Cath Lab Spotlight
Bakersfield Heart Hospital
August 2010
Tell us about your cath lab.
Bakersfield Heart Hospital is a 47-bed cardiac specialty hospital. The cath lab has four procedure rooms joined by a central control room. Having a central control room works well, since all staff immediately knows when a case begins and is completed, helping in efficient turnover. Two of our rooms predominantly serve as coronary procedure suites. One has a flat-panel imaging system (GE Medical Systems, Waukesha, WI) and the second has an image intensifier GE system. Both rooms also have the iLab intravascular ultrasound (IVUS) (Boston Scientific, Natick, MA). Our third room is predominantly used as the peripheral procedure room, with a flat-panel GE system equipped with all inventory for complex peripheral percutaneous interventions. The fourth room has an image intensifier system and is used for electrophysiology procedures (EP), including EP studies and pacemaker/defibrillator placements.
Bakersfield Heart Hospital cath lab staff includes 6 full-time registered nurses (RNs) (one traveler), 5 full-time radiologic technologists (RTs), and 1 full-time inventory clerk. Eighteen interventional cardiologists use the cath lab, with the largest operating group being Central Cardiology Medical Clinic, with 7 physicians (headed by Dr. Brij Bhambi and including Drs. Atul Aggarwal, Tetsuo Ishimori, Peter Nalos, William Nyitray, Kirit Desai and Sanjiv Sharma), and Dr. Dennis Maddox and Dr. Jared Salvo (for complex EP ablation procedures).
One per diem RN and 2 per diem RTs share in covering call and are assigned periodic shifts. Our senior RN has been ‘in residence’ for 5 years and our chief RT has been working in the cath lab for 9 years, with 5 years at Bakersfield Heart Hospital.
What types of procedures are performed at your facility? We perform: • All forms of retrograde left and right heart catheterizations; • All forms of percutaneous coronary interventions (PCIs), including balloon angioplasty with adjunctive intracoronary stenting using various drug-eluting stents, and Cutting Balloon (Boston Scientific, Natick, MA) and rotational atherectomy; • Intracoronary ultrasound (IVUS); • Aspiration thrombectomy using the Possis AngioJet device (Minneapolis, MN); • Placement of percutaneous left ventricular assist device (Impella 2.5, Abiomed, Inc., Danvers, MA); • Percutaneous device closure of patent foramen ovale (PFO) for cryptogenic stroke; • Intracardiac echocardiography, using the Biosense Webster AcuNav ultrasound catheter (Diamond Bar, CA); • Electrophysiologic procedures, including radiofrequency ablation for atrial flutter and atrial fibrillation [using the Ensite navigation system (St. Jude Medical, St. Paul, MN)]; • Permanent pacemaker implantation; • Implantable cardioverter defibrillator (ICD) implantation; • Peripheral arterial angiography and intervention; • Carotid artery stenting; • Peripheral arterial atherectomy using the SilverHawk device (ev3 Endovascular, Inc., Plymouth, MN); • Orbital atherectomy using the Diamondback 360˚ PAD System (Cardiovascular Systems, Inc., St. Paul, MN); • Peripheral atherectomy using the Jetstream G2 device (Pathway Medical Technologies, Inc., Kirkland, WA); • Endoluminal graft placement for aortic aneurysms; • Inferior vena cava filter placement; • Hemodialysis access catheter placement. The catheterization laboratories handle approximately 70 cases per week, of which 85% are coronary/cardiac rhythm management procedures, and 15% are peripheral vascular procedures.
Does your lab perform primary angioplasty with surgical backup on site? The catheterization laboratory does not perform angioplasty without surgical backup and facilities for coronary artery bypass grafting are always available on site. What percentage of your patients is female? Approximately 45% of patients undergoing different procedures in the cath labs are female.
What percentage of patients go on to have an interventional procedure and what percentage of your diagnostic caths are normal? Approximately 50% of the patients undergoing diagnostic coronary angiography go on to have ad hoc percutaneous coronary intervention in the same setting. About 10% of the diagnostic coronary angiograms are normal, i.e. free of any significant angiographic narrowing.
Do any of your physicians regularly gain access via the radial artery? None of the physicians regularly gain access via the radial artery, and all the operators predominantly gain retrograde transfemoral access.
Who manages your cath lab? Roger Sadberry manages the catheterization laboratories, day patient area, and gastrointestinal laboratory. He possesses 36 years of cardiac catheterization laboratory experience.
Who scrubs, circulates and monitors? RTs scrub, and RNs circulate for administration of intraprocedural medications and help in delivery of catheters and equipment. Either an RT or RN monitors the procedure.
Does an RT (radiologic technologist) have to be present in the room for all fluoroscopic procedures in your cath lab? Yes, an RT has to be present for all fluoroscopic procedures in the catheterization laboratories.
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? Only California fluoroscopy-licensed CRT(F) personnel can step on the fluoroscopic pedal. This may be an RT or a physician. Physicians usually step on the fluoroscopy pedal, and an RT usually controls the table and pans the imaging.
How does your cath lab handle radiation protection? The scrubbed RT collimates appropriately, and physicians stay off the pedal when an RN is administering medications. In-services and yearly competencies on radiation safety are conducted rigorously.
What are some of the new equipment, devices and products introduced at your lab lately? We have recently begun to use the Pathway Medical Jetstream G2 peripheral arterial atherectomy device, the Amplatzer “Cribriform” atrial septal defect occluder (AGA Medical Corporation, Plymouth, MN), and are part of the Boston Scientific carotid Wallstent CABANA post-market approval study.
How does your lab communicate information to staff and physicians to stay organized and on top of change? Monthly staff meetings combined with a small hospital size and a friendly atmosphere facilitate informal communication between staff, physicians, and administration.
How is coding and coding education handled in your lab? Procedural and equipment charges are bundled together into our Witt monitoring system (Philips Medical Systems, Bothell, WA). Every morning, one of our two charge experts verifies accuracy of the equipment used, and posts employee initials next to any mistakes. The employee then makes the necessary correction accordingly. Current procedural technology (CPT) guidelines are posted in the Witt monitoring system under a ‘frequently asked questions’ section.
How does your lab handle hemostasis? Most of our physicians use StarClose (Abbott Vascular, Redwood City, CA), Angio-Seal VIP (St. Jude Medical) or Perclose ProGlide (Abbott Vascular) vascular closure devices, when applicable. Otherwise, manual compression is performed using the SyvekPatch (Marine Polymer Technologies, Danvers, MA) or D-Stat Dry (Vascular Solutions, Inc., Minneapolis, MN), when sheath removal is performed in the catheterization laboratory. Manual compression is performed when the activated clotting time (ACT) is less than 170 seconds or 2 hours after termination of bivalirudin (Angiomax, The Medicines Company) infusion on the floor (for inpatients) or day patient area (for outpatients).
How are hematomas managed? Hematomas are managed with manual compression or application of the FemoStop compression device (St. Jude Medical), per physician preference. Hematomas are documented on occurrence report sheets and forwarded to the risk management personnel, who then calculate the rate of complication for hematomas on a quarterly basis.
How is inventory managed at your cath lab? An Excel spreadsheet contains line item and par levels for each piece of equipment in our department. Our inventory clerk arrives before start of shift and is responsible for stocking the rooms and ordering all supplies.
Has your cath lab recently expanded in size and patient volume? Our volumes are up slightly from the last year (5%), but no new expansion is expected in the near future.
Is your lab involved in clinical research? We are currently enrolling patients in multiple clinical trials, including a carotid stenting trial sponsored by Abbott Vascular (CHOICE) and Boston Scientific (CABANA), and a drug-eluting stent trial sponsored by Boston Scientific (TAXUS LIBERTE). In addition, the cath lab submits all data on percutaneous coronary interventions to the CATH PCI registry of the American College of Cardiology’s National Cardiovascular Data Registry (ACC-NCDR). Data on all ICD procedures are submitted to the ACC-NCDR ICD registry. This serves to help the hospital benchmark its performance against the >1000 hospitals currently participating in the ACC-NCDR.
Have you had any cath lab-related complications in the past year requiring emergent cardiac surgery? None of the catheterization laboratory complications in the past year required emergent cardiac surgery.
Can you share your lab’s average door-to-balloon (DTB) times and some of the ways employees at your facility have worked together to keep DTB times under the mandated 90 minutes? The average DTB time for patients presenting with acute myocardial infarction is 60 minutes on average. Constant coordination between emergency room staff and physicians, the hospital charge nurse, interventional cardiologists, the performance improvement committee, and the catheterization lab staff helps facilitate updates and improvements. Upon identification of ST-elevation acute myocardial infarction (STEMI) in the emergency room, the clock starts ticking, and the interventional cardiologist and the catheterization lab staff are activated simultaneously, so that the cath lab staff is at the patient’s bedside within 30 minutes of a STEMI alert. The average door-to-balloon time for 2009 was 73 minutes, and the goal for door-to-balloon time for 2010 is 60 minutes.
What other modalities do you use to verify stenosis? Are you using physiology for lesion assessment? We use IVUS and quantitative coronary analysis with our GE Medical x-ray system (Waukesha, WI) to verify the degree of coronary stenoses. Both the coronary rooms have integrated grayscale intravascular ultrasound integrated into the imaging system (the Boston Scientific iLab). We have grayscale IVUS only and do not have virtual histology (Volcano Corporation, Rancho Cordova, CA). We use non-invasive modalities only for assessment of physiology of coronary stenoses, and we do not have a fractional flow wire.
What measures has your cath lab implemented in order to cut or contain costs? We run lean on staff, negotiate locally with vendors, and are enrolled in capitation programs.
What types of quality control/quality assurance measures are practiced in your cath lab? Along with our participation in the ACC-NCDR, catheterization laboratory outcomes are followed by a quality assurance committee and individual physicians are informed of variances in outcomes.
How does your cath lab compete for patients? Has your institution formed an alliance with others in the area? Our physicians prefer to work here because our staff makes an effort to accommodate them and our patient satisfaction scores remain high. Contracts get shuffled amongst facilities around town, but typically our catheterization laboratory stays quite busy.
How are new employees oriented and trained at your facility? New employees are teamed up with the senior RN or chief RT for 3-6 months for a hands-on orientation. New employees typically start covering call with their preceptor within a month. Each staff needs to be either an RN or RT, along with basic life support (BLS)/advanced cardiac life support (ACLS) certification.
What types of continuing education opportunities are provided to staff members? The education department provides CME programs in-house. Also, the staff is encouraged to attend lectures with guest speakers on a monthly basis.
How do you handle vendor visits to your lab? All vendors are required to sign in and must be able to access Vendormate (Atlanta, GA) to be allowed in the cardiac catheterization laboratory. All vendors must come by prior appointment, and visits are limited to specific times and days.
How is staff competency evaluated? Mandatory annual and bi-annual department specific competencies are tracked by the education department.
How does your lab try to reduce patient anxiety? The day patient nurses and floor nurses are always there to reassure and inform the patients about their procedure, so that they feel relaxed and comfortable. Periprocedure conscious sedation is provided depending on American Society of Anesthesiology class, with a physician in presence.
How does your lab handle call time for staff members? At least one RN and one RT, and one other staff RN or RT are present for handling urgent/emergent cases that need to be done after regular hours and on the weekends. We cover one night call per week and one weekend per month.
Within what time period are call team members expected to arrive to the lab after being paged? The call team members, including interventional cardiologist, are supposed to reach the hospital within 30 minutes of STEMI call.
Do you have flextime or multiple shifts? Our staff works four 10-hour shifts per week.
Has your lab has undergone a Joint Commission inspection in the past three years? We are currently in a survey readiness mode, with a Joint Commission inspection due at any moment. We have a ‘focus goal of the week’ for preparation in the catheterization laboratory and also perform mock tracers in the hospital.
Where is your cath lab located in relation to the operating room (OR) and emergency department (ED)? Our cardiac laboratory lies directly between the ED and surgical operating rooms.
How do you see your cardiac catheterization laboratory changing over the next few years? Bakersfield Heart Hospital is part of Medcath Corporation, which is up for sale, so any number of things may happen as a result. We do expect that a larger percentage of radial procedures and endoluminal stent-graft placements will take place at our lab.
What do you consider unique or innovative about your cath lab and its staff? The staff provides relevant input towards process improvement to our physician owners, and since our facility has a short chain of command, changes get implemented quickly.
Is there a problem or challenge your lab has faced? Staffing and training seems to be a constant challenge for the laboratory. Creative scheduling around personal lives and education needs, along with support from our colleagues, makes everything work out.
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”? Bakersfield, California lies 120 miles north of Los Angeles and is the 11th largest city in the state. We have a small-town atmosphere, and because our hospital is small, everyone knows each other by name.
The Society of Invasive Cardiovascular Professionals (SICP) has added two questions to our spotlight: 1. Do you require your clinical staff members to take the registry exam for Registered Cardiovascular Invasive Specialist (RCIS)? Does staff receive an incentive bonus or raise upon passing the exam? We recommend all staff try for RCIS certification, or discipline-specific advanced credentialing (CIT, CCRN, etc.), though no pay incentive is in place at this time.
2. Are your clinical and/or managerial team members involved with any professional organizations that support the invasive cardiology service line, such as the SICP, ACVP, or regional organizations? Yes, the clinical team is involved with multiple professional organizations. All the physician operators are fellows of the American College of Cardiology and its state chapter, and most are fellows of Society for Cardiovascular Angiography & Interventions (SCAI) as well. Dr. Atul Aggarwal can be contacted at vipulatul7@yahoo.com
What types of procedures are performed at your facility? We perform: • All forms of retrograde left and right heart catheterizations; • All forms of percutaneous coronary interventions (PCIs), including balloon angioplasty with adjunctive intracoronary stenting using various drug-eluting stents, and Cutting Balloon (Boston Scientific, Natick, MA) and rotational atherectomy; • Intracoronary ultrasound (IVUS); • Aspiration thrombectomy using the Possis AngioJet device (Minneapolis, MN); • Placement of percutaneous left ventricular assist device (Impella 2.5, Abiomed, Inc., Danvers, MA); • Percutaneous device closure of patent foramen ovale (PFO) for cryptogenic stroke; • Intracardiac echocardiography, using the Biosense Webster AcuNav ultrasound catheter (Diamond Bar, CA); • Electrophysiologic procedures, including radiofrequency ablation for atrial flutter and atrial fibrillation [using the Ensite navigation system (St. Jude Medical, St. Paul, MN)]; • Permanent pacemaker implantation; • Implantable cardioverter defibrillator (ICD) implantation; • Peripheral arterial angiography and intervention; • Carotid artery stenting; • Peripheral arterial atherectomy using the SilverHawk device (ev3 Endovascular, Inc., Plymouth, MN); • Orbital atherectomy using the Diamondback 360˚ PAD System (Cardiovascular Systems, Inc., St. Paul, MN); • Peripheral atherectomy using the Jetstream G2 device (Pathway Medical Technologies, Inc., Kirkland, WA); • Endoluminal graft placement for aortic aneurysms; • Inferior vena cava filter placement; • Hemodialysis access catheter placement. The catheterization laboratories handle approximately 70 cases per week, of which 85% are coronary/cardiac rhythm management procedures, and 15% are peripheral vascular procedures.
Does your lab perform primary angioplasty with surgical backup on site? The catheterization laboratory does not perform angioplasty without surgical backup and facilities for coronary artery bypass grafting are always available on site. What percentage of your patients is female? Approximately 45% of patients undergoing different procedures in the cath labs are female.
What percentage of patients go on to have an interventional procedure and what percentage of your diagnostic caths are normal? Approximately 50% of the patients undergoing diagnostic coronary angiography go on to have ad hoc percutaneous coronary intervention in the same setting. About 10% of the diagnostic coronary angiograms are normal, i.e. free of any significant angiographic narrowing.
Do any of your physicians regularly gain access via the radial artery? None of the physicians regularly gain access via the radial artery, and all the operators predominantly gain retrograde transfemoral access.
Who manages your cath lab? Roger Sadberry manages the catheterization laboratories, day patient area, and gastrointestinal laboratory. He possesses 36 years of cardiac catheterization laboratory experience.
Who scrubs, circulates and monitors? RTs scrub, and RNs circulate for administration of intraprocedural medications and help in delivery of catheters and equipment. Either an RT or RN monitors the procedure.
Does an RT (radiologic technologist) have to be present in the room for all fluoroscopic procedures in your cath lab? Yes, an RT has to be present for all fluoroscopic procedures in the catheterization laboratories.
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? Only California fluoroscopy-licensed CRT(F) personnel can step on the fluoroscopic pedal. This may be an RT or a physician. Physicians usually step on the fluoroscopy pedal, and an RT usually controls the table and pans the imaging.
How does your cath lab handle radiation protection? The scrubbed RT collimates appropriately, and physicians stay off the pedal when an RN is administering medications. In-services and yearly competencies on radiation safety are conducted rigorously.
What are some of the new equipment, devices and products introduced at your lab lately? We have recently begun to use the Pathway Medical Jetstream G2 peripheral arterial atherectomy device, the Amplatzer “Cribriform” atrial septal defect occluder (AGA Medical Corporation, Plymouth, MN), and are part of the Boston Scientific carotid Wallstent CABANA post-market approval study.
How does your lab communicate information to staff and physicians to stay organized and on top of change? Monthly staff meetings combined with a small hospital size and a friendly atmosphere facilitate informal communication between staff, physicians, and administration.
How is coding and coding education handled in your lab? Procedural and equipment charges are bundled together into our Witt monitoring system (Philips Medical Systems, Bothell, WA). Every morning, one of our two charge experts verifies accuracy of the equipment used, and posts employee initials next to any mistakes. The employee then makes the necessary correction accordingly. Current procedural technology (CPT) guidelines are posted in the Witt monitoring system under a ‘frequently asked questions’ section.
How does your lab handle hemostasis? Most of our physicians use StarClose (Abbott Vascular, Redwood City, CA), Angio-Seal VIP (St. Jude Medical) or Perclose ProGlide (Abbott Vascular) vascular closure devices, when applicable. Otherwise, manual compression is performed using the SyvekPatch (Marine Polymer Technologies, Danvers, MA) or D-Stat Dry (Vascular Solutions, Inc., Minneapolis, MN), when sheath removal is performed in the catheterization laboratory. Manual compression is performed when the activated clotting time (ACT) is less than 170 seconds or 2 hours after termination of bivalirudin (Angiomax, The Medicines Company) infusion on the floor (for inpatients) or day patient area (for outpatients).
How are hematomas managed? Hematomas are managed with manual compression or application of the FemoStop compression device (St. Jude Medical), per physician preference. Hematomas are documented on occurrence report sheets and forwarded to the risk management personnel, who then calculate the rate of complication for hematomas on a quarterly basis.
How is inventory managed at your cath lab? An Excel spreadsheet contains line item and par levels for each piece of equipment in our department. Our inventory clerk arrives before start of shift and is responsible for stocking the rooms and ordering all supplies.
Has your cath lab recently expanded in size and patient volume? Our volumes are up slightly from the last year (5%), but no new expansion is expected in the near future.
Is your lab involved in clinical research? We are currently enrolling patients in multiple clinical trials, including a carotid stenting trial sponsored by Abbott Vascular (CHOICE) and Boston Scientific (CABANA), and a drug-eluting stent trial sponsored by Boston Scientific (TAXUS LIBERTE). In addition, the cath lab submits all data on percutaneous coronary interventions to the CATH PCI registry of the American College of Cardiology’s National Cardiovascular Data Registry (ACC-NCDR). Data on all ICD procedures are submitted to the ACC-NCDR ICD registry. This serves to help the hospital benchmark its performance against the >1000 hospitals currently participating in the ACC-NCDR.
Have you had any cath lab-related complications in the past year requiring emergent cardiac surgery? None of the catheterization laboratory complications in the past year required emergent cardiac surgery.
Can you share your lab’s average door-to-balloon (DTB) times and some of the ways employees at your facility have worked together to keep DTB times under the mandated 90 minutes? The average DTB time for patients presenting with acute myocardial infarction is 60 minutes on average. Constant coordination between emergency room staff and physicians, the hospital charge nurse, interventional cardiologists, the performance improvement committee, and the catheterization lab staff helps facilitate updates and improvements. Upon identification of ST-elevation acute myocardial infarction (STEMI) in the emergency room, the clock starts ticking, and the interventional cardiologist and the catheterization lab staff are activated simultaneously, so that the cath lab staff is at the patient’s bedside within 30 minutes of a STEMI alert. The average door-to-balloon time for 2009 was 73 minutes, and the goal for door-to-balloon time for 2010 is 60 minutes.
What other modalities do you use to verify stenosis? Are you using physiology for lesion assessment? We use IVUS and quantitative coronary analysis with our GE Medical x-ray system (Waukesha, WI) to verify the degree of coronary stenoses. Both the coronary rooms have integrated grayscale intravascular ultrasound integrated into the imaging system (the Boston Scientific iLab). We have grayscale IVUS only and do not have virtual histology (Volcano Corporation, Rancho Cordova, CA). We use non-invasive modalities only for assessment of physiology of coronary stenoses, and we do not have a fractional flow wire.
What measures has your cath lab implemented in order to cut or contain costs? We run lean on staff, negotiate locally with vendors, and are enrolled in capitation programs.
What types of quality control/quality assurance measures are practiced in your cath lab? Along with our participation in the ACC-NCDR, catheterization laboratory outcomes are followed by a quality assurance committee and individual physicians are informed of variances in outcomes.
How does your cath lab compete for patients? Has your institution formed an alliance with others in the area? Our physicians prefer to work here because our staff makes an effort to accommodate them and our patient satisfaction scores remain high. Contracts get shuffled amongst facilities around town, but typically our catheterization laboratory stays quite busy.
How are new employees oriented and trained at your facility? New employees are teamed up with the senior RN or chief RT for 3-6 months for a hands-on orientation. New employees typically start covering call with their preceptor within a month. Each staff needs to be either an RN or RT, along with basic life support (BLS)/advanced cardiac life support (ACLS) certification.
What types of continuing education opportunities are provided to staff members? The education department provides CME programs in-house. Also, the staff is encouraged to attend lectures with guest speakers on a monthly basis.
How do you handle vendor visits to your lab? All vendors are required to sign in and must be able to access Vendormate (Atlanta, GA) to be allowed in the cardiac catheterization laboratory. All vendors must come by prior appointment, and visits are limited to specific times and days.
How is staff competency evaluated? Mandatory annual and bi-annual department specific competencies are tracked by the education department.
How does your lab try to reduce patient anxiety? The day patient nurses and floor nurses are always there to reassure and inform the patients about their procedure, so that they feel relaxed and comfortable. Periprocedure conscious sedation is provided depending on American Society of Anesthesiology class, with a physician in presence.
How does your lab handle call time for staff members? At least one RN and one RT, and one other staff RN or RT are present for handling urgent/emergent cases that need to be done after regular hours and on the weekends. We cover one night call per week and one weekend per month.
Within what time period are call team members expected to arrive to the lab after being paged? The call team members, including interventional cardiologist, are supposed to reach the hospital within 30 minutes of STEMI call.
Do you have flextime or multiple shifts? Our staff works four 10-hour shifts per week.
Has your lab has undergone a Joint Commission inspection in the past three years? We are currently in a survey readiness mode, with a Joint Commission inspection due at any moment. We have a ‘focus goal of the week’ for preparation in the catheterization laboratory and also perform mock tracers in the hospital.
Where is your cath lab located in relation to the operating room (OR) and emergency department (ED)? Our cardiac laboratory lies directly between the ED and surgical operating rooms.
How do you see your cardiac catheterization laboratory changing over the next few years? Bakersfield Heart Hospital is part of Medcath Corporation, which is up for sale, so any number of things may happen as a result. We do expect that a larger percentage of radial procedures and endoluminal stent-graft placements will take place at our lab.
What do you consider unique or innovative about your cath lab and its staff? The staff provides relevant input towards process improvement to our physician owners, and since our facility has a short chain of command, changes get implemented quickly.
Is there a problem or challenge your lab has faced? Staffing and training seems to be a constant challenge for the laboratory. Creative scheduling around personal lives and education needs, along with support from our colleagues, makes everything work out.
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”? Bakersfield, California lies 120 miles north of Los Angeles and is the 11th largest city in the state. We have a small-town atmosphere, and because our hospital is small, everyone knows each other by name.
The Society of Invasive Cardiovascular Professionals (SICP) has added two questions to our spotlight: 1. Do you require your clinical staff members to take the registry exam for Registered Cardiovascular Invasive Specialist (RCIS)? Does staff receive an incentive bonus or raise upon passing the exam? We recommend all staff try for RCIS certification, or discipline-specific advanced credentialing (CIT, CCRN, etc.), though no pay incentive is in place at this time.
2. Are your clinical and/or managerial team members involved with any professional organizations that support the invasive cardiology service line, such as the SICP, ACVP, or regional organizations? Yes, the clinical team is involved with multiple professional organizations. All the physician operators are fellows of the American College of Cardiology and its state chapter, and most are fellows of Society for Cardiovascular Angiography & Interventions (SCAI) as well. Dr. Atul Aggarwal can be contacted at vipulatul7@yahoo.com
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