Cath Lab Spotlight

Southside Hospital Cardiac Cath Lab/Northwell Health

Susan Murphy, RN, MSN, Bay Shore, New York

Susan Murphy, RN, MSN, Bay Shore, New York

Tell us about your facility and cath lab.   

Southside Hospital is a 341-bed, Level II trauma center located on the south shore of Long Island, New York. Our cath lab is part of the cardiovascular service line in the Northwell Health system. Over the past 20 years, our lab has experienced tremendous growth in volume and advances in the delivery of care utilizing cutting-edge technologies. Healthgrades named Southside Hospital as one of the nation’s 100 best hospitals for coronary interventions in 2018. Recently, we were named by IBM Watson Health in the 2019 Watson Health 50 Top Cardiovascular Hospitals Study for providing high quality and high efficiency in cardiac care.

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

The interventional cardiology procedural areas include the cardiac cath lab, the electrophysiology (EP) lab, transesophageal echocardiography (TEE) lab, and a newly built invasive neurology lab.

The cardiac cath lab suite consists of 3 invasive labs (2 GE Healthcare and 1 Siemens Healthineers), 2 electrophysiology labs (1 GE Healthcare and 1 Siemens Healthineers), and 1 invasive neurology (Siemens Healthineers). Southside’s cath lab employs a mix of registered nurses (8), radiologic technologists (5), and cardiovascular technologists (3) to staff our department daily. The recovery area is a 17-bed suite open 24 hours a day, 5 days a week. The cath labs are open 7 am-9:30 pm, Monday to Friday.

What is the mix of credentials at your lab, and how long have staff members been “in residence”?

Occasionally, our lab has interventional fellows who rotate through our area and assist the interventionalists by scrubbing for procedures. Our technologists and nurses also assist in prepping patients and scrubbing for procedures. In addition, nurse practitioners (NPs) (6), a physician’s assistant (1), and nursing assistants (NAs) (2) are staffed in our recovery suite area. Some of our staff have been employed in the cath lab for over 25 years, while others have been newly hired in the past year.

What procedures are performed in your cath lab?

Our lab performs a variety of complex procedures that involve both cardiac and peripheral angiograms and interventions. Our procedures include left heart catheterization, right heart catheterization with and without nitric oxide, percutaneous coronary interventions (PCIs), peripheral angioplasties, peripheral mechanical thrombectomy, thrombolysis, and atherectomy. We also perform atrial septal defect (ASD), patent foramen ovale (PFO), and ventricular septal defect (VSD) closure, cardiac biopsies, aortic valvuloplasty, pulmonary embolism (PE) treatment with EKOS (BTG), extracorporeal membrane oxygenation (ECMO), intravascular ultrasound (IVUS), Impella (Abiomed), intra-aortic balloon pump (IABP) placement, optical coherence tomography (OCT), fractional flow reserve (FFR,) instant wave-free ratio (iFR), orbital (Diamondback 360, CSI) and rotational (Rotablator, Boston Scientific) atherectomy, chronic total occlusion (CTO) procedures, carotid interventions, laser, transcatheter closure of paravalvular leak (PVL), pericardiocentesis, Permacath insertion and removal, inferior vena cava (IVC) filter placement, and fistula repair.

As of October 2018, for the year, we have performed over 2100 diagnostic cardiac catheterizations, approximately 800 percutaneous coronary interventions (PCIs), around 260 diagnostic peripheral angiograms, and more than 100 peripheral interventions.

If your cath lab is performing transcatheter aortic valve replacement (TAVR), can you share your experience?

The Southside Hospital TAVR program has been extremely successful since 2012. We use a hybrid lab (Siemens Healthineers) in the operating suite for TAVR, MitraClip (Abbott Vascular), and transcatheter mitral valve repair (TMVR) procedures. Since the inception of the program, our facility has performed 379 TAVRs. As of October 2018, we have successfully completed 84 TAVRs and 20 MitraClips. Our objective is to meet the target of 100 TAVRs by the end of the year. Our TMVR program started in August 2018 and Southside Hospital was the first to provide TMVR within Norwell Health. The cut down approach is utilized by our cardiac surgeons for all of our TAVRs, MitraClips, and TMVR procedures. We work in conjunction with our skilled cardiothoracic team in the operating room (OR) for all of our complex minimally invasive valve procedures. Our continued success has been as a result of the excellent communication and cooperation between the cath lab and OR staff and physicians.

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

Before Southside Hospital received its open-heart surgery program, we did perform primary angioplasty without surgical backup. Our hospital enrolled in a study conducted by John Hopkins Medicine Heart & Vascular Institute that collected and evaluated data from community hospitals throughout the U.S. that were permitted to perform elective angioplasty without surgical backup. The Cardiovascular Patient Outcomes Research Team (CPORT-E) trial was the first randomized control trial undertaken to closely examine the performance of elective PCIs in community hospitals in the United States. The department of health and Northwell Health monitored our outcomes. This program proved to be extremely successful and led to our lab receiving approval from the department of health in 2005 to provide elective angioplasties to our patients.

What is your percentage of normal diagnostic caths?

Our normal cath rate is about 41%, which includes patients with a lesion of 50% or less in a coronary artery, as defined by the New York State Department of Health. Approximately one-third of our diagnostic procedures advance to PCI, while the rest of our patients have normal coronaries, are treated medically, or are referred for open-heart surgery.

Do any of your physicians regularly gain access via the radial artery? If you are performing peripheral vascular procedures, do any operators utilize pedal artery access when appropriate?

All of our staff physicians utilize the transradial approach for access in cardiac diagnostic, interventional, and ST-elevation myocardial infarction (STEMI) cases as their primary choice of access, which results in about 60% of our cases. Some of our community private physicians also utilize the femoral approach. For all complex procedures (CTOs and high-risk PCI with Impella, etc.), the femoral approach is considered with ultrasound guidance. Our interventionalists do not utilize the pedal artery for access.

Who manages your cath lab?

Dr. Puneet Gandotra is vice chairman of the department of cardiology and the interventional director of our lab. Rachael Haddock, RN, MSN, CVRN-BC, is the director of patient care services for invasive and non-invasive cardiology, as well as the cardiac recovery unit. Kelly McCann, RN, MSN, CVRN-BC, is the nurse manager of the cath lab and recovery suite. Eileen Reilly, RN, MSN, is the nurse manager for EP. Paul Ferrari, LRT, is supervisor of the invasive cardiovascular technologists.

Who scrubs, who circulates, and who monitors?     

Nurses are responsible for scrubbing, circulating, and monitoring. Technologists are responsible for monitoring and circulating. The nurses perform scrub responsibilities during both cardiac and peripheral cases.

Are there licensure laws in your state for fluoroscopy?

Yes, we adhere to the New York State Department of Health regulations, which stipulate that only a physician and a licensed radiologic technologist are permitted to operate fluoroscopy. In our lab, the radiologic technologists perform a daily equipment check by turning on and testing fluoroscopy and the x-ray equipment. Our physicians position the image intensifier (II), pan the table, step on the pedal, and operate fluoroscopy during the procedure.

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

Radiation exposure is managed by limiting exposure time, allowing for the maximum distance, and shielding from the source of radiation. We also apply low-dose fluoroscopy protocols for all our procedures. Every staff member assigned to work in our lab is provided with a lead attire (skirt, vest, and collar) and a personal thermoluminescent dosimetry (TLD) that measures exposure to ionizing radiation. Lead glasses are worn by physicians. We are also in the process of ordering lead glasses for our lab staff members. The radiology supervisor and the lead radiologic technologist are responsible for visual inspection of all lead every 6 months. The lead is barcoded, registered to the individual staff member, and tracked for bi-yearly inspection. Dosimeters are replaced monthly and exposure level reports are made available to the staff.   

Anyone exceeding exposure limits is notified and reeducated by the hospital radiation safety officer. Annual mandatory education in radiation safety and yearly competencies are maintained by all staff working in an area using ionizing radiation. Quarterly radiation safety meetings are conducted by the radiation safety officer where adverse results, overexposure, and policies and procedures are discussed.

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

One of the newer therapies introduced in our lab is EKOS therapy in the treatment of acute, massive, and sub-massive PE. In addition, we use Jetstream (Boston Scientific), AngioJet (Boston Scientific), and Pantheris (Avinger) for peripheral interventions. Impella devices are placed before performing complex PCIs in patients who are critically ill and with an ejection fraction <30%. The 2.5, CP, 5.0, and RP Impella devices are in use in our labs. ECMO is provided with collaboration and participation between the interventional cardiology physicians, staff, and the cardiothoracic team.

How does your lab communicate information to staff and physicians to stay organized and on top of change?

We have monthly quality meetings, Collaborative Care Councils, emails, briefs, and daily huddles to promote and reinforce communication among the staff. The service line also conducts quarterly meetings that are attended by our quality coordinators and physicians in the health system.

How is coding and coding education handled in your lab?

We have centralized coding system and all coding is handled by certified coders. Updates on coding are presented to our physicians and our mid-level providers through quality from our cardiac service line.

Who pulls the sheaths post procedure?

Generally, diagnostic femoral sheaths are pulled by the recovery suite nurses, and the interventional and large-bore sheaths are pulled by the NP/PA. New staff members must pull 10 sheaths under supervision of a preceptor to be signed off and deemed proficient to pull sheaths independently. Adverse bleeding events or groin complications are tracked, reported, and discussed at the monthly quality meetings. Reeducation is provided to staff when necessary.

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

Patients are prepped and recovered in a 17-bed recovery suite. Post intervention, some of our patients are kept overnight in our recovery suite and discharged home in the morning by the NP. About 80% of our femoral approach cases receive a vascular closure device (Angio-Seal, [Terumo], Mynx [Cardinal Health], or Perclose [Abbott Vascular]) to achieve hemostasis. All radial sheaths are pulled immediately post procedure in the lab while the patient is still on the table, by the interventional cardiologist or fellow, and hemostasis is obtained with the application of a radial band (Vasc Band or D-Stat Rad Band [Teleflex]). The radial band is removed after 1-2 hours by the RN while the patient is in the recovery suite. Occasionally, patients with a radial band have to be sent to the telemetry unit for their overnight stay. Transfer is made after the patient has safely recovered from sedation. In this situation, the RN in the telemetry unit will remove the band. The same competency process is practiced before a RN or NP/PA can remove a radial band.

How is inventory managed at your cath lab?

Our inventory coordinator’s responsibilities include ordering and stocking the supplies. An inventory list of all the equipment and products utilized in every procedure is generated daily from the Mac-Lab (DMS) (GE Healthcare). DMS is set up to send the inventory coordinator a notification when any of our supplies drop below the preset par levels. Based on our usage information, par levels are maintained or altered accordingly. The coordinator collaborates with the department administrative team to purchase products that are cost effective. Northwell Health negotiates costs for all products and equipment with our vendors, which helps to contain costs and achieve the most competitive pricing in the market.   

Has your cath lab recently expanded in size and patient volume?

Our cath lab has grown structurally with the addition of a Siemens Healthineers biplane lab for use in our upcoming interventional neurology program. The addition of Peconic Bay Medical Center to Northwell Health has increased our regional area of care to include the central and eastern end of Long Island. Our lab and staff members have been instrumental in supporting and training the Peconic Bay Medical Center cath lab staff, as well as providing advanced treatments and therapies to their patients. Recently, our lab has also expanded to accommodate vascular interventional procedures.    

Is your lab involved in clinical research?

Southside Hospital maintains a very active role in the field of clinical research under the direction of Dr. Luis Gruberg. Our active trials are:

• ONYX ONE CLEAR: A single-arm study with Resolute Onyx in one-month DAPT for high bleeding risk patients who are considered one month clear

Sponsor: Medtronic

The purpose of this study is to evaluate the clinical safety and effectiveness of the Resolute Onyx stent in subjects deemed at high risk for bleeding and/or medically unsuitable for more than 1 month dual antiplatelet therapy (DAPT) treatment receiving reduced duration (one month) of DAPT following stent implantation.

• SHIELD: Safety and effectiveness of remote ischemic conditioning with the autoRIC prior to elective PCI study

Sponsor: CellAegis US, Inc.

The purpose of this study is to evaluate the safety and effectiveness of the autoRIC device to reduce damage to the myocardium of subjects undergoing elective PCI.

• DEFINE: Physiological assessment of coronary stenosis following PCI

Sponsor: Philips Volcano

This is a study to assess the relationship between iFR and coronary stenosis. iFR safely and accurately quantifies stenosis severity in a wide range of lesions and may be helpful in assessing post PCI (percutaneous coronary intervention) physiology.

• Myocardial Ischemia and Transfusion (MINT) trial

Sponsor: National Heart Lung and Blood Institute

The purpose of this study is to determine at what blood count patients should be given a transfusion. Physicians frequently transfuse patients to maintain specific (and often differing) hemoglobin levels, despite the lack of evidence supporting the strategy. The study results, which will determine the benefit (or risk) of a liberal transfusion strategy, will influence the allocation of red blood cells worldwide.

• COBRA: Randomized trial of Cobra PzF stenting to reduce triple therapy

Sponsor: CeloNova BioSciences

The primary purpose of this study is to determine whether treatment with the Cobra PzF stent with 14-day DAPT has a better safety profile compared to standard FDA approved drug-eluting stent plus 6-month DAPT in patients undergoing coronary intervention who also require oral anticoagulation.

The cVAD registry for percutaneous temporary hemodynamic support: A prospective registry of Impella mechanical circulatory support use in high-risk PCI, cardiogenic shock, and decompensated heart failure.

Can you share your lab’s door-to-balloon (D2B) times and ways employees at your facility have worked together to keep D2B times under 90 minutes?

Our overall D2B time is 60 minutes. The implementation of the emergency medical services (EMS) STEMI pre-notification initiative with early activation of STEMI care teams has significantly reduced D2B times at Southside Hospital. Over the past 5 years, we tracked times when the cath lab is open to as low as 28 minutes and when the lab is closed to as low as 40 minutes. 2018 demonstrated measurable improvements in other data points such as door-to-electrocardiogram (EKG), measuring as low as 7.2 minutes, and door-to-cath, measuring as low as 43.5 minutes. Our interdisciplinary D2B workgroup including leadership, physicians, nurses from the cath lab, emergency department (ED), cardiac care unit (CCU), quality, and data registry worked aggressively to address several data points: door-to-EKG, on-call team activation, door-to-cath, and facilitating transport of the patient to cath lab. The ED re-educated staff on signs/symptoms that require immediate EKG. The application of LifeNet (Physio Control) promotes immediate transmission of EKGs to the ED from the field. Once the EKG is received in the ED, a designated ED attending expedites the EKG reading and the STEMI activation. The medical resident or cardiac NP/PA, nursing supervisor, the ED charge nurse, and physician coordinate the transport of the patient to the cath lab. If the cath lab is open, the cardiology NP and ED staff bring the patient directly to the prepared procedure room. Our community EMS is largely supported by volunteer fire/rescue departments. Ambulances are universally equipped with EKG transmission with LifeNet, and all staffed with emergency medical technicians (EMTs). We are registered with the American Heart Association’s (AHA’s) Mission:Lifeline. The multidisciplinary STEMI care teams have been successful in achieving the AHA’s Mission:Lifeline “STEMI Systems of Care” performance awards. Southside Hospital was one of 8 New York State hospitals to earn the AHA’s highest recognition for STEMI care, the Gold Award, 2 years in a row, in 2017 and 2018. Southside Hospital will continue to serve as a leader in the region and benchmark ourselves against others nationally.

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

If the team is involved with a procedure when a second STEMI is activated, the on-call physician will use medical judgment to decide the best plan of care for the patient. A nurse and the nursing supervisor transports the first STEMI to the ICU, while the second nurse and technologist prepare the second lab for the second STEMI. A second physician is available, if needed, but this option is used infrequently.

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

We are careful in our approach when using higher cost intravenous antiplatelet therapy for PCIs. An increase in the use of heparin for PCIs has significantly decreased our costs over the past few years. We also verify the need of every piece of equipment or device before we order or open it for procedures.

What quality control measures are practiced in your cath lab?

We provide patient data to the American College of Cardiology’s National Cardiovascular Data Registry (ACC-NCDR) and New York State Department of Health databases on all cardiac interventional procedures performed in the lab. We do not report on diagnostic cardiac procedures to the department of health and/or the ACC-NCDR. Quality outcomes, STEMIs, D2B times, bleeding incidents, groin complications, mortality, and morbidities are reported and discussed monthly at our quality meetings.

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

Our physicians use a power injector and a few also hand inject contrast during the procedure. The contrast dose, indicated on the injector, is noted at the start and at the end of the case, which is reported to the technologist or nurse at the monitor for documentation. The maximum volume of contrast to be used is noted at the beginning of the case for patients with a glomerular filtration rate (GFR) <60 to minimize the potential for acute kidney injury (AKI).

Are you tracking the incidence of contrast-induced AKI in patients?

NCDR data is tracked by the registry nurses and discussed at the monthly quality meeting. Recently, a decision was made to standardize hydration practices for our patients, determined by their GFR and left ventricular end-diastolic pressure (LVEDP). A guideline was developed by our physicians and NPs, based on the AHA and ACC recommendations for high risk patients with GFR <60, utilizing the maximum allowable contrast dose (MACD) (5 x weight [kg]/creatinine), to recognize the potential for AKI and to manage contrast-induced nephropathy. Our patients are monitored closely, and are hydrated pre and post procedure accordingly.

How are you recording fluoroscopy times/dosages?

In every procedure, the patient’s total amount of fluoroscopy time, as well as the cumulative dose area product (DAP), is recorded in the Mac-Lab report by the monitoring technologist or RN. Any patient exposure to fluoroscopy time over 60 minutes is monitored and reported in the monthly quality meetings.

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

Patient exposure to extended fluoro time (>60 minutes) is documented and reported to the physician, who discusses it with the patient. The nurse provides education regarding signs and symptoms of exposure. The patient receives a follow-up phone call after 3 weeks to evaluate for any adverse reaction. While this is a rare incident, patients are clinically monitored for any adverse skin effects such as burn, rash, peeling, or itching.  

Who documents medication administration during the case?

The Mac-Lab hemodynamic monitoring system is used for the documentation of all equipment, medications, and procedures by the monitoring technologist/RN. During the procedure, the medications are ordered verbally by the physician, are verified and given by the nurse, and the technologist/RN documents it. At the end of the procedure, the physician, nurse, and technologist review and sign the printed report that is generated from the Mac-Lab monitoring system.

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

The Centricity GE Medical reporting system is utilized by all physicians who practice in our invasive cardiology labs.

How are you populating ACC-NCDR records?

The service line has a team of nurses located offsite and who are trained to collect data exclusively for registry reporting. They review charts electronically and manually complete registry forms. The two registries (ACC-NCDR and New York State Department of Health) look at data from all our cardiac interventional procedures.

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

Southside Hospital is part of the Health System, therefore Northwell negotiates all of our agreements involving services, insurance agents, medical practices, and operational constraints. We work with independent private community cardiologists as well as the Northwell staff cardiologists to ensure consistency and continuity of patient care in the community.

How are new employees oriented and trained at your facility?

New employees are required to attend the health system’s orientation program called “Beginnings.” The president and CEO of Northwell attends each orientation to introduce himself, and to communicate the mission and vision of the health system. Afterwards, new hires attend site orientation at their hospital of hire, where they are introduced to and welcomed by our chief nursing officer and the executive director of the hospital. Subsequently, they begin orientation in their department/unit. The invasive cardiology educator works closely with the new employee and the management team to ensure that competencies, specific to our specialty, are met by utilizing the preceptor program and the ILearn education pathway. Technologists are required to maintain competencies for their scope of practice as well.

What continuing education opportunities are provided to staff members?

There are a variety of continuing education programs offered by nursing education. The cardiology physicians at Northwell conduct several conferences during the course of the year that employees are invited to attend. Nurses can take advantage of an on-site BSN program offered by Farmingdale State College SUNY and the on-site MSN program in leadership offered by Stony Brook University. There is also a NP program, an MBA, and MHA that the health system offers at Hofstra University. All degree programs are offered at minimal costs or supported with tuition reimbursement of $5000 per year. Certification programs are provided off site through the health system. Employees who successfully complete the certification exam are reimbursed and are given an increase in hourly rate of pay. Our nurses and technologists receive full reimbursement for program registration and continuing education time each year. An annual cardiology conference is held by Southside Hospital physicians and the staff is encouraged to attend for a reduced fee. Staff development and education is encouraged and actively promoted in our institution.

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)?

Our staff physicians hold memberships in the ACC and AHA. Our nurses belong to the American Association of Critical Care Nurses (AACN), AHA, and the Extracorporeal Life Support Organization (ELSO), while our nurse practitioners’ memberships include the American Association of Nurse Practitioners (AANP) and the American Nurses Credentialing Center (ANCC).

How do you handle vendor visits to your lab?

Vendors are limited to scheduled visits each month with our inventory coordinator. Vendors enter the building through the main entrance, where they sign in by using a vending machine that issues a daily pass, paper scrubs, and red hats, which is the required attire for their visit. The pass expires and turns color after 8 hours of activation. Southside Hospital utilizes RepTrax to ensure that the representatives meet health screening requirements and competencies set forth by the health system.

How is staff competency evaluated?

Staff competencies and mandatories are performed, evaluated, and validated annually. The invasive cardiology educator works with our staff and management to develop ongoing competency assessment tools. Competency skills specific to the cath lab are developed with the support of nursing education (sheath removal, radial band removal, preparation and use of manifold, EKG, intra-aortic balloon pump [IABP], Impella, EKOS, hemodynamics, stroke, intravenous conscious sedation, and our new interventional neurology program, etc.).

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

Yes, the cardiovascular technologists are required to take the registry exam and become credentialed for the RCIS. They do not receive an incentive or raise upon passing the exam.

Does your lab have any physical (layout) bottlenecks or limitations?

Since we have increased our volume, the physical space of the recovery suite has presented difficulties with throughput. We have use of a 4-bed post recovery area in the telemetry unit for our patients. While this helps with the bottleneck, it does not solve the problem completely.

What do you like about your physical space?

Our recovery suite has large windows that let in sunlight, which supports a healing environment. We have large windows throughout our unit. Our newest rooms are our staff lounge and the 2 new labs that are spacious and bright, with a television and a built-in sound system.    

Is there a particular mix of credentials needed for each call team? Are staff permitted to leave early or start later after a night of on-call?

Two RNs and one technologist are scheduled for call at all times. If it has been a difficult call schedule, they are allowed to leave early if the cath schedule permits.

How does your lab schedule team members for call?

Call hours are dispersed equally to staff members. Staff members are required to take call for one summer holiday, one winter holiday, and at approximately 2 weekend days per schedule. Volunteers are welcomed to sign up for holiday or weekend call, but if there are no volunteers, then it is assigned according to seniority and subject to the hours of call that the employee has taken for the past holidays. Staff members are permitted to give away or swap call, if needed.

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

The call team is expected to arrive within 30 minutes of activation.

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

Our lab uses part-time, full-time, and per diem staff. The earliest shift starts at 7:00 am and the latest shift begins at 9:30 am. Our technologists mainly work 8- and 10-hour shifts, and nurses work 8- and 12-hour shifts. Leadership huddles daily to determine and adjust staffing according to the daily needs of the department. On days with decreased volume or if we finish early, we are allowed to use our time to leave early or take the day off. During inclement weather, staffing is reviewed and managed by leadership to ensure staff and patient safety.

Do staff members have any perks you’d like to share?

Southside Hospital celebrates all staff with many celebration days: nurse week, respiratory week, radiology week, an employee barbeque, a holiday celebration for employee children, etc. Staff has free parking. We also have specific designated parking spaces assigned to the call team during off hours that are close to the hospital and visible by security personnel. We are offered free holiday meals that are hosted and served by administration. Our harvest festival includes fun-filled activities, games, and delicious treats (candied apples, popcorn, chocolate covered pretzels, freshly baked pies, apple cider, etc.) that are appreciated by staff and administration. Our employee recognition program allows anyone to award employees with recognition points. Employees can use their points to purchase gift cards, entertainment, or merchandise. We have recently instituted self-scheduling for our daily work and call schedules. Our employees who preceptor new hires and those who assume charge responsibilities are given a higher rate of pay for their efforts.

Has your lab recently undergone a national accrediting agency inspection?

Our lab has successfully undergone Joint Commission inspection and we have begun our journey to attain Magnet status.

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

Recently we have seen an increase in the number of heart failure and PE patients being treated in our institution. A new congestive heart failure support group has been created to support this patient population. The use of CardioMEMS (Abbott) to monitor high-risk patients, ECMO, Impella, and the use of EKOS have all been implemented to meet the clinical needs of our patients.

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

Our cath lab is continually introducing new treatments and therapies. The latest and most advanced treatments that have been added over the past few years include the MitraClip, TAVR, TMVR, EKOS, Impella, and ECMO. We are able to provide advanced cardiac treatments and therapies to our community so that they no longer have to travel far for high quality and efficient care.

Is there a problem or challenge your lab has faced?

Staff is encouraged to participate in a self-governance committee, the Collaborative Care Council (CCC) for interventional cardiology. Currently, the chair and co-chairs are two cath lab nurses and a technologist. Leadership that attend include executive directors and nursing management. Their role is to provide solutions, listen and address concerns. Increase in our case volume and structural space can lead to challenges in the organization of workflow, confusion and potential critical errors unless communication is encouraged and managed appropriately. We seek to foster a culture that supports patient safety and the delivery of quality care. Therefore, the cath lab Collaborative Care Council (CCC) recently addressed the lack of a patient schedule board for the staff to be informed about the flow of patients, physicians and procedures with the corresponding labs, and a visitor information board for families to track the location of their loved ones during the procedure process. This was escalated to our deputy executive director and our site chief information officer, who approved the request, procured, and installed an 80-inch electronic patient scheduling board for the cath lab and a 55-inch electronic visitor information board in the waiting room. Currently, we are collaborating with the information technology staff to develop programs that can be effectively utilized in the assignment of procedures, physicians with the corresponding labs, and for use with the visitor information board.

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

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

Our PCI task force meets with the system service line leaders to drive changes to improve quality outcomes. We have monthly meetings with the chair and director of the invasive cardiology department to discuss and review quality measures, which includes a major focus on AKI. We communicate with the private community physicians regarding documentation, changes to policies, procedures, and quality initiatives.  

Susan Murphy, RN, MSN, can be contacted at