South Carolina Heart Center

What is the size of your cath lab staff and facility? South Carolina Heart Center is a freestanding outpatient facility, privately owned by our physician partners. We have 24 cardiologists; six are interventionalists. South Carolina Heart Center has 3 cath labs, one of which is a dual lab for both peripheral and cardiac procedures. We have 15 private and family-friendly patient rooms where pre and post procedures occur. We employ 11 full-time staff and 3 part-time staff: 2 full-time registered nurses (RNs), 2 medical assistants, 4 cardiovascular technologists (CVTs), 3 part-time RNs, and 1 administrative assistant. Years of service range from 1 to 14 years, with 8 years being the average time spent working in the cath lab. Our facility also houses a 64-slice CT scanner, nuclear medicine department, clinical research, as well as a clinical area for physician office visits. What types of procedures are performed at your facility? We do diagnostic heart catheterizations as well as peripheral diagnostic and interventional procedures, excluding carotid stents. We average around 190 cardiac caths, 32 peripheral procedures and 11 peripheral interventions each month. Last year, our procedures totaled 2,707. All of our procedures are performed as outpatient procedures. We perform left heart catheterizations, right heart catheterizations, graft cases, renal angiograms, carotid angiograms, aortography, peripheral runoffs, iliac stents, subclavian stents and renal stents. We also do transesophageal echocardiograms (TEEs), and average around 12 TEEs a month. How does your cath lab employ surgical backup? Since we are freestanding, we do not have surgical backup on site. If there is a need for emergent intervention or coronary artery bypass graft surgery (CABG), the patient is transported by ambulance to the designated facility, which is within a mile in distance. Fortunately, this occurs in only about 5% of the cases we see at the South Carolina Heart Center. What percentage of your patients is female? Fifty percent of our patients are female. What percentage of your diagnostic cath patients go on to have an interventional procedure? What percentage of your diagnostic caths are normal? Five percent of our diagnostic cases are normal. Around 30 percent of our diagnostic cases go on to have a interventional procedure. Who manages your cath lab? Jack Reese, CVT and Stacey Rosbrugh, RN, are the co-managers of our cath lab. Do you have cross-training? Who scrubs, who circulates and who monitors? The RNs circulate and occasionally monitor. The CVTs scrub and monitor. Does an RT (radiologic technologist) have to be present in the room for all fluoroscopic procedures in your cath lab? No, our procedures are performed in the presence of a physician. 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? CVTs can position the II, pan the table and change angles. The cathing physician operates the fluoro. How does your cath lab handle radiation protection for the physicians and staff that are in the lab day after day? We have a radiation safety officer who monitors each employee’s radiation exposure on a monthly basis. We utilize dosimetry badges, individual lead and full-body lead shields for protection. Since your lab performs peripheral interventions, what disciplines are involved? Our interventional cardiologists and assigned staff are involved in the peripheral interventions. We do not utilize interventional radiologists. What are some of the new equipment, devices and products introduced at your lab lately? The GE Innova 3100 (GE Medical, Waukesha, WI) is our newest addition. It is utilized for both peripheral and cardiac cases, and has digital subtraction. We also have incorporated a new electronic medical records system practice-wide, called NexGen (NextGen Healthcare Information Systems, Inc., Horsham, PA). For archiving, we utilize Siemens syngo Dynamics (Malvern, PA), also practice-wide. Can you describe a system or process you utilize to help smooth cath lab daily life? Our days usually begin at 6:30 am. We have patients coming in at designated staggered times. When the patients arrive, we implement our “AIDET” system. AIDET is a acronym for: A = Acknowledge the patient by name I = Introduce yourself D = Duration (state your experience and time employed at practice) E = Explanation of procedure T = Thank you (thank patient for choosing our facility) After the patient is prepared for their procedure (consent signed, IV in and EKG done), they are taken to one of our three labs. After the procedure, the patient is taken back to his or her original room for hemostasis and recovery. We also make follow-up phone calls to our patients the next morning. How is coding handled in your lab? The nurses circle the charges on a pre-printed form. At the end of the day, the charges are taken to the billing department. How does your lab handle hemostasis? All of our hemostasis is achieved using manual compression by cath lab staff, in the patient’s room. What is your lab’s hematoma management policy? If a patient develops a hematoma, their recovery time is extended until they are discharged by the physician. If the physician feels the patient needs to be observed overnight, they are transferred to the designated hospital. How is inventory managed at your cath lab? We utilize a JIT (just-in-time) inventory management system. There are three designated staff members in charge of assigned supplies and equipment. One staff member is assigned to pharmaceuticals and nursing supplies, and the other two staff members are assigned to lab supplies. Has your cath lab recently expanded in size and patient volume, or will it be in the near future? We have not recently expanded, but we did recently renovate our entire facility. Our patients always comment on the attractiveness of our facility. Is your lab involved in clinical research? The South Carolina Heart Center does have a research department. If a patient fits the criteria for a study, they are notified. We have been involved in the Boston Scientific TAXUS trial series follow-up catheterizations. What measures has your cath lab implemented in order to cut or contain costs? We have contacted several vendors to assure we are receiving the best price. We have kept overtime to a minimum. We are also a member of VHA-GPO (a group purchasing organization). What type of quality control/quality assurance measures are practiced in your cath lab? We have a database where all of our dispositions, outcomes, and complications are entered. Our administrative assistant compiles monthly reports, which are sent to the physicians and administration team. How does your cath lab compete for patients? The South Carolina Heart Center has six regional offices in outlying areas, along with the main campus in downtown Columbia where the cath lab is located. How are new employees oriented and trained at your facility? Each new employee is precepted by a designated staff member and shadowed until he/she is felt to be competent by their preceptor and management. Currently, all staff members have more than one year of experience. Most of our staff members have prior cath lab experience. All clinical staff must be ACLS/BLS licensed. Each RN must also have a current South Carolina license. What type of continuing education opportunities are provided to staff members? Each staff member is encouraged to attend at least one seminar yearly. Since we are a diagnostic lab, our balloon pump representative comes in yearly with a refresher course for the staff. How do you handle vendor visits to your lab? We require our vendors to wear name tags and set appointments up through our administrative assistant or cath lab managers. How is staff competency evaluated? Staff competency is evaluated through yearly reviews/evaluations by the dual manager team and continual physician feedback. Does your cath lab do electives on weekends and or holidays? We work Monday through Friday from 6:30 am until the last patient leaves. We are not open on major holidays. Staff is staggered in and out depending on the patient load. On light days, our staff is utilized in other aspects of the practice. Has your lab undergone a Joint Commission inspection in the past three years? We are currently starting the process of accreditation and are looking forward to the future. How do you see your cardiac catheterization laboratory changing over the next decade? We see our cath lab changing over the next few years through continued technological improvements that will streamline and enhance patient care. Also, we anticipate a continuing, strengthened focus on quality measures and reporting with payers, as well as close maintenance of negotiating efforts with supply and inventory control management. What do you consider unique or innovative about your cath lab and staff? South Carolina Heart Center was the first and is still the only private freestanding cardiac catheterization lab in the state of South Carolina. We continuously receive high marks from our patient surveys. Patients enjoy receiving high quality care in a efficient manner. Each staff member strives to give every patient the individual attention that they deserve. In Columbia alone, there are six facilities that offer cardiac catheterizations. We want to make sure that the patient feels like they have made the right choice by choosing us. Is there a problem or challenge your lab has faced? In our facility’s infancy (1994), we had issues with insurance payers not recognizing the benefits of a outpatient cardiac catheterization, but with time and positive outcomes, the insurance companies realized the cost savings and high patient satisfaction our facility has to offer. The community has been supportive of our presence and the services we have to offer since the beginning. 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 lot of rich southern food makes South Carolina an unhealthy state. Hypertension, diabetes and stroke cases are high in our state. We pay increased effort and attention to patient education and offer instruction on how our patients can control some of their risk factors and improve their lifestyles. The Society of Invasive Cardiovascular Professionals (SICP) has added a question to our spotlight: 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? Several of our staff are members of the SICP. Authors Jack Reese and Stacey Rosbrugh can be contacted at jreese@scheart.com and srosbrugh@ scheart.com.

NULL