Charlotte Regional Medical Center

What type of procedures are performed at your facility? At Charlotte Regional Medical Center, we perform diagnostic and interventional procedures, including EP studies, tilt table studies, cardioversions, ablations, automatic implantable cardioverter defibrillator (AICD) and pacer implants, PTCA, stents, Rotoblator® (Boston Scientific Corporation, Maple Grove, MN), intra-aortic balloon pump (IABP), brachytherapy, FilterWire (Boston Scientific), AngioJet® (Possis Medical, Inc., Minneapolis, MN) and intravascular ultrasound (IVUS). Our lab performs an estimated 3,000 cases per year with 19 different cardiologists. As a high-volume lab with limited space, most of the peripheral cases are done in the radiology department. Does your cath lab perform primary angioplasty with surgical backup? The OR is staffed during daytime business hours, but we do not routinely schedule backup for our cases. If we do require level one backup from the OR, it is scheduled prior to the start of the case. What procedures do you perform on an outpatient basis? Tilt tables, noninvasive programmed stimulation (NIPS), pacemakers, implantable cardiac defibrillator (ICD) changeouts, EP studies, ablations, cardioversions, and left and right heart caths. What percentage of your patients are female? Approximately 40 percent of our patients are female. Who manages your cath lab? The Cardiac Catherization Lab Manager is Brenda Neuman, RT(R). She reports directly to the Director of Cardio/Pulmonary Services, Don Wilson. As cath lab manager, Brenda is in charge of staffing, ordering supplies and day-to-day operations of the lab. Do you have cross-training? Who scrubs, who circulates and who monitors? Not at this time. Our hospital requires that a registered nurse administer certain drugs, such as those needed for moderate sedation. Our techs [RT(R)s and RCIS] interchange recording and scrubbing. Does an RT (radiologic technologist) have to be present in the room for all fluoroscopic procedures in your cath lab? The State of Florida requires that the cath lab have a licensed radiology technologist to operate the radiographic equipment. 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? A physician must be present for anyone other than a radiology technologist to operate the radiographic equipment. Does your lab have a clinical ladder? While we don’t use a clinical ladder, yearly evaluations are conducted and staff is paid accordingly. Technologists [RT(R), RRT] are required to have a Florida license and others are encouraged to obtain their RCIS. What are some of the new equipment, devices and products introduced at your lab lately? The newest addition to our cath lab equipment is Boston Scientific’s Taxus drug-eluting stent. Eighty percent of stents placed in our lab are Taxus stents. Also recently added to our inventory are the FilterWire Ex Distal Protection Device, Galileo brachytherapy system (Guidant Corporation, Santa Clara, CA), AngioJet and Guidant Corporation’s Pilot wires. Is your cath lab filmless? We currently operate with two systems that are digital, by Siemens and Philips. They speed up our room turnover time, in addition to making storage less of an issue. How does your lab handle hemostasis? For hemostasis, we primarily use Marine Polymer Technologies’ SyvekPatch® (Danvers, MA) for our diagnostic and interventional procedures. We also use the vascular closure device Angio-Seal (St. Jude Medical, Minnetonka, MN) on about 15 percent of our diagnostic and interventional procedures. For approximately 70 percent of our interventional procedures, the sheath is sutured in place and pulled on our ICC floor at a later time with a SyvekPatch. Outpatients are currently discharged in a three-hour time period with the use of the SyvekPatch or Angio-Seal. Does your lab have a hematoma management policy? No, but hematomas are tracked by the risk management department at Charlotte Regional. How is inventory managed at your cath lab? At this time, our inventory is generally obtained through an inventory order process. The manager is in charge of replacing stock and equipment. Has your cath lab recently expanded in size and patient volume, or will it be in the near future? No. However, during the months of October through April when our seasonal residents return, our patient volume increases by about 30 to 40 percent. Is your lab involved in clinical research? Yes, our cardiology groups are very active in clinical research. Following are a few of the clinical studies that we are involved with at the present time: 1. CREATE (Carotid Revascularization with ev3 Arterial Technology Evolution Trial) 2. DECREASE-HF (Guidant Corp.) 3. ASSIST (Atrial Tachyarrhythmia Suppression Strategy in ICD Subjects Trial, St. Jude Medical) 4. SAVE PACe (Search AV Extension for Promoting Atrioventricular Conduction Study, Medtronic, Inc.) 5. ACTIVATE Trial (A new drug study to reduce the progression of atherosclerosis) Does your lab perform elective cardiac interventions? Yes. Have you had any cath lab-related complications in the past year requiring emergent cardiac surgery? During the past year, we have not had any complications requiring emergent cardiac surgery. Our cardiac events requiring emergent surgery are less than one percent. What measures has your cath lab implemented in order to cut or contain costs? We negotiate pricing contracts with our limited primary vendors and we use a consignment program for interventional products. We also participate in bulk-buying, which allows us to make purchases at a lowered cost. Finally, the length of stay for our patients is below the normal time period typically between 24 to 36 hours for interventional patients. What type of quality control/quality assurance measures are practiced in your cath lab? In addition to all the regulatory agency requirements such as emergency equipment QC/QA, we practice a variety of quality controls including, but not limited to, daily ACT checks, Mennen Medical monitoring equipment (Trevose, PA), radiographic equipment and defibrillator. How does your cath lab compete for patients? Has your institution formed an alliance with others in the area? At this time, we are the only interventional lab in our county and serve as a referral site for hospitals without interventional services. How are new employees oriented and trained at your facility? The orientation process is individualized to the employee’s needs, depending on prior experience. Orientation lasts roughly four weeks, with new employees assigned to preceptors. Registered nurses must be licensed with the State of Florida and must have at least two years of critical care experience. Techs, including RTs, RT(R)s, RCISs and CVTs, are licensed where required or credentialed. What type of continuing educational opportunities are provided to staff members? Our hospital offers an extensive on-site continuing education program. All members of the cardiovascular team, including the cath lab, IVH and ICC units, are ACLS-certified. In addition, the cath lab’s ongoing education focuses on low-volume, high-risk procedures using devices such as the AngioJet, Rotoblator and IVUS. How do you handle vendor visits to your lab? Vendors must provide identification, proof of HIPAA training and check in prior to visiting the cath lab with our materials management department, where they are provided with a badge. All vendors must schedule an appointment with the cath lab manager prior to their visit. Only one vendor is scheduled at a time. How is staff competency evaluated? The staff is evaluated on an annual basis with high-risk, low-volume procedures and equipment being the highest priority. Does your lab utilize any alternative therapies, such as guided imagery, etc.? No. How does your lab handle call time for staff members? We have three staff members on call at any one time. One of the three must be a RN, with the others being a mix of technologists. The staff works four 10-hour days a week, starting at 7 am. The lab is staffed with on-call people after 7 pm and on weekends and holidays. What trends do you see emerging in the practice of invasive cardiology? With the more deployable drug-eluding stents, their use will continue to rise, leading to the treatment of more complex and multi-vessel interventions. A little further in the future, we’ll see fewer invasive diagnostic procedures with the newer CT scanners becoming more widely used. Has your lab undergone a JCAHO inspection recently? Charlotte Regional Medical Center had a JCAHO inspection in 2003 with a successful outcome. Where is your cath lab located in relation to the OR department, ER, and radiology department? The CCL is located just down the hall from both the Emergency Department and the OR Department. This location is a great benefit, especially with ER acute MIs. Please tell readers what you consider unique or innovative about your cath lab and its staff. With limited space, our challenges are many. An eight-bed Intravascular Holding area (IVH), located down the hall, was created to help facilitate our pre- and post-patient care. The cath lab works closely with the IVH staff, creating a cohesive team. The dedication of these two teams has provided a streamlined continuum of patient care, resulting in the honor of being named four times in the past five years as a Top 100 Hospital for cardiovascular services by Solucient. Is there a problem or challenge your lab has faced? How was it addressed? When we started experiencing problems scheduling our elective cases, we switched to a block scheduling system. This system enabled the cardiologists to better manage their time in the cath lab. 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? A few years ago, this area was considered a small, sleepy fishing village located on the west coast of southern Florida. Now that our area has been discovered, Punta Gorda is experiencing a population boom, with a large number of retirees relocating here. Our population almost doubles in the winter months with the arrival of the snowbirds, thus giving rise to many challenges regarding staffing of the department. Author Rose Marie McCafferty can be reached at rose.mccafferty@ crmc.hma-corp.com

NULL