Rush North Shore
Medical Center

Our 12 staff members include: 1 administrative director, 1 clinical coordinator, RN;  3 registered cardiovascular invasive specialists (RCISs);  1 radiologic technologist;  3 registered nurses;  2 per-diem nurses;  1 office coordinator; and  1 laboratory assistant. How Did the ACIST System Come to Our Attention? I had previous experience utilizing the ACIST Contrast Management System (CMS) at Washington Hospital Center (Washington, D.C.) and thought it would be a great opportunity for our facility to decrease expenses and contrast usage. One of the physicians had expressed prior interest in the system, and so, along with the cardiologists, I made the decision to trial the ACIST system. I knew what the system had to offer and its capabilities, so there was no need to consider other systems. Implementation: A Happy Result, a Focused Process The key to success with Acist system implementation is training, setup and troubleshooting. Once the staff is appropriately trained and has mastered proper setup, the system is essentially fail-proof. However, switching to a computer-operated system can be a challenge; the manifold has been a trusted, reliable tool. The benefits, however, outweigh the challenges. The ACIST system is programmable, and as with any computer, there may be glitches. This is where effective troubleshooting comes into play. The staff needed to be trained extensively on the use of the system and on troubleshooting. One can™t underestimate the importance of getting the nurses™ and technologists™ buy-in first, and then the physicians™ buy-in. The troubleshooting abilities of the scrub technologist and circulating nurse are crucial and can make or break your experience with the system. The ACIST Clinical Specialist and Sales Representative were key in this implementation process. They were available to train and support during the installation period and to provide additional support if deemed necessary. The process, however, wasn™t always smooth. We had to convince the physicians that the system can and will work for us. The physicians™ buy-in eventually came when they realized: 1) how much money we were saving in contrast, and 2) that the staff really liked the system and could effectively troubleshoot in a timely manner. Staff Reactions Dr. Bruce Bergelson, Director of Interventional Cardiology, believes there are several benefits to utilizing the system. First and foremost, the staff is kept happy, since they really like the system. The injections are standardized from staff member to staff member and the risk of injecting air bubbles is essentially eliminated. Dr. Bergelson also stated that the image quality with the use of the ACIST and 4F catheters is good, but does require some fine-tuning with catheter placement and injection strength. Technologists. Our technologists simply can™t do without the system for several reasons. From a physical standpoint, they are no longer struggling to inject contrast through a catheter with a balloon and wire down it and no longer tilting their body diagonally to inject contrast while taking care not to displace the catheter. The system is much quicker to set up; once it is set up at the beginning of the day, it is essentially ready for the rest of the day. The constant worry of injecting air bubbles is eliminated because the ACIST has a built-in air bubble detector. This, of course, is not to devalue the benefit of occasionally checking the system. Nurses. The nurses realized additional benefits to utilizing the system. They are able to focus on the patient™s status because they are no longer preoccupied with the power injector, by which I mean loading it up, debubbling it and turning away from the monitors. In addition, some of my staff have had problems injecting dye, especially through smaller catheters. Over time, manually injecting contrast can cause pain. The ACIST CMS does all the work, thereby alleviating hand and joint pain. Our Experiences The ACIST system has reduced our procedure time through several factors:  Decreased setup time;  Decreased time spent changing contrast bottles;  Decreased time taken to load the power injector;  Decreased procedure-to-procedure breakdown time. We have converted to using Cordis 4F catheters on 98% of our diagnostic procedures. There was some initial hesitation, but the physicians and staff have adapted well. The strength of injection, flow, and pressure rates had to be adjusted to capture quality images. Visualization of the coronaries with the use of 4F catheters and the ACIST system is of excellent quality. The time to hemostasis has also dropped significantly with the decrease in sheath size. It takes about 10 minutes to achieve hemostasis on a 4F sheath. This translates into huge cost savings for us. The cost of the procedure has dropped substantially with the elimination of closure device usage on diagnostic procedures. We have fewer groin complications with the 4F system, and we have saved $100,000 in the cost of closure devices. One potential patient complication we may have avoided through use of the ACIST system is the possibility of an air bubble traveling down the coronary artery or left ventricle. Our three most noticeable advantages have been: 1) Financial savings with decreased contrast usage; 2) Decreased set-up and hemostasis time; 3) Decreased usage of closure devices. Contrast Needs We also made the decision to utilize the Isovue 370 Multipack. We have always been Isovue 370 users but found additional cost savings in utilizing the Multipack. The Multipack costs less per cc than smaller bottles, and the Acist system minimizes contrast usage a perfect combination. The contrast bottle doesn™t have to be changed as often with the Multipak use. This fact alone allows more attention to be focused on the patient. A Final Note Our bottom line has been tremendously affected. Contrast usage has been decreased by about 50%, with the combined usage of the Multipack, ACIST system and 4F catheters. The ACIST and 4F catheters work hand-in-hand. Another very strong advantage to utilizing the system with 4F cath- eters is the ability to eliminate the use of closure devices on diagnostic procedures. With the use of the ACIST system, 4F catheters and the Isovue 370 Multipack, Rush North Shore has recorded a cost savings of approximately $150,000. We don™t have to change the bottle of contrast as frequently, and we have increased our ability to focus more attention on the patient.

NULL