ADVERTISEMENT
Central Baptist Hospital
What is the size of your cath lab facility and number of staff members?
Central Baptist is a 374-bed tertiary hospital. The invasive cardiology department includes 5 cardiac cath labs, 3 electrophysiology (EP) labs and a 28-bed observation unit. The staff composition in our lab consists of:
• 13 registered nurses (RNs);
• 13 registered radiologic technologists (RT[R]s)
• 1 clinical nurse educator
• 3 patient transporters
• 1 cardiac picture archiving and communication systems (PACS) administrator.
Our cardiac observation unit, pre-post procedure area staffing consists of 16 RNs, 3 patient care techs, 2 health unit coordinators, 1 clinical nurse manager, and 1 administrative assistant. Staffing longevity ranges from one year to over 20 years. For the third year in a row, Central Baptist Hospital has been recognized among the top 10 Best Places to Work among large companies in Kentucky.
What type of procedures is performed at your facility?
Routine procedures include diagnostic catheterizations, cardiac interventions and stents (drug-eluting and bare metal), Rotoblator (Boston Scientific, Natick, MA), intra-cardiac ultrasounds and AngioJet (Possis Medical, Inc., Minneapolis, MN). We perform an average of 400 cardiac cath procedures including stents, thrombectomies and permanent pacemakers, per month.
Our facility has seen a significant increase in vascular procedure volume. Two of our five cardiac cath labs are equipped for peripheral use. One lab has anesthesia setup available as well. We have been performing carotid stent procedures for over 3 years, and had the second-highest patient enrollment in the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) trial.
Does your cath lab perform primary angioplasty with surgical backup?
Our facility performs primary percutaneous coronary intervention (PCI) with surgical backup 24/7. The cath labs and operating rooms are located on the same floor of the heart institute.
What procedures do you perform on an outpatient basis?
We perform pacemaker generator changes and left heart catheterizations as outpatients.
What percentage of your patients is female?
46%
What percentage of your diagnostic cath patients go on to have an interventional procedure?
Approximately 37% of diagnostic cath patients have an intervention.
Who manages your cath lab?
Nanette Jackson, RT(R), is the Director, Cardiovascular Services. Dr. Hal Skinner is Medical Director of the Cath Lab. Dr. Michael Jones is Medical Director of the Baptist Heart and Vascular Institute. The Baptist Heart and Vascular Institute board consists of physicians and administrative staff who oversee the cardiac services operations.
Do you have cross-training?
Who scrubs, who circulates and who monitors? Each cath lab team consists of 3 staff members, a mixture of RNs and radiologic technologists. The RT(R)s primarily scrub with the physician, and RNs are responsible for circulating, giving medications and patient assessments. RNs have learned to scrub as a personal goal, but are not required to do so. Patient monitoring is performed by either a RN or a RT(R). Before staff is scheduled to monitor independently, they must pass a competency exam that covers numerous areas, including rhythms, waveforms, and documentation.
Does an RT (radiologic technologist) have to be present in the room for all fluoroscopic procedures in your cath lab?
One RT(R) is always present in each cath lab procedure.
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?
An RT(R) and physician pan and operate the x-ray equipment in the cath lab.
What are some of the new equipment, devices and products introduced at your lab lately?
We have 4 fixed iLab ultrasound units (Boston Scientific) installed in our labs and one Stereotaxis Magnetic Navigation System (St. Louis, MO) for interventional cardiology.
Can you describe the system(s) you utilize?
We use the Axiom Sensis (Siemens Medical, Malvern, PA) for hemodynamic and clinical data monitoring, Axiom Artis (Siemens) for radiography, and Volcano Corporation’s FloWire (Rancho Cordova, CA) and the iLab for intravascular ultrasound (IVUS) imaging. Our Sensis system is interfaced with billing and patient information management, which has improved overall charge efficiencies. The AGFA/Heartlab digital archiving system (Westerly, RI) has been in place for over a year and includes web access for viewing outside the facility.
How is coding and coding education handled in your lab?
We have two dedicated nurse auditors that audit all cath procedures. Nurse auditors communicate with a corporate charge master who approves and verifies all procedural and supply charges.
How does your lab handle hemostasis?
Our physicians hold varied opinions on hemostasis and closure devices. Some opt to use closure devices frequently and others opt for manual pressure for any interventional procedure. Several of our physicians use 4 French diagnostic catheters routinely, which has minimized patient discomfort, decreased time holding pressure, and reduced bed rest for patients. The most commonly used hemostasis devices at this facility are Angio-Seal (St. Jude Medical, Minnetonka, MN), Starclose (Abbott Vascular Devices, Redwood City, CA), Perclose (Abbott) and SyvekPatch (Marine Polymer Technologies, Danvers, MA).
Our department includes a state-of-the-art, 30-bed pre/post CardioVascular Observation Unit (CVOU). Patients enter at the CVOU and are prepped for their procedure. If a PCI procedure is done, they go to the hospital’s post-interventional unit, which is easily accessible from the cath labs. If the patient is being discharged after the procedure, they return to the CVOU for recovery and discharge. At present, about 50% of our patients are discharged the same day from the CVOU.
Does your lab have a hematoma management policy?
Central Baptist’s hematoma/ bleeding policy is based on protocols and guidelines for the staff which includes notification of the physician at various points throughout the protocol. This protocol was recently revised by the physician board to manage anti-coagulation therapies.
How is inventory managed at your cath lab? Who handles the purchasing of equipment and supplies?
An inventory control buyer manages our inventory. She tracks usage and re-ordering of supplies according to par levels. Purchasing and the cath lab supply team meet monthly to discuss new supplies and slow-moving supplies. The cath lab director takes care of capital equipment, which is submitted in the budget.
Has your cath lab recently expanded in size and patient volume, or will it be doing so in the near future?
Our heart institute is fortunate in that our volumes continue to increase. As a result, we have received approval to reconfigure our eighth cath lab as a combination EP/cath lab to improve scheduling capabilities and lab utilization for our physicians.
Is your lab involved in clinical research?
As a community-based hospital, our cardiac research has expanded significantly as a result of the Lexington Cardiac Research Foundation, established in 2006. We have full-time interventional cardiology research RNs who facilitate the process along with our physicians and staff. Some of the recent studies we have participated in include:
• The Carotid Revascularization Endarterectomy versus Stenting Trial (CREST)
• TAXUS V: Assessing the safety and efficacy of a slow-release formulation paclitaxel-eluting coronary stent system in reducing restenosis in de novo lesions 10–46 mm in length and 2.25–4.0 mm in diameter.
• Lower Extremity Atherosclerotic Plaque Excision (LEAP, looking at the SilverHawk Plaque Excision System by FoxHollow Technologies, Inc.)
• The second phase of “Carotid Rx Acculink/Rx Accunet Post-approval Trial to Uncover Unanticipated or Rare Events” (CAPTURE-2)
• IMProved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVE IT)
• Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY, looking at bivalirudin)
• SPIRIT IV: Continued evaluation of the safety and efficacy of Abbott’s Xience V everolimus-eluting coronary stent system for the treatment of coronary artery disease in a more complex patient population.
• An evaluation of the Stereotaxis Navigation system.
Have you had any cath lab-related complications in the past year requiring emergent cardiac surgery?
Our emergent cath lab to coronary artery bypass surgery rate is 0.4%.
What other modalities do you use to verify stenosis?
We use IVUS and angiography to verify stenosis. Our physicians use a FloWire Doppler guide wire (Volcano Therapeutics).
What measures has your cath lab implemented in order to cut or contain cost?
We require all balloons and stents to be on consignment from our vendors. We also have a cath lab supply team that meets monthly to evaluate requests for new items and changes or decline utilization of supplies. The team also evaluates and reports overall utilization in inventory to the corporate supply team.
What type of quality control (QC)/quality assurance (QA) measures are practiced in your cath lab?
Quality control/assurance is an ongoing process. Our facility participates in National Registry for Myocardial Infarctions (NRMI), American College of Cardiology National Cardiovascular Data Registry (ACC-NCDR), Centers for Medicare and Medicaid Services (CMS) database, and various others. Within the department we monitor processes that range from daily equipment checks to the multi-functional teams that monitor our processes for door-to-balloon times for acute myocardial infarctions. Our internal QA indicators evaluate conscious sedation practice and patient outcomes, with recovery scores on every case where the patient received sedation.
We also accumulate data on service satisfaction with day-after-service callbacks and survey cards sent to the patient’s home if we are unable to speak with them by phone. The cath lab’s education team continuously works on improving the orientation process from the orientee’s perspective by including input from employees who completed orientation in the last year.
How does your cath lab compete for patients? Has your institution formed an alliance with others in the area?
We are in a very competitive market for cardiac services. Other hospitals in our area are acquiring smaller hospitals to maintain volume. Central Baptist Hospital (CBH) has the largest cardiac program in a five-hospital system located in Kentucky. As a tertiary hospital, CBH has maintained its competitive edge with an ongoing focus to strengthen and enhance physician relationships and provide the highest standards for quality care. Our 15-member heart and vascular board works cooperatively to develop strategic initiatives for our program. This board has been extremely effective in facilitating expansion of our vascular program, women’s heart health initiatives, establishment of a cardiac research foundation and enhancing physician’s communication and elevating awareness of CMS, ACC and Society of Thoracic Surgeons (STS) quality-of-care initiatives.
How are new employees oriented and trained at your facility? What licensure is required for all professionals who work in your lab?
New employees complete a 2-week general hospital orientation before starting in their assigned area. Each orientee is assigned to a preceptor based on licensure and training needs. The average timeline to complete orientation is twelve weeks, but is evaluated at intervals to meet the employee’s needs. Each orientee is required to obtain basic life support (BLS), complete and pass a 2-day basic dysrrhythmia course and exam, as well as the American Heart Association’s advanced cardiac life support (ACLS). We employ only RNs and RT(R)s in the cath lab. Critical care experience is preferred. Radiologic technologists are required to be registered. We have employed RCVTs (registered cardiovascular technologists, now the RCIS credential) in the past, but none currently. The registered cardiovascular invasive specialist (RCIS) is not required, but recognized. Skill competencies are designated annually, either on the job or via simulation to maintain the highest level of competency.
What type of continuing education opportunities are provided to staff members?
Central Baptist has a well-developed and active education department. The hospital has routinely held annual symposiums for stroke care, cardiac services, med-surg nursing, oncology and women’s care. Central Baptist also offers online learning modules that include the annual mandatory topics. The Baptist Heart and Vascular Institute offers cardiac “Grand Rounds” each month for our physicians and staff, which has been very well attended. The hospital provides CEU/CME certification for attendance. The interventional cardiology department has a designated nurse educator for the cardiac cath lab and pre and post interventional units. We are fortunate to have an education center within the heart institute building, complete with auditorium, classrooms, audiovisual center with designated staff, and a kitchen/ bistro to cater our events.
How do you handle vendor visits to your lab?
We do not allow company vendors in the lab unless there is an educational need. Staff in-services must also be provided when a vendor is present in the lab. Several vendors have supply contracts that include access to the cath lab for various days per month. All vendors must check in to the purchasing department for badge access when they arrive at the hospital.
How is staff competency evaluated?
Competency is evaluated by the orientee’s preceptor during that process. Annually, skill sets are chosen for staff to do hands-on demonstration in order to prove competency. ACLS is required of all staff and a rhythm/ waveform test is required before staff is deemed competent to monitor cases.
Does your lab have a clinical ladder?
Our facility does support a clinical ladder called “Professional Practice Model” for nurses. It is based on years of experience in nursing as well as year of expertise in your area of practice. The ladder promotes clinical skills, knowledge, committee service and continuing education. The Nursing Leadership committee governs the “Model” and has staff nurses, educators, and administrative representatives. We do not have a clinical ladder for RT(R)s.
How does your lab handle call time for staff members?
The call team consists of one RN, one RT(R) and a third person, either an RT(R) or RN. We have multiple shifts of 8, 10 and 12 hours. We do not have a cardiologist on site.
Within what time period are call team members expected to arrive to the lab after being paged?
Our call team has a response time of 30 minutes from time of being paged.
Do you have flex time or multiple shifts?
Employees have time off during slow periods. We use slow periods for cross-training staff in other roles and scheduling competencies, staff meetings, etc.
Does your cath lab do electives on weekends and or holidays?
Yes, we do elective cases on Saturday. We have 3 staff members and one transporter that are scheduled for hours of 7am to 5pm on Saturdays and an on-call team as well. All staff are required to rotate working Saturdays. We do only emergent cases on holidays.
Has your lab undergone a Joint Commission inspection in the past three years?
Yes. Our first unannounced survey will be in 2008.
Where is your cath lab located in relation to cardiac surgery, the emergency department (ED), and radiology department?
Our cath labs are located on the second floor, directly down the corridor from the operating room and cardiac intensive care unit. Because CBH is a tertiary facility, many of our transfers are received directly into the pre-procedure area of the cath lab CVOU. Our ED is located on the first floor of the hospital, directly across from the radiology department. In emergent situations, our ED staff and cath lab staff have access to an elevator for immediate, non-stop transfers to the cath lab.
What trends do you see emerging in the practice of invasive cardiology?
With the drug-eluting stent market expanding, the number of choices available for physicians and patients will impact management of supplies for the cath lab in the future.
Please tell the readers what you consider unique or innovative about your cath lab and its staff.
Central Baptist Hospital cardiac cath lab has the reputation for developing and acquiring the latest technology in cardiac care. We frequently are asked to participate in clinical trials involving new technology from major cath lab companies. We feel our staff has the unique skills to perform in versatile roles to meet the clinical needs of our patients and physicians.
Is there a problem or challenge your lab has faced?
With rapidly changing cardiac technology, managing staff competencies and skill levels is a constant challenge for our cath lab. A dedicated cath lab educator was hired in the past year and has been integral in addressing this issue.
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”?
The Baptist Heart and Vascular Institute at Central Baptist Hospital is located in Lexington, Kentucky, the “Horse Capital of the World.” Lexington is the second-largest city in Kentucky, after Louisville, Kentucky and the 69th largest in the United States. Lexington is home to the Kentucky Horse Park, Keeneland race course, the Red Mile race course, Transylvania University and the University of Kentuky (UK). UK’s basketball program is immensely popular in the city and throughout the state. The University of Kentucky Wildcats basketball team has won more games than any other team in college basketball history. Visitors immediately get a taste of Lexington’s signature features, including its gently rolling countryside lined by white, wooden fences, which are home to some of the world’s greatest and most well-known thoroughbred horses. The true charm of Lexington lies in the fact that it has all the amenities of a big city, while maintaining that special small-town feel. In mere minutes, motorists can drive past horse farms, through downtown and back to the rolling countryside. Lexington has been selected to be the site of the 2010 Fédération Equestre Internationale (FEI) World Equestrian Games. 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)? Do staff receive an incentive bonus or raise upon passing the exam? No, this is not required but it is encouraged for anyone who wants to take the exam.
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? Not at the present time.
The authors can be contacted at christine.mcintyre@bhsi.com
