Email Discussion Group: Cardiac Call Team Dilemma

RT doesn’t need to pan My first question is, why four staff? We use one RT/CVT or RN to scrub, one RN circulating, one RT/CVT to monitor, and the MD pans the table. YOU DO NOT NEED TO HAVE AN RT PANNING THE PATIENT SINCE THE MD HAS A FLUORO SUPERVISOR LICENSE. You don’t even have to have an RT in the room, IF THE MD IS PANNING and stepping on the fluoro/cine pedal. Note: I am in California, so your state laws may be different. But this covers Title 22 requirements in my state and also Title 17. ALL staff can scrub ANY and ALL procedure types. Our call team covers any after-hour cases that are left after 1500 in one room. Call team comes in at 1030. Good Luck! Bill Colditz, RCIS, Manager Cath Lab Mercy San Juan Medical Center Wcolditz@chw.edu Enlist cardiologists’ help If I was in this fix, I would bring in the cardiologists and explain the no coverage for cardiac emergencies. I think they would take care of the rest. Good luck, BCole@ftsm.mercy.net One team performs all cases Currently we have four rooms in our facility: 1 specials, 2 cardiac and 1 EP. The call team is made up of four staff members and the physician. Any case is performed by this team, be it EP after hours, peripheral, cardiac, etc. Dan Witt, Manager, Cardiovascular Diagnostics SwedishAmerican Hospital Rockford, Illinois dwitt@swedishamerican.org Some guiding questions I have more questions than I have answers in regard to this question. I think if I pose the questions, by your answering them, it will guide you to an answer to your original question. Your call team is 2 RTs and 2 RNs: 1. Is there a skill mix that would allow you to have 1 RT with 3 RNs and make the call less of a burden on the RTs? 2. How is your scope of service worded? That may drive the issue of providing care for off-hours emergencies. 3. I am assuming that the staff is cross-trained between the rooms...Is there cross-training between the roles? 4. Who can monitor, who can scrub? The more diversified the staff, the more flexible the scheduling will be, but that won't happen immediately. All cath labs are struggling with this issue and it is changing. I don't know that there is any one sure-fire answer, but if you make your decision a 3-month trial (anyone can do something for 3 months) and re-evaluate, it might be easier to commit to. Then in 3 months, you can say yes, this is working or no, this won't work Let’s try Plan B. Hope this helps! Anna, annasmith@chi-east.org Morale is important Their desire is unrealistic, especially in light of the dramatic change in available nurse & techs who are even nearly qualified. I would strongly suggest that emergency cases of all kinds are closely monitored and evaluated regularly. The call teams that we work with consist of one RN and one RT, with the RN often making hasty calls for an additional nurse to come in to help. It will lead to staff burnout, as we are seeing nurses leaving and techs being hired away for more money. MONEY it’s funny that people often point to money, but it’s often recognition that is being sought. Recognition as being a part of the team; recognition that the outside of the hospital needs of the RN and RT are important; recognition that the contributions of the RN and RT are vital. My suggestion would go as follows: 1) Create a system of two teams: On Call A and On Call B. A gets called in first, and B if there is a second call. Not enough staff? Hire per diems to help make up the two teams that you will be creating. (Pay your staff at a higher rate than the per diems.) 2) Try your best to create a reward system. Maybe the heavy-hitter physicians could invite the vendors who you do business with to donate Out To Dinner certificates to give to each person, every fourth or fifth call-in. This, in addition to pay, will let that person know that they are valued! 3) Review emergencies to make sure that the cases bringing in your staff are true emergencies. No staff will want to feel that they are being abused. Bob Basile bobstero@ptd.net All one lab means one call team Is the lab staff considered one? If so, it seems that you can only have one call team to cover any emergencies and that would be based on how emergent the cases are. We do not do peripheral cases in our lab. They are done in radiology and they have their own call team. But if your lab operates as one, you can only have one call team, I would think. Annie Ruppert RN Annie.Ruppert@sharp.com MDs set guidelines We have 3 cath labs and do peripheral cases and EP also. Our MDs have set the guidelines to be that peripherals will only be done during normal day hours. If cases run over into the call team, electives will need to be rescheduled. As for night and weekend call, they have set the standard as follows: any emergency peripheral will need to be done in the radiology suite, as we can’t tie up the cath lab team for a peripheral in case an emergent cardiac case comes in. BEES9909@aol.com Call team takes everything Our weekday call team consists of 2 staff members, either a nurse/tech combo or nurse/nurse. These individuals finish up the cases at the end of day and assume call responsibility from 6pm-6am. The weekend teams consist of 3 staff members: nurse/tech/nurse. The hours they cover are from Saturday 6am to Monday 6am. This includes all acute, urgent, and yes, even elective caths. Not to mention the rollover cases from Friday night. These call team members come in together and leave together when the cases are done. Our yearly volume includes 4000 caths and 1500 PCIs per year. We also average 6-10 cases per weekend. I know I just did 12 this last weekend. Good luck. Mark Lessard, RCIS lizrd65@yahoo.com Full cross-training Our call team has three people. Either 2 techs and 1 RN, or 2 RNs and 1 tech. Our techs are RTs, RCIS, and we have two EMTs in training. All RNs have had prior critical care experience. Our department has 8 techs. There have been times we have operated rooms with 3 RNs. And on other occasions, we have operated rooms with 3 techs. Everyone is fully cross-trained. Unless pointed out, (the RNs from the techs), the average person would not know who is who. We have close to 200 years of total experience amongst our team members. codywms@mail.weber.edu Same for us I can relate. It’s the same for us, except we have taken a peripheral off the table for an emergent/acute cardiac. Good luck MelodyBelaire@aol.com MD operates x-ray We have 3 rooms, two invasive and one EP. Since everyone is cross-trained and (this is key) we only work with cardiologists, there is no problem as to what type of emergency. We only use a cath table and no stepping table so the doctor is the responsible party for operating the x-ray; therefore the RT doesn’t have to be the designated one to scrub in, but is included in the call team. We do more caths (2500) than 700 interventional cases, but only 250 peripheral cases a year. We have 3 RTs, 2 paramedics, and 5 RNs. Hope this helps. roberta.sparks@advocatehealth.com Take yourself out of the line of fire We have been using our call team for all and/or, any case/cases still needing to be finished at the end of the day for years. The call team consist of 3 staff members 1 RT, 1 RN and 1 RCIS/CVT or other qualified staff person. Emergency cases always come first when ordered. That means if arterial access has not been achieved, you stop and do the emergency procedure. We make the ordering physician talk to the physician being bumped. This takes the staff out of the line of fire that occasionally happens when bumping someone. If a case is in progress you do the emergency ASAP. These cases should be treated no differently then what your hospital would do during your busy daytime hours. Scott Fylling, Manager of Cardiac Cath/Special Procedures scott.fylling@bhsnet.org Protocol is first come, first serve At our hospital, we also staff a peripheral room and a cardiac room with only three people. Our protocol is first come, first serve. If there are two emergencies at the same time, the docs have to talk and decide whose emergency is more emergent. As far as late staffing, most of the time, other people have to stay and finish one room or the other, then you can go back and forth finishing up the day’s cases. We’ve talked about making more than one call team, but who has enough staff to do that without making everyone on call all of the time? Wonder how long it would be before you didn’t have any staff at all. v_greenlee@yahoo.com HAVE A SUGGESTION FOR A FUTURE QUESTION? Email us at cathlabdigest@hotmail.com

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