Cath Lab Spotlight

Cath Lab Spotlight: Lowell General Hospital’s Heart and Vascular Center

Allayne Mendys, MBA, BSN/RN, CV-BC, AACC, Clinical Manager; Stacey Cayer BSN/RN; Deidre Goad RT(R); Anne Marie Jussaume RT(R); and Laura Pruyn BSN/RN, CV-BC, Lowell, Massachusetts

Allayne Mendys, MBA, BSN/RN, CV-BC, AACC, Clinical Manager; Stacey Cayer BSN/RN; Deidre Goad RT(R); Anne Marie Jussaume RT(R); and Laura Pruyn BSN/RN, CV-BC, Lowell, Massachusetts

Tell us about your cath lab and facility.

Our cath lab is part of a 390-bed community hospital located in Lowell, Massachusetts. Our mission aligns with that of the hospital: we put “Patients First in Everything We Do”. The staff and cardiologists are patient-oriented, and strive to provide the highest quality care and services. The Heart and Vascular Center is part of a service line that meets quarterly. We look at how we can grow in our region, improve services for our patients, and collaborate with our partnering hospitals under the Wellforce system, which includes Tufts Medical Center and MelroseWakefield Hospital.

What is the size of your cath lab facility and number of staff members?

The Heart and Vascular Center has 4 state-of-the-art cath labs, with 1 room that is shared with interventional radiology and used for our peripheral vascular program. We have a separate, dedicated electrophysiology (EP) room for ablations and implants, and 2 dedicated cath labs for our cath/percutaneous coronary intervention (PCI) cases. We run a 5-bay holding area most days, but have an additional 3 bays if needed for overflow.

We have 10 full-time employees for nursing, with a total 13 registered nurses (RNs), of whom some are cross-trained to cover the stress lab, others to staff the holding area, and 8 who are part of the ST-elevation myocardial infarction (STEMI) call team. We have 7 registered radiologic technologists (RT[R]s), including our per diem. Six of our RT(R)s are part of the STEMI team, with one data coordinator to manage our American College of Cardiology (ACC) National Cardiovascular Data Registry (CathPCI) and statistics, and one utility aide for room turnover and stocking.

We also have additional support staff for scheduling and a cardiology service team that supports echo, stress, monitors, and electrocardiograms.

What procedures are performed in your cath lab?

We perform diagnostic left and right heart catheterizations, primary and elective angioplasty, cardioversions, transesophageal echocardiograms (TEEs), implantable loop recorders, implantable cardioverter-defibrillator (ICD)/permanent pacemaker (PPM) implants, pericardiocentesis, atrial flutter and supraventricular tachycardia (SVT) ablations, tilt table tests, catheter-directed thrombolysis for pulmonary embolism, and peripheral angiography and stenting. Our RT(R)s also support the operating room staff during peripheral hybrid cases. We currently do not perform structural heart interventions. Our team averages between 40-50 cases a week.

Does your cath lab perform primary angioplasty without surgical backup on site?

Yes, since August 2004, we have performed primary angioplasty without surgical backup on site. We also were part of the MASS-COMM trial, a randomized trial to compare PCI between Massachusetts hospitals with cardiac surgery on site and community hospitals without cardiac surgery on site. This trial took place from June 2006 to June 2010 and resulted in the progression to elective angioplasty without surgery on site.

How has COVID-19 affected your cath lab and facility?

At the height of the pandemic in our area, all elective cases were canceled. Our staff was decreased, and only providing care to emergent and inpatients needing cath lab procedures. Our holding area was changed into a “clean” inpatient care floor and our cath lab nurses staffed the area 24/7. Some nurses were also deployed out as COVID-19 “helpers” in the ICU. Our RT(R) staff was utilized as nursing assistants and/or deployed out to our urgent care centers to be greeters and screen patients coming in for testing.

Do you wear personal protective equipment (PPE) with all STEMI cases?

Yes, our staff wears N95s and eye protection with all STEMI cases. Patient COVID-19 status is treated as unknown until the rapid COVID-19 swab result is returned.

Can you describe your process of donning and doffing PPE?

Staff buddy up and monitor each other during the donning and doffing process to ensure the proper process is followed. We also have signage in the room where donning and doffing occurs for reference.

How are you improving communication while wearing PPE?

We are speaking more clearly and using verbal confirmation of orders, equipment, and medications to prevent any errors, and to assure accurate documentation. We have adopted the “Sitting Down Stands Out” communication practice and use eye contact to look for understanding to improve clear communication with our patients. During COVID-19 high-volume periods, visitors and families are not allowed in. We are sure to include them in education via iPad or using the telephone upon discharge.

When are patients masked?

All patients within our organization are masked unless they are alone in their rooms. This includes during procedures in the cath lab.

Can you describe if/when patients are being tested for COVID-19? Physicians/team members?

All patients that are scheduled for a cath lab procedure must have evidence of a negative COVID-19 test within 72 hours of procedure. If a STEMI patient comes in, they get a rapid swab in the emergency department (ED) prior to coming to the cath lab, but this does not delay transfer to the cath lab. The team moves forward without the results and wears full PPE until test results are received.

All employees must fill out an attestation to wellness prior to reporting to work. If you have no symptoms, you sign your initials to be eligible to work. If any staff has symptoms that may be related to infectious disease, the staff member is not cleared for work and must call their manager and the Occupational Health nurse.

What do you expect will happen with COVID-19 and your local population?

We are happy to say we are through the post-holiday peak and have begun to see a steady decrease in COVID-19 admissions. We have had meetings within the state and with our partner hospital, Tufts Medical Center, and managed to transfer patients when census was high in our intensive care units (ICUs) during the peak. We had set up a field hospital in collaboration with the state, at UMass Lowell, to support extra capacity of patients and have been able to decommission the site in March 2021. Recently, we opened the Lowell General Hospital Mass Vaccination Program, a regional vaccine clinic. We are currently vaccinating about 2,000 people a day, with the flexibility to expand up to 3,000 doses a day based on vaccine availability. We have seen a decrease in hospital-wide staff cases since the vaccine rollouts and are hoping for the same results in the community. We will continue to track several metrics including state volumes, local volumes, inpatient admissions and acuity levels to determine if we will need to decrease or cut down on outpatient procedures.

Can you describe the extent and use of radial access at your lab?

We consider ourselves a radial lab. We screen all patients for radial access for cath procedures. We perform Barbeau/modified Allen’s test to assess patency of the ulnar artery. Every case that rolls in the door will be radial access, unless the patient is in severe cardiac shock requiring a support device. Currently our radial percentage is about 77% (includes STEMI cases).

Do any operators utilize pedal artery access for peripheral vascular procedures when appropriate?

Yes, we have a new interventional cardiologist that has a special interest in peripheral vascular disease. Pedal access is not standard, but if unable to access via femoral artery, he will access the pedal artery.

Who manages your cath lab?

Allayne Mendys, MBA, BSN, RN-BC, is the Clinical Manager of The Heart and Vascular Center and Cardiology Services. We have 4 dedicated staff members, either RT(R) or RN, who rotate being in charge each day to oversee the daily workflow in the Heart and Vascular Center.

Do you have cross-training? Who scrubs, who circulates and who monitors?

Our RT(R)s scrub and operate fluoro, and our RNs circulate and administer sedation. The monitor role can be done by either an RT(R) or an RN. During STEMI cases, we staff with 2 RNs and our RT(R) is scrubbed in as first assist. All staff cover the EP lab and the cath lab. Our nurses are cross-trained to the holding room and some are cross-trained to the stress lab.

Are there licensure laws in your state for

Yes, all cases require an RT(R) present to operate fluoroscopy.

Which personnel can operate the x-ray equipment (position the II, pan the table, change angles, step on the fluoro pedal) in your cath lab?

Physicians and RT(R)s are the only personnel that can operate the x-ray equipment and perform all listed actions.

How does your cath lab handle radiation protection for the physicians and staff?

All staff/physicians must wear lead aprons and radiation badges while in the room. Anyone scrubbed in at table must wear lead goggles. Lead-lined caps are available for use. We have ceiling- and table-mounted lead shields. Everyone is educated yearly on radiation safety, including time/distance and shielding. All team members are monitored by radiation badges and receive reports on dosing monthly.

What are some of the new equipment, devices and products recently introduced at your lab?

In the past 3 years, we have grown as a community hospital that provides care to the sickest of patients. We are able to implant the left-sided Impella (Abiomed) for left ventricular support and also have an intra-aortic balloon pump. We provide ultrasound-accelerated thrombolysis for pulmonary embolism with catheter-directed tPA (EKOS, Boston Scientific). We have moved from the use of fractional flow reserve (FFR) to diagnose coronary artery disease to instantaneous wave-free ratio (iFR) (Philips), which eliminates the use of adenosine. Our peripheral operators use intravascular lithotripsy (Shockwave Medical) and Jetstream atherectomy (Boston Scientific) for calcified plaque.

How does your lab communicate information to staff and physicians to stay organized?

Monthly staff meetings address departmental issues and updates. Email communication is used for information that is imperative to communicate in real time. We also have a daily huddle in the morning to review cases, staffing, census, and any other pertinent information of the day. We recently obtained Cath Lab Accreditation through the ACC and now have quarterly Heart and Vascular Center interdisciplinary performance improvement meetings where all our quality metrics and policy updates are shared. We have vendor educational training on all new equipment and then periodically on less-used devices to keep everyone proficient. We have monthly cath conferences that frequently include a speaker from a tertiary center to provide updates on new and upcoming procedures, and share case studies and research updates.

How is coding and coding education handled in your lab?   

We have a coding department that works directly with the manager and dedicated RT(R) to review billing and coding questions. We also have a CPT manual and an RT coder book for reference. We work collaboratively with our interventional radiology department on any peripheral billing/coding questions and our vendors are also a great source for coding information.

Who pulls the sheaths post procedure?

Interventional cardiologists, trained cath lab RNs, and RT(R)s pull the sheaths. There is a policy for reference and training requires 5 sheath removals with competency under direct physician oversight. We have a yearly mandatory educational video on our hospital’s learning platform that covers access site management as well.

Where are patients prepped and recovered (post sheath removal)?

We have a dedicated holding area for outpatients or for patients transferred in from our other hospital campus. If inpatients require closer monitoring, prior to returning to their room, they may transfer to the holding area to be monitored. Since we are mainly a radial access lab, we use TR Bands (Terumo) for compression. We also have Angio-Seal (Terumo), Starclose, and Perclose (both Abbott Vascular). If a closure device is unable to be used, manual compression is done on the table, when able, or in the holding area. We have the FemoStop device (Abbott Vascular) available as well.

How is inventory managed at your cath lab?

Lowell General’s inventory management is manual, and all RT(R)s assist in reordering and outdates. There is one dedicated RT(R) that oversees the overall process. Angioplasty items such as stents and balloons are on consignment using par levels. Diagnostic products are ordered twice monthly as needed, while maintaining stock in a common area and par levels within each procedure room. To reduce product inventory and costs, peripheral supplies are utilized from interventional radiology inventory. EP supplies are ordered by use of the Kanban system.

When new products are required or requested by a cardiologist, Lowell General has a form request that is completed and reviewed by management, and then reviewed by a new product committee comprised of purchasing agents and the purchasing director of our health system, Wellforce. The cath lab has ongoing communication with a designated purchasing representative to assure support around supply management.

Has your cath lab recently expanded in size and patient volume, or will it be in the near future?

We have been growing our peripheral vascular services. Two of our interventional cardiologists currently perform occasional peripheral angiography/intervention, as well as our vascular surgeons. We recently hired a new interventional cardiologist that has an interest in peripheral vascular disease. Our staff also assist the vascular surgeons with hybrid peripheral cases in the operating room (OR). Due to COVID-19, our cardiac volume has decreased slightly this year, but since we have opened back up, volume is quickly returning to normal. We do expect an overall increase in procedures with our new interventionist.

Can you share your lab’s door-to-balloon (D2B) times and some of the ways employees at your facility have worked together in order to lower D2B times?

We are very proud of our STEMI D2B times: our median door-to-balloon time is 43 minutes and well above the national benchmark according to the ACC’s national data registry. The ACC accreditation team, at our recent review, said, “This is a noteworthy accomplishment, as the vast majority of your cases are performed via radial approach.” To accomplish these times, we have collaborated with our paramedics and have yearly STEMI Continuing Education programs. Paramedics are able to activate the STEMI system with any potential STEMIs. The electrocardiogram is sent via protected health information (PHI) file to the interventional cardiologist, who can then make a decision on the spot. This allows our team to get a head start to the hospital before the patient arrives. This process also takes place at our outside hospitals. Another process in place allows the patient to bypass the ED and go directly to the cath lab, per the interventionalist’s decision (any transfer in or field activation).

Who transports the STEMI patient to the cath lab during regular and off hours?

The ED staff nurse/paramedic and interventional cardiologist transport all STEMI patients to the cath lab during regular and off hours.

What do you do when the call team is already busy doing a procedure and a STEMI comes into the ED?

First, we inquire about mobilizing a second call team (frequently, a second interventionalist will call in). We determine (if possible) how long before the room would be freed up; if it is more than the time it would take to transfer, we communicate for immediate transfer to a close tertiary facility.

What measures has your cath lab implemented in order to cut or contain costs?

The cath lab is very involved in containing costs. We are part of a health system (Wellforce) with several partnering hospitals, which give us better contracted pricing from our vendors on many supplies, including our devices for implants and stents.

All management and staff have undergone education on lean processes (how to eliminate waste and work more efficiently together) and have participated in projects such as setting up our EP lab on the Kanban system for inventory management and going through our supply room to assure we have appropriate par levels for our supplies. One of our RT(R)s came up with a great idea for soon-to-expire balloons and stents called the “blue light special.” We put them together in a section on the counter that can be reviewed before looking at the regular supply carts as an attempt to use these devices first (if appropriate). We have also looked at our workflow processes and are trying to get some projects done between cases if possible, rather than saving them for the end of the day, which makes the overall day more efficient.

What quality control measures are practiced in your cath lab?

We have several ongoing quality projects, including bleeding risk screening, renal protection protocol, medication scanning, radiation safety protocol, contrast allergy protocol, diabetic patient management, universal timeout, and a Surgical Care Improvement Project (SCIP) protocol for our device implants, and we track all adverse outcomes for our invasive procedures.

How do you determine contrast dose delivered to the patient during an angiographic procedure?

We calculate max contrast dose on all patients. We look at comorbidities, prior renal history, glomerular filtration rate (GFR), and any prior doses of contrast within their hospital stay.

Are you tracking the incidence of contrast- induced acute kidney injury in patients?

Yes, we have a nurse that follows all patients that fall into the renal protocol based on GFR and comorbidities. She also gets data on creatinine rise from our ACC registry reports and from a custom report created through our electronic medical record (EMR). She then abstracts data on prior history and lab work, medications, amount of contrast, and fluids ordered. She presents this information at the Heart and Vascular Center interdisciplinary performance improvement meetings and to the nursing quality committee meetings.

How are you recording fluoroscopy times/dosages?

We have Philips x-ray equipment that produces a dose report on every patient. This report is placed in the medical record for future reference.

What is the process that occurs if a patient receives a higher than normal amount of radiation exposure?

We include on our pre-procedure checklist any prior radiation dosing within a year and during the procedure, we notify the cardiologist when we are at 2 Gray (Gy) and then update at 5-minute increments. If a patient receives >2Gy, the case gets reviewed at the radiation safety meeting. If any patient receives >5Gy, the patient receives an educational sheet about how to monitor, and is scheduled for an in-person follow-up with the cardiologist within 7-10 days. This is also reported at radiation safety committee meeting. The physician performing the procedure and patient’s primary care physician are also notified.

Who documents medication administration during the case?

The RN or RT(R) monitoring the case documents all medications. All meds are then reviewed at the end of procedure and confirmed with the circulating RN.

Are your physicians dictating their cath procedure reports, or do they use a structured reporting tool?

Our GE Healthcare system has a built-in structured reporting system that is used by all physicians for procedural reports.

Do you use the American College of Cardiology National Cardiovascular Data Registry (ACC-NCDR) or any other outside data collection registry?

We participate in the ACC-NCDR for all emergent/elective PCIs and ICDs.

How are you populating registry data records?

Our GE system has an interface with the registry so there is some data migration from our GE reports directly into the registry. We also have a dedicated data coordinator who oversees the overall data, with support from some of the cath lab staff. We have one RN dedicated to the ICD registry.

How does your cath lab compete for patients? Has your institution formed an alliance with others in the area?

Our cath lab receives patients based on physician practice referrals. We have a position dedicated to physician retention and recruitment. The largest cardiology service in our area is hospital-owned, which ensures the majority of market capture for the service line. We have a featured magazine that does occasional spotlights on the cardiac service line and we have recently obtained Cath Lab with PCI Accreditation from the ACC, which helps promote our service. Being the closest PCI-capable hospital, we have an understanding with another close facility and their fire departments (not in our hospital system) to accept transfer of patients in need of STEMI.

How are new employees oriented and trained at your facility?

Staff that are orienting new employees must attend a mandatory preceptor class in order to precept new employees. All new staff are given an orientation packet to be signed off during their orientation that includes all the required competencies. The new employee is teamed up with a main preceptor for several months (unless they have prior cath lab experience), with incremental check-ins on progress with the manager. We have learning video tutorials on important requirements, and schedule vendor inservices on important equipment and devices.

What continuing education opportunities are provided to staff members?

Prior to COVID-19, staff was able to attend one local conference a year, of their choice. The Heart and Vascular Center organizes a biannual cardiovascular nursing conference that is a full-day conference and includes presentations from our own cardiologists and/or vascular physicians, including our affiliated tertiary site physicians. There are also opportunities to obtain CEUs at our monthly cath/echo conferences. RNs can access our online CE library for additional CEUs and RT(R)s are offered the availability for Category A CEs twice yearly.

Are your clinical and/or managerial team members involved with any professional organizations that support the invasive cardiology service line, such as the Alliance for Cardiovascular Professionals (ACVP) or regional organizations?

The manager of our Heart and Vascular Center is an associate member of the American College of Cardiology (ACC), a member of the Organization of Nurse Leaders (ONL), and a member of the American Society of Echocardiography (ASE). After obtaining our Cath Lab/PCI Accreditation from the ACC, all staff members have access to the ACC’s, the Clinical Toolkits, and Quality Campaigns.

How do you handle vendor visits to your lab?

All vendors are required to have a scheduled appointment and check-in via Vendormate (GHX) to ensure all requirements are up to date. This system supplies them with a paper badge. In addition, due to COVID-19, vendors are screened at the entrance using our COVID-19 screening tool. Prior to COVID-19, we would have a vendor lunch once weekly for staff/physician education and updates with cardiac medications or equipment. These were booked through our data coordinator. Our procedural vendors are present by physician request to assist during a procedure/device implant, but follow the same process as above. We do not allow vendors who are not required for equipment/device support into the cath labs during procedures.

How is staff competency evaluated?

Staff competency is evaluated by yearly manager reviews. Peer reviews are also taken into account by the manager at the yearly review. We have skill-specific learning videos that are required each month, including topics such as arterial site management, no reflow, dissection, tamponade, anaphylaxis, Impella, IABP, and stroke, to name a few.

Does your lab have a clinical ladder?

The hospital has an RN clinical ladder, but this is not specific to the cath lab.

Do you require your clinical staff members to take the registry exam for Registered Cardiovascular Invasive Specialist (RCIS)?

Not at this time.

Does your lab have any physical (layout) bottlenecks or limitations? How do you work around the resulting challenges?

Our holding area only allows 5 outpatients to be in the area at one time. This can limit the amount of outpatients that are scheduled daily or slow the day down waiting for a discharge in order to accept another patient into the holding area. We have all become very creative with workflow, including recovering patients in the cath lab itself, bypassing the holding room on transfers in, opening an overflow holding area with additional staff, and arranging the schedule to allow for quicker procedures early to free up beds later in the day.

What are some things you enjoy about your physical work space?

We have a large Heart and Vascular Center area that is on the first floor of the hospital. We also have large windows to the outdoors in our hallways to the procedure rooms. Most of the time you can catch a great sunrise (if you are there on call) or sunset at night. We also have a bird’s eye view in our holding area to view the ED ambulance bay and our on-site helipad. Being directly next to the ED allows for quick transport of STEMI patients.

Is there a particular mix of credentials needed for each call team?

Our call team is comprised of 1 interventional cardiologist, 2 RNs, and 1 RT(R). If the call team is in a case that goes past midnight, they are permitted 4 hours of “sleep time” the following day, if the schedule allows. The team staggers their sleep time with one RN coming in at the start of the shift and leaving 4 hours early, and the other coming in four hours late. The RT(R) bases their 4 hours off on the next day’s schedule as not to stress the staffing for the following day.

How does your lab schedule team members for call?

We have a dedicated RN that schedules call for the RN staff and a dedicated RT(R) for the RT staff. We chose to have a dedicated call night during the week and are required to do one weekend a month from Friday night until Monday morning. We submit our request to the call scheduler for weekend availability. We have a rotating call schedule for our summer/winter holidays as well. Holidays are grouped under letters, each staff member is assigned a letter, and each year, staff members take call during a different set of holidays based on how their individual letter rotates.

Within what time period are call team members expected to arrive to the lab after being paged?

The team must be ready to start the case within 30 minutes of being paged. The hospital has a contract with a few local hotels and covers the cost for any staff that stays on their call nights.

Do you have flextime or multiple shifts? How do you handle slow periods?

Flextime is granted on a rotating basis. We keep track in a binder of who has taken it recently. If the schedule is slower, each staff member has departmental projects that they are assigned to complete.

Do staff members have any perks that you might like to share?

Prior to COVID-19, we used to have some staff lunches, and the hospital often sponsored meals and snacks for staff appreciation. We were all granted a conference day to be used during the year to attend one conference. We have excellent tuition reimbursement and hold collaboration agreements with a few local colleges for discounts. We have close, free on-site parking and the call team has a pass that allows for parking directly outside the door for emergency calls.

Has your lab recently undergone a national accrediting agency inspection?

Our cath lab received Cardiac Cath Lab Accreditation with PCI from the ACC in October 2020. It was a great experience and required collaboration with all our team members (cardiologists, nurses, and RT[R]s) to streamline protocols, ensure we were following the latest evidence-based care, and review and share our registry data consistently and use these data to develop quality projects to improve patient care. Our hospital also earned its 3rd consecutive Magnet designation for nursing excellence in June 2020, an achievement reached only by 2% of hospitals nationwide.

What trends have you seen in your procedures and/or patient population?

Cardiovascular disease is increasing along with obesity, resulting in an increased incidence of atrial fibrillation and the need for cardioversions. Patients are getting younger and presenting sicker due to COVID-19, as they have delayed needed care. This is demonstrated by the fact that the myocardial infarction volume was down during the height of COVID-19 in our area. Now our numbers are back to and exceeding baseline.

What is unique or innovative about your cath lab and staff?

We are a small, tight-knit staff with many long-term employees who have been in the cath lab for over 15 years. We are very patient-focused, as our hospital’s mission is “Patients First in Everything We Do” and we live by that mission statement! We developed a committee called the Cardiac Cares Task Force that holds events to raise money for cardiac needs in the community, such as educational programs and support groups. We try to do social gatherings outside of work, as we all know it can get stressful in the workplace. We would do a yearly post-Christmas party. We adopt a family during the holidays as well to benefit a couple of local charities. Every year during Nurses Week, the RT(R)s and physicians collaborate to provide breakfast and lunch every day during the week. The RNs reciprocate during RT week.

Is there a problem or challenge your lab has faced?

The challenge our team experiences the most is the need for hospital beds. This problem is not unique to the pandemic, but obviously is now much more pronounced. With such a small staff, it is difficult to manage a holding area, moving patients out on time and also covering STEMI call. It is difficult having to stay late and then having to come back in for a STEMI. We work through these challenges by trying to rotate late stays and relieving each other when call in has been heavy. We also ask for volunteers for a second call team if holding is running late or if the ICU is at capacity. The hospital currently stopped elective surgeries and is opening our post-anesthesia unit (PACU) as another ICU. We all know these are tough times and we will get through it together, as we always do.   

What’s special about your city or general regional area in comparison to the rest of the U.S.?  How does it affect your “cath lab culture”?

Lowell General Hospital is a community hospital located in Lowell, Massachusetts, one of the largest cities in the state. Back in the early 1990s, there were three hospitals serving the community. Today, the two inpatient campuses of Lowell General Hospital serve the entire region. Lowell is only 30 miles north of Boston, making it convenient to transfer our patients who require more specialized cardiac care to some of the most renowned tertiary facilities in the country.

Our area is both economically and culturally diverse. The city of Lowell is known as the birthplace of the Industrial Revolution and has a long history of being a melting pot of ethnicities and cultures. Today, Lowell has the second largest Cambodian refugee population in the United States, after it became a destination for immigrants fleeing the Khmer Rouge regime. In order to best serve our community, it is important to understand and respect diversity and social determinants of health. Lowell General Hospital’s Organizational Strategic Plan includes a People Pillar (strategic goal) to be the best place to work and practice medicine. One of our multiyear objectives is to “cultivate and support our workforce with skills and perspectives that ensure diversity, equity, and inclusion.” In addition to this strategic goal, we work hard to establish strong partnerships with local organizations focused on serving diverse and historically underserved populations. In addition to providing access to interpreters on-site, we also provide interpreter services remotely through electronic communication tools and resources. The hospital has also recently expanded our DEI (Diversity, Equity and Inclusion) Council with employee and provider representation across the organization to better create a culture of belonging for all at our organization, and the Wellforce system has hired a Chief Diversity Officer. We celebrate recognition and awareness months for all cultures and have ongoing diversity education programs for leaders, staff and providers.

A question from the American College of Cardiology’s National Cardiovascular Data Registry:

How do you use the NCDR Outcome Reports to drive QI initiatives at your facility?

We have quarterly Heart and Vascular Center interdisciplinary performance improvement meetings that include the cath lab medical director, non-invasive cardiologists, interventional cardiologists, the cath lab manager, cath lab RNs and RT(R)s, an inpatient unit nurse manager, and the ACC data coordinator. This committee reviews ACC-NCDR outcomes reports and uses these data metrics (trending data) and evidence-based guidelines to develop quality improvement plans. Once these plans are implemented, the data is again monitored for improvement to ensure continued quality care. Ongoing performance improvement projects are also presented bi-annually to the hospital-wide quality council. 

The authors can be contacted via Allayne Mendys, MBA, BSN/RN, CV-BC, AACC, Clinical Manager, at