator who has just taken 70 minutes to cross a peripheral lesion by finally using the Outback.
Housewide Code When CPR Used
Gaylia: Anyone out there required to call a general facility housewide code when CPR is initiated in the cath lab?
Heather: As a traveling RN in the cath lab, I have been to a few hospitals where this was protocol.
Ruth: No housewide code call in our lab. We just do it.
Registered cardiovascular invasive specialist (RCIS) credential
(Originally posted in the June 2011 issue)
My name is Kory Briggs and I am an RCIS working at St. Joseph Medical Center in Towson, MD. Recently, I have began a crusade in Maryland trying to gain support for the RCIS in our fight to be able to utilize and manipulate radiation equipment under the supervision of our diagnostic or interventional cardiologist. We have met a lot of resistance in the fight from government boards and I need help. I want to know if there is any other state where RCIS have successfully fought for this privilege. I have gained minor support from two of my state representatives and am trying to get pointed in the right direction. Could somebody please respond to me and join my cause? My desire is not to remove other credentials from the cath lab, just to be considered equals. Currently we all feel like second-class staff with a higher level of education and patient care quality is suffering.
J. Kory Briggs, RCIS, St. Joseph Medical Center, Towson, MD
My name is Brandon McDonnell, RT(R)(CV). I am a registered radiologic technologist. I have an Associate of Applied Science (AAS): Radiologic Technology Degree. I have been a RT for thirteen years. I have worked the cath lab for three years. In the time I have been in the cath lab, I have encountered the issue of a RCIS wanting to x-ray a patient. I understand that you do not feel equal. The training course for a RT is far different from the study of a RCIS. In the state of Texas, you must have a medical radiologic technologist certification to x-ray a patient. I am sure other states have similar laws. To ensure that only licenced professionals are radiating patients, the American Registry of Radiologic Technologist (ARRT) and the American Society of Radiologic Technologist (ASRT) introduced the CARE bill. The two groups are working diligently on the bill being placed into law. Part of an article about the CARE bill states:
“The ARRT’s mission is to promote the highest possible standards for patient care by recognizing qualified individuals in medical imaging, interventional procedures, and radiation therapy.”
The rest of the article can be found at: https://www.arrt.org/News/articles/2011-03-04-CAREBill-BuildingAwarenessandMomentum.aspx/. The link to the actual bill is: https://www.asrt.org/media/pdf/GovRel/CARE_HR2104.pdf
You may not gain a lot of support because of the CARE bill. You must be a licensed imaging professional to radiate a patient. To become a licenced RT, you must learn about: biological aspects of radiation, minimizing patient exposure, personnel protection, radiation exposure, radiation physics, equipment, and quality control of radiographic equipment. I do not believe that a RCIS would study the same courses. RTs are very committed to a high level of patient care. The ARRT and ASRT, with the help of the CARE bill, will ensure high levels of patient care.
Brandon McDonnell, RT(R)(CV)
We have an ongoing debate about modifier -59 (distinct procedural service). Some physicians order an EKG (also known as an ECG) the morning of a cardiac catheterization procedure to obtain a baseline reading before the procedure and some order an EKG approximately one hour after the procedure to be certain the patient is not experiencing a rhythm change. The cardiology department charges for the EKG, but claim generates an edit that requests modifier -59. We frequently assign modifier -59 to bypass this edit. Is doing so appropriate?
Our CCL is currently looking at the way we bill and create pricefiles. I am looking at different methodologies for billing and coding our procedures and supplies. Currently, we use CPT codes and “hard code” our pricefiles. How do other CCLs implement their billing practices? I know some institutions use Patient Care Hours (PCH) for their procedures & “soft code”. Any ideas?
Cindy (Email: email@example.com)
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