Spotlight: Novant Health Presbyterian Medical Center Heart & Vascular Institute

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

Our cath labs are shared between interventional cardiology and electrophysiology (EP). Our department has a 20-bay pre/post unit, three cath lab procedure rooms, and utilizes a hybrid OR room as necessary. One room is a dedicated cardiac suite, one room can be used for coronary or specials, and our third room (shared with EP) is a single-plane room that can also be used for structural heart procedures. We employ 15 staff members, including four registered nurses (RNs), three radiologic technologists (RTs), six registered cardiovascular invasive specialists (RCISs), 1 registered cardiac electrophysiology specialist (RCES), and 1 lab coordinator. Staff experience ranges from a modest 20-plus years to new orientees that just began their cath lab adventure a month ago. The doors to the NH PMC Cardiac Cath Lab first opened in 1985. We have been offering our services for over 33 years. 

What procedures are performed in your cath lab?  

The NH PMC Cath Lab is a combination cardiac and special procedures unit. Our coronary work involves diagnostic and interventional procedures, including chronic total occlusions (CTOs). We also perform peripheral vascular procedures, including upper and lower extremity angiograms and interventions, abdominal angiograms and stents, patent foramen ovale (PFO) closures, use of the EkoSonic Endovascular System (BTG), chronic limb ischemic (CLI) procedures, Watchman (Boston Scientific) procedures, laser therapy, transcatheter aortic valve replacement (TAVR), and MitraClip (Abbott Vascular) transcatheter mitral valve repair (TMVR).

Can you share your experience with structural heart procedures?

The NH PMC Cath Lab has a hybrid OR suite with an Artis zee system (Siemens Healthineers), and is staffed with a combination of cath lab and OR staff members. We performed our first TAVR in November 2011 and have since performed over 350 cases. The program was initially birthed and nurtured by Dr. Richard Jacoby, Jeff Kittle, RN, BSN, RCIS (Cardiac Cath Lab Manager), Barry Horsey, RCIS, and now-retired interventional cardiologist Dr. Akinyele Aluko, all of whom underwent training at the Cleveland Clinic. After Dr. Aluko’s retirement from our organization in 2016, Dr. Oluseun Olukayode Alli became Novant Health’s structural heart specialist and director.

The NH PMC Cath Lab has a robust MitraClip program in conjunction with structural procedures such as atrial septal defect (ASD) closures and PFO closures, along with thriving Watchman procedure volumes. We are also able to do less common procedures like perivalvular leak closures.

Do any of your physicians regularly gain access via the radial artery?

All nine of our interventional cardiologists adopted radial access about five years ago. Transradial access can be utilized for diagnostic, interventional, and acute (ST-elevation myocardial infarction [STEMI]) cases, unless a limiting factor is present. 

If you are performing peripheral vascular procedures, do any operators utilize pedal artery access when appropriate?

Yes, pedal access is obtained by four of our interventional cardiologists and vascular surgeons, when necessary. NH PMC Cath Lab undertakes a high volume of complex peripheral cases.

Who manages your cath lab? 

Genteal Pelzer, MHA, NE-BC, is the director of invasive and non-invasive cardiology. Jeff Kittle, RN, BSN, RCIS, is the manager of invasive and non-invasive cardiology, and Ruben Filimonczuk, RCES, AS-PMD, CCEMT-P, is supervisor of invasive cardiology (cardiac cath and EP labs).

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

Yes. RNs can be cross-trained to the scrub position, but primarily circulate, with our technologists monitoring and scrubbing. Currently, only nurses have the capacity to dispense and administer medications.

Are there licensure laws in your state for fluoroscopy?

All technologists/nurses run the fluoroscopic equipment under the direction of the physician. North Carolina has a radiation control agency responsible for regulating radiation-producing equipment and materials used for medical, industrial, and energy purposes. The agency may or may not be responsible for regulating medical imaging and radiation therapy professionals. The NH radiation safety officer is responsible for the quality management program in radiation protection and for maintaining all state, federal and accreditation standards, regulations, and laws.

Which personnel can operate the x-ray equipment in your cath lab? 

The physicians primarily operate the x-ray equipment while technologists tend to inject contrast, but not always. Staff who moves to NH from other facilities with “panning” experience are a big asset in assisting physicians. At NH PMC, where a high volume of complex cases are performed, collaborative efforts and experiences are invaluable to ensure a successful outcome for all our patients. Our cath lab values a team approach. 

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

The staff is provided with lead aprons and lead glasses. All staff is required to wear dosimetry badges that are analyzed quarterly. Protection is also provided by means of lead shielding, Radpads (Worldwide Innovations & Technologies, Inc.), and education on radiation safety and internal radiation protection initiatives.

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

The cath lab works with a large variety of technology and equipment, including Jetstream (Boston Scientific), AngioJet (Boston Scientific), TurboHawk (Medtronic), intra-cardiac echocardiography (ICE), intra-aortic balloon pumps, Impella – CP & RP (Abiomed), Ekos (BTG), Diamondback 360 (coronary and peripheral) (CSI), ACIST CVi contrast injection system, laser therapy, Rotablator (Boston Scientific), intravascular ultrasound (IVUS) with the multi-modality platform for fractional flow reserve and diastolic fractional flow reserve (dFFR) (Philips Volcano), Watchman procedures, MitraClip procedures, PFO closure procedures, TAVR and TMVR procedures, TandemHeart procedures (LivaNova), CardioMEMS (St. Jude Medical) insertion, and various closure devices such as Angio-Seal (Terumo), Mynx (Cardinal Health), Perclose (Abbott Vascular), and the TR Band (Terumo). This year, we introduced the HD-IVUS in conjunction with the Comet FFR wire (Boston Scientific) and Wolverine cutting balloon (Boston Scientific).    

How does your lab communicate information to staff and physicians?

We have weekly huddles, monthly staff meetings, internal email, educational in-services, and cardiac cath conferences for staff and physicians.

How is coding and coding education handled in your lab? 

All coding is handled through our corporate coding department. A designated cath lab charge specialist mediates all information between staff, physicians, and the hospital’s chargemaster department, which in turn handles all coding for the cardiac cath lab department. 

Who pulls the sheaths post procedure? 

After completing required NH PMC cardiac cath lab competencies, registered technologists and nurses are qualified to apply manual pressure and pull sheaths. Sheath removal may, at times, need to be performed by nursing staff from adjacent units. The nursing staff from these units are trained under the same competencies as the cardiac cath lab staff. 

Patients who have had their radial artery accessed are managed with radial bands (TR Band) applied by the scrub individual prior to patient leaving the cath lab. Perclose, Angio-Seal, and Mynx are utilized for those patients that have undergone a femoral approach and are deployed by the interventional cardiologist.

How is inventory managed at your cath lab? 

A designated operating room coordinator (ORC) for supply chain is responsible for ordering and maintaining par levels on a daily basis. Inventory for the cath lab is done annually in December and the ORC is responsible for ensuring their area is in order. Corporate finance will audit the manual count of the entire department, allowing minimal counting errors. Inventory and storage remain dynamic challenges.

Is your lab involved in clinical research? 

NH PMC Heart & Vascular Institute is a leader in national and international cardiovascular research. Our exceptional doctors and coordinators have allowed us to become a top-performing cardiovascular investigative site and participate in many pivotal trials. Currently, we are participating in the following studies:

• Xience 90 – Short Dual Antiplatelet Therapy (DAPT) Study
• LEADERS-FREE: polymer-free drug-eluting stent study, short DAPT
• COPPER-A: occlusion perfusion catheter (OPC) for optimal delivery of paclitaxel for the prevention of endovascular restenosis ­— above and below the knee
• We are a future trial site for TAVR and TMVR research studies.

Can you share information about your lab’s door-to-balloon (D2B) times?  

Median door-to-device timing is 51 minutes for non-transfer patients (national benchmark is 60 minutes) and 79 minutes for transfer-in patients (national benchmark 106 minutes) for PMC as of Q1 2018. (Source: American College of Cardiology’s National Cardiovascular Data Registry [ACC-NCDR] CathPCI registry).

Are you registered with the American Heart Association’s Mission:Lifeline or the ACC’s D2B Alliance?

PMC participates in AHA Mission: Lifeline, and the ACC-NCDR Chest Pain-Myocardial Infarction (MI) national registry (formerly ACTION) award performance programs. PMC has received the highest award levels for both these programs since their recognition programs began: 

• Mission:Lifeline STEMI receiving facility – Gold Plus Level;
• ACTION registry MI performance – Platinum Level.

Who transports the STEMI patient to the cath lab?

Patient transport is facilitated by emergency medical services (EMS) directly to the cath lab. If the patient was first brought to the emergency department (ED), the ED nurse transports to the cath lab. If the patient is in-house, team members from all units may work together to assist in transporting the patient to the cath lab.    

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

The STEMI on-call physician, ED physician, and the cath lab team triage patients if a second room, team, and physician are not available. If necessary, the patient on the table will be moved and held in the recovery area temporarily until their case can be completed. Our team leaders have also reached out to other members NOT on call to ask for volunteers to help mend the situation.

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

Our designated ORC in the cath lab supply area is dedicated and meticulous. The ORC has several initiatives that have been instituted to help reduce cost:  

1.    Any balloon or stent that does not cross the lesion gets full replacement from the vendor FREE;

2.    Anything that can be consigned is consigned;

3.    Vendors check their stock to ensure products don’t expire;

4.    Cath lab team also helps to check expiration dates;

5.    ORC keeps the physicians informed of upcoming expired products so these products can be used or removed from the par level;

6.    ORC checks balloons and stents every day to ensure she doesn’t need to order (because of the “no-cross” free exchange, she may have balloons/stents coming in);

7.    Management consistently seeks out cost-saving initiatives.    

What quality control measures are practiced in your cath lab?

There are many elements to an effective quality control plan, including setting a quality control schedule, educating staff on the value of the program, training staff to perform tasks, and maintaining records for verification. Quality control allows optimal delivery of patient care, and promotes stewardship of the limited resources available in the modern healthcare environment. An effective quality control program establishes uniform standards of excellence, and enables the staff to understand the value of the processes and practices that are involved to create and maintain it. At Novant Health Presbyterian Medical Center, each day begins with reviewing and updating the schedule, opening the labs, making sure they are properly supplied, and performing comprehensive quality control. Quality control is a foundational concept that we adhere to in order to promote patient and staff safety. We verify that the lab’s equipment works properly, and that we are compliant with industry- and regulatory-based standards of excellence. The equipment that needs to be “QC’d” includes the Avoximeter and Hemochron (Accriva Diagnostics), defibrillator, emergency equipment, fluoroscopic and imaging systems, personal protection equipment, climate control, medical gasses, personal lead, and any procedural equipment necessary to perform patient care.

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

In 1976, the Cockcroft Gault (CG) formula was developed to predict creatinine clearance (CrCl) based upon the serum creatinine (SCr) alone versus formal creatinine clearance, which requires additional measurement of urine creatinine in a timed urine collection. Since then, the CG formula has become a common method to estimate renal function, as it is widely available, relatively quick, and inexpensive. It certainly provides a quick estimate of creatinine clearance that may be helpful in determining the appropriate dosages of nephrotoxic drugs (iodinated contrast) or drugs that reply on renal excretion. Therefore, we determine the amount of contrast delivered to our patients based on the CG formula.

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

Yes, we track acute kidney injury (AKI) events, based on the NCDR definition. Our process includes:

• If patients are identified during scheduling (office labs or if in-house, unit staff) as at-risk of an AKI event pre percutaneous coronary intervention (PCI), the physician decides on cancellation or how to better prepare patient for the procedure.
• If an AKI event occurs, an established subcommittee drills down each event and determines if anything could have been done differently (contrast amount, pre-procedure hydration, etc.) The committee attempts to determine if the event is related to anything in the process or structure of care that may have impacted the outcome.
• Every AKI event is identified as soon as possible, and feedback via email is given directly to the cardiologist with the patient history/factors and lab results.

How are you recording fluoroscopy times/dosages? 

The American College of Radiology-Society of Interventional Radiology (ACR–SIR) Practice Guideline for the Reporting and Archiving of Interventional Radiology Procedures recommends that radiation dose data be recorded in the final report for all fluoroscopically-guided procedures and that, if possible, all radiation dose data recorded by the fluoroscopy unit should be transferred and archived with the images from the procedure. We currently use our Mac-Lab system (GE Healthcare) and Epic to document the fluoroscopy time (unit: minutes) used during each procedure and the amount of radiation dose absorbed (cumulative air kerma [CAK], unit: milligray [mGy]).

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

A record of the investigation(s) are kept for a minimum of two years. There are adequate guidelines provided to the users of fluoroscopic x-ray equipment that satisfies the regulatory standards under clinical use conditions. The radiation safety department reviews exposures on a regular basis that are in accordance with the ALARA (As Low As Reasonably Achievable) policy and procedure. If an incident is reported, then an incident report is filed. The radiation safety officer reviews the case and a follow-up is completed by the radiation safety officer according to hospital policy. However, with radiation exposures greater than 5Gy, it is the responsibility of the NH radiation safety officer to notify the patient.

Who documents medication administration during the case?

Medications are documented in both the patient’s electronic medical record (Epic) by the administering nurse and in the Mac-Lab report, which is done by all staff members, but is verified by the nurse.

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

Physicians perform their dictation using structured reporting tools like Centricity (GE Healthcare) or PowerScribe 360 (Nuance).

In which registries do you participate?

PMC participates in several ACC-NCDR registries:

1.    CathPCI;

2.    Chest Pain-MI (previously ACTION);

3.    Implantable Cardioverter Defibrillator (ICD);

4.    Left Atrial Appendage Occlusion (LAAO);

5.    TAVR (Society of Thoracic Surgeons [STS]/ACC Transcatheter Valve Therapy [TVT] Registry); 

6.    Under consideration for participation: Vascular (Peripheral Vascular Intervention [PVI]).

PMC out-of-hospital cardiac arrest data is entered into the Cardiac Arrest Registry to Enhance Survival (CARES) national registry. We also participate in American Heart Association – Get With The Guidelines (GWTG) Coronary Artery Disease (CAD) Registry; for 2018, we are exporting files from ACC-NCDR Chest Pain-MI registry and uploading into GWTG-CAD for our Mission:Lifeline MI initiative.

How are you populating registry data records?

Currently, we retrieve this information and enter it into our databases manually. Clinical improvement analysts abstract, enter, validate, and analyze all registry data. There are future plans to automate and populate fields wherever possible. Depending on the registry, we either enter into a third-party vendor or use direct entry into the national registry database. The source of all data entered is the patient’s chart. We do utilize the procedure event logs and dictation to complete cath lab-based fields. 

How does your cath lab compete for patients? 

Novant Health is a four-state integrated network of physician clinics, outpatient facilities, and hospitals that delivers a seamless and convenient healthcare experience to our communities. The Novant Health network consists of more than 1,500 physicians and over 28,000 employees that provide care at over 580 locations, including 14 medical centers and hundreds of outpatient facilities and physician clinics. Headquartered in Winston-Salem, North Carolina, Novant Health serves more than 4 million patients annually. By bringing together world-class technology and clinicians to provide quality care, we are committed to creating a healthcare experience that is simpler, more convenient, and more affordable, so patients can focus on getting better and staying healthy. Novant Health, in conjunction with Carolinas Medical Center (now Atrium) and the Mecklenburg County Health Department, decided to collaborate and focus on the public health priority areas within Mecklenburg County. This collaboration was driven by innovative organizational leadership, and the comparison of social determinant data to patient data and outcomes. They also identified physician leadership in organizations working to improve community health.

How are new employees oriented and trained at your facility?

All employees initially undergo an entire week of our organization’s corporate orientation program prior to going to their designated units. Once the new employees arrive at the cardiac cath lab, the new member is paired with an elected staff member who is a certified proctor. They are then mentored for 90 days or until the proctor deems the new recruit ready to function independently in the unit.

Senior cath lab nurse Emily Luna has helped direct the program and streamline the training for new cath lab recruits. A portion of this training takes place in various cardiovascular units such as the coronary care unit (CCU), intensive care unit (ICU), EP lab, etc., given the fact that becoming a cardiac cath lab nurse specialist entails rigorous post-licensure training and clinical experience. For those nurse candidates who lack clinical experience, our program allows the new nurse recruit to obtain the needed background. Rose Servido serves as our primary liaison and proctor for training our cardiovascular and radiologic technologist students from Central Piedmont Community College during their clinical rotations.

What continuing education opportunities are provided to staff members?

Education is an integral part of what we do, given the numerous devices, evolving technology, new staff, and new procedures introduced into the lab, and continues to be an ongoing process (as it should). Increased education is certainly a tool, one that leads to increased skill levels, which in turn also increases physician confidence in staff. We at NH PMC Cardiac Cath Lab work closely with various company representatives who graciously provide in-services and educational opportunities for all staff members to also obtain CEUs. Once per quarter, our physicians also provide an educational opportunity by taking our staff to dinner and simultaneously providing an in-service on various topics or procedures performed within our lab. 

How do you handle vendor visits to your lab? 

Vendors must schedule visits with the inventory coordinator (the ORC in the cardiac cath lab) who oversees this task. The hospital has a check-in system (Vendormate) for the vendor each time they visit, which logs them in and produces a visitor badge for that day. The number of vendors each day is controlled in order to avoid disrupting the care provided to our patients.

How is staff competency evaluated? 

New initiatives are currently being put into action for a bi-annual skills fair conducted yearly that evaluates each individual’s competency for various skills, device usage, and applications. The skills fair is a week-long process with various representatives reviewing and refreshing team members on the application of devices with hands-on setup and preparation. Each team member carries a packet containing check-off sheets for each station, and will go through each station completing the hands-on review and being signed off. Examples include intra-aortic balloon pumps (IABPs), sheath pulling, AngioJet, IVUS, etc. 

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

All cardiovascular technologists working in the cath or EP lab are required to have the RCIS or RCES prior to becoming an employee at Novant Health. Radiologic technologists are required to obtain the Cardiovascular Interventional Radiography (CV) credential within 2 years of employment. Nursing staff has the option of whether to obtain the RCIS/RCES credential(s).

What do you like about the physical space in which you work? 

All cath lab rooms are located to one side of a long hallway. Coincidently, Unit Coordinator Wendy Ballentine’s station is located opposite of the cardiac cath lab rooms in order to maintain a visual on progress of all procedures, ensuring the seamless workflow of the lab. The manager’s office is on the far end of the hallway and the supervisor’s office is on other end of the hallway. All patients coming for procedures enter and exit through only one set of secured doors, admissible by employees with badge access.   

How does your lab schedule team members for call?

Team members self-schedule themselves for call. Our scheduler (Rose Servidio) determines how many days each team member needs to take and each individual then signs up. The order in which people sign up rotates each cycle so everyone gets a chance to eventually pick first. Once team members pick call, the scheduler assigns late days, being mindful of the days each individual picked for call and tries not to assign a late day on a post call day. The schedule also ensures that people are not assigned call or late on the days which the team members are scheduled off. 

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

Call team credential mix is one nurse with 2 technologists.

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

The team has a 30-minute response time. In light of the Charlotte traffic due to the large influx of people that have relocated to this city, our current door-to-balloon time performance testifies to our team’s commitment.

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

Recruiting and retaining top talent has a lot to do with the benefits and incentives offered by the company/organization. Today, it can be difficult to discern what it is that really attracts employees, and then what continues to motivate them once they have been hired. At NH PMC Cardiac Cath Lab, we recognize hard work and efforts put forth by our incredible team. Some perks we have implemented are:

1.    Education and development opportunities – paid conferences, symposiums and seminars;

2.    Yearly performance bonus;

3.    Proctor pay – additional pay for experienced proctors overseeing the training of new employees;

4.    Self-scheduling for call rotation;

5.    Extended lunches – a relaxed lunch can go a long way in order to face the rest of the day;

6.    Free parking – this can be a “biggie” – many large facilities/ organizations charge their own people to park…yikes!

Has your lab recently undergone a national accrediting agency inspection? 

NH PMC Cardiac Cath Lab has an ongoing system to maintain our proficiency for unannounced Joint Commission inspections. Our hospital last went through Joint Commission accreditation in 2017. Advice that our cath lab has to offer: 

1)    Avoid errors committed in the TIME-OUT procedure:

a.    Time-outs occurring before all staff members are ready or before prep and drape occurs;

b.    Performing time-outs without full participation of all the staff involved;

c.    Lack of senior leadership engagement in the time-out;

d.    Staff feeling passive or inattentive to time-out process;

e.    Inconsistent organizational focus on patient safety;

f.    Distractions or rushed time-outs.

^*Needless to say that the Joint Commission underscores the crucial need for effective preoperative communication and planning for surgical teams.

2)    Focus on narcotics control (waste/count procedures and documentation, and how long it is kept and where).

3)    Radiation monitoring and annual lead apron checks (ensure documentation).

4)    Maintain staff educational records, and proof of licensure and certifications.

5)    Initial and ongoing competency checks (documentation within the department and in human resources).

6)    Be knowledgeable of the conscious sedation policy and training.

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

Peripheral work and the growth of structural heart procedures has become a focus and means of volume growth for us. The PFO program commenced 16 years ago under the direction of Dr. Akinyele O. Aluko and we have performed 528 PFO cases to date. 

We started our MitraClip program in 2014 and performed our first case in December 2014. To date, we have performed about 108 cases. 

Our Watchman program started in 2016 with the first case done in November 2016. To date, we have completed 49 cases. Currently, we have one physician who is trained and performing these cases, Dr. Oluseun Alli.

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

Our cardiac cath lab nursing staff comes from a variety of backgrounds: emergency care, intensive care, cardiac telemetry, step down, and med surg. Our technologists come from just as diverse a background, from 20-plus years of experience in the cath lab to new graduates from our local cardiovascular program. This brings a robust and dynamic view of patient care and treatment.  

We are also a primary training site for Central Piedmont Community College (CPCC) students in the Cardiovascular and Radiology Technology program here in Charlotte, North Carolina. The CPCC students are proctored by our senior technologists and nurses, allowing them to gain hands-on experience in order to enhance their learning and education. 

Is there a problem or challenge your lab has faced? 

In today’s competitive market for cardiovascular services, job opportunities within the specialty have increased as a result of nationwide program growth. Staff retention should always be considered of major importance to hospital and service line leaders. Industry estimates reveal that the increased expenses for recruitment and relocation of new staff, overtime rates to ensure adequate coverage during the hiring process, the costs of temporary/agency staff, as well as the costs associated with training the new team members can easily exceed $25,000 for every new hire. While these expenses can be quantified, it is much more difficult to assess the impact of vacancy and turnover on the organization as a whole in terms of the morale and job satisfaction of the existing staff. Furthermore, unhappy employees are typically under-productive, which can translate into operational inefficiencies, higher care delivery costs, and decreased patient satisfaction scores. NH PMC Cardiac Cath Lab designed a retention plan to help with this issue, starting with our leadership:

1.    Leaders need to have a high investment in “retention”;

2.    Using core members, build a council to help develop retention strategies; this in itself “tightens” the bonds with stable members;

3.    Choose the right person for the job – avoid the “turnstile to turnover”;

4.    Treat your employees like extended family – be kind to one another;

5.    Get your employees to understand the vision, mission and values of the organization. Frankly, most formal mission statements fail to embody adequate amperage to grab the attention of a workforce. At Novant Health, we go beyond the vison, mission and values of the organization and include “Our People” and “Our Promise”. 

    Our People Credo states, 

    “We are an inclusive team of purpose-driven people inspired and united by our passion to care for each other, our patients, and our communities”. This is not a slogan. Our People Credo articulates a unifying vision that aligns the organization’s engagement initiatives, patient-centered goals, and overall mission.

     Our Promise says, 

    “We are making your healthcare experience remarkable. We will bring you world-class clinicians, care and technology – when and where you need them. We are reinventing the healthcare experience to be simpler, more convenient and more affordable, so that you can focus on getting better and staying healthy”.

    Novant Health is the transformation in healthcare! How can you not want to work for an organization with such a deep commitment to their patients, employees and communities?

6.    Focus on the end result that the organization produces, not just the tasks individuals perform. The member of the housekeeping staff who contributes to a remarkable guest experience is more engaged than the one who just cleans hotel rooms.

7.    As a leader…stand behind the vision, mission and values – practice what you preach.

8.    Recognition, in various forms, is a very powerful retention tool.

9.    Have fun! Remember this is your extended family. Go to dinner together.

10.    Strong retention strategies become strong recruitment advantages.

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”?

Charlotte is a region that is equal parts old-fashioned southern charm and high-energy cosmopolitan bustle. You’ll still hear “y’all” dropped into casual conversation, but Charlotte is a metro area on the rise, and has its own culture, culinary sophistication, and unique feel that’s making it a more enticing place for people from all over the world to settle down. This melting pot effect makes Charlotte an easy area to become a part of. As the influx of growth continues with its diversity of people, you can often hear from a true Charlottean, “You’re not from here”? Well, neither are most people you’ll meet.

Charlotte has become a place filled with new restaurants to try and events that attract people from all over. It’s a standalone destination area now, no longer living in the shadows of Atlanta or Charleston, South Carolina. Though Charlotte has evolved significantly in the past decade, the transformation is only continuing, as evidenced by the numerous construction cranes across the skyline.

New census numbers released in May show that Charlotte is the 17th largest city in the country and the third fastest growing city across the nation.

You’ll frequently hear the word “manageable” used to describe Charlotte. Its climate is more manageable than Florida’s climate, and its housing prices and living expenses are more manageable than those of other major cities. Charlotte is a vibrant city that has something for everyone, allowing us to attract the best and the brightest.

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?

Each Best Practice Team is driven by a national registry population. We set goals (usually top 10%) and report to our teams regularly. This information drives where we wish/need to focus. 

We provide regular case feedback and have regular case review meetings with all teams, including EMS. Benefits of participating in quality improvement initiatives and national registries:

• Elevates use of data
• Promotes consistency of reporting
• Promotes exchange of information/tools
• Learn from other sites
• Share best practices
• Friendly competition (corporate-wide, regional, and national)
• Provides a collaborative effort toward change
• Provides communication with senior management
• Provides benchmarks and comparison data
• Provides a voice in changing/growth of registries 

Acknowledgments. A special thank you to:

Dr. Michael Miller and Brian Harkey, for lending their talents in photography and granting us these wonderful pictures. 

Rosanne Short and Alyson Flood, for their time and assistance with not only gathering needed data, but walking us through it.