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Spotlight Interview: Oregon Health & Science University
Tell us about your cath lab.
Oregon Health & Science University (OHSU) is a 537-bed facility located in the heart of downtown Portland, Oregon. We are the only academic medical institution within the state of Oregon and our hospital has been recognized nationally not only for its research, but has also been listed as one of the top 100 hospitals nationwide by US News for the past 16 consecutive years. OHSU has a long history of excellence in cardiovascular care and innovation: from the first shaped coronary catheters by Judkins and first mechanical prosthetic valve by Starr, to the first peripheral angioplasty by Dotter. We are also pleased to announce that OHSU has recently been accredited for an Interventional Cardiology Fellowship. We are very excited about this opportunity.
Our cardiac cath lab has four procedure rooms and eleven staff physicians, as well as other physicians with cath lab privileges associated with our outreach programs and affiliates. Our support staff currently consists of fourteen full-time members and a flex-pool staff of two, with varied disciplines, including nursing (6), radiologic technologists (6), cardiovascular invasive specialists (2), a registered cardiovascular electrophysiology specialist (RCES) (1), and a certified electrophysiology specialist (CEPS) (1). Our staff includes ten members who have been with us between ten and thirty years, and four members who have become part of the team within the last six months to four years. Our flex-staff personnel have been part of the cath lab for ten and five years, respectively, for a cumulative effect of over 120 years of experience.
What procedures are performed at your lab?
It is easiest to address which procedures we do not perform within our cath lab: we do not perform neuro or peripheral studies. OHSU is a huge complex, and as such, has a dedicated cardiac cath lab, with interventional radiology next door as part of the Dotter Interventional Institute. But to offer perspective on the procedures we do perform, it’s best to think of our cath lab as an umbrella organization embracing three forms of specialization. We have a:
- Pediatric and Adult Congenital Lab, with 2 congenital interventionalists on site;
- Electrophysiology Services, with 3 electrophysiologists on site; and
- An Adult Cardiovascular Lab, offering coronary services as well as procedures involving prospective and current cardiac transplant patients, with 3 cardiac interventionalists and 3 cath attendings on site.
Within our Adult Cardiovascular lab, we perform diagnostic and interventional studies, including percutaneous coronary intervention (PCI)/stent placements, intra-aortic balloon pump (IABP) insertions, Rotablator (Boston Scientific) procedures, valvuloplasty, and pericardiocentesis. We perform TandemHeart (CardiacAssist, Inc.) procedures, right heart catheterizations and right ventricular biopsies, both for transplant patients and those with intact pericardiums to rule out sarcomas. We also perform RAMP studies for left ventricular assist device (LVAD) patients, generally outpatients. These procedures involve doing a right-heart cath and changing rotations on the VAD to optimize cardiac output, while not compromising orthostasis. The rotations might decrease or increase, although sometimes after the study, the VAD settings remain the same; the process is essentially about trying to make the patient feel better.
Our electrophysiology services (EPS) include, but are not limited to, intracardiac electrophysiology study (EPS)/ablation procedures and implants, such as reveal monitors, pacemakers, and implantable cardioverter defibrillators (ICDs), including bi-ventricular ICDs. Our Pediatric/Adult Congenital lab serves a patient population ranging from neonates to geriatrics, and the types of procedures we perform vary in accordance to the congenital defects acquired. This is the lab where we may do procedures other labs may not be familiar with, but our more routine cases involve septostomies, closure devices (for patent ductus arteriosus [PDA], patent foramen ovale [PFO], atrial septal defect [ASD], and ventricular septal defect [VSD]), coil procedures, diagnostic studies for pre-surgical patient, and dilatation/stent deployment of coarctations, pulmonary atresia (PA), and conduits. We also serve a pediatric transplant population in which we perform right heart catheterizations and biopsies to rule out rejection. OHSU is also one of 35 institutions nationwide to utilize the Melody valve (Medtronic), in which a bovine pericardial valve is placed in the pulmonic position percutaneously. Last year, we performed a total of 1,674 procedures, with the breakdown between specializations as follows: 300 congenital catheterizations, 634 electrophysiology procedures, and 740 adult cardiovascular catheterizations. Average procedures per week are a little more than 32.
What percentage of your diagnostic cath patients goes on to have an interventional procedure?
Over half of our adult cardiovascular patients have PCI/stent placement procedures, with only about one-third of the population within that subgroup resulting in a “normal” cath. The rest are referred to surgery or medical therapy. Within the Pediatric/Adult Congenital lab, there really is no such thing as “normal.” We do have procedures that are scheduled as diagnostic/pre-surgical, but patients not being referred to surgery typically have some form of intervention performed, ranging on the type of congenital defect with which they present. Even some of our pre-surgical patients have interventions performed before surgery, such as coils placed in collateral vessels.
Do any of your physicians regularly gain access via the radial artery?
In the Adult Catheterization lab, all of our attendings have gained access via the radial artery, but only one physician on site does so regularly, as does a physician associated with our outreach program who has cath privileges within our institution.
Who manages your cath lab?
Our cath lab is currently without a manager, but we do have a well-liked Interim Director, Barry Hawthorne, RN, MSN, (BE Smith), who oversees daily operations and staff scheduling, as well as administrative duties. We have three lead techs, representing each of the specializations: Alana Turner, RT(R), for the pediatric and adult congenital heart catheterizations; Tom Clark, RCIS, CEPS, for electrophysiology services; and Tamara Werderber, RT(R), for the Adult Cardiovascular lab, as well as responsibility as acting manager in the absence of an official filling. Deb Cox, RN, BSN, is the charge nurse for the entirety of the lab. Barry meets with these four individuals every morning to discuss any new implementation of policies/procedures, as well as to iron out any scheduling conflicts that may arise due to shortage of staff or additional patients scheduled throughout the day.
Do you have cross training? Who scrubs, who circulates and who monitors?
As recently as 2006, our staff was completely cross-trained to address the scope of practice within the cath lab, but as legislation changed, as well as mandates from within our hospital, we adapted to what is more typical of the modern cath lab. Our nurses primarily circulate. We are all trained to scrub, and x-ray personnel operate the fluoroscopic equipment. All personnel are trained on the console. The daily rotations are based on staff availability, depending on how many persons are assigned to each room and what type of procedure is being performed. All staff is required to have pediatric advanced life support (PALS) and advanced cardiac life support (ACLS) certification. However, once the patient is on the table, it is understood that we are the eyes and the ears of the physician, and we are all responsible for monitoring the patient, recognizing EKG changes, saturation changes, etc., and alerting the physician as well as other staff within the lab.
Are you recording fluoroscopy times and dosages?
Our fluoroscopy times and dosage are recorded in the log as part of the Mac-Lab/CardioLab Information System (GE Medical). This information becomes part of the patient’s medical record. All of our fluoroscopic units tally the time of fluoro and cine, plus exposure dose (dose area product, DAP) for fluoroscopy and recorded runs. The monitor personnel manually transfer this information into the patient’s log.
Who documents medication administration during the case?
All documentation of the procedure, including drug administration, is done by the monitor personnel. RNs administer all sedation medication and any medication pushed through the patient’s IV or administered orally. Scrub techs and physicians administer medication such as contrast, nitroglycerin, verapamil, adenosine, heparin, and heparinized saline through the catheters.
Does an RT have to be present in the room for all fluoroscopic procedures in your cath lab?
Yes. The Oregon Board of Medical Imaging dictates that a radiologic technologist be present in the room for all fluoroscopic procedures.
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?
Radiologic technologists are assigned to each room, and are responsible for positioning the II, panning the table and changing angles as necessary. The physicians primarily operate the fluoro pedals, but radiologic technologists are permitted to as well, if the case requires such.
How does your cath lab handle radiation protection for the physicians and staff?
To reduce radiation exposure during procedures, all personnel within the room must have lead on at all times. As new hires come in, whether as support staff or physicians, each member is measured, and lead aprons are ordered for them. Our lead aprons are evaluated for quality before being worn and we have annual checks. Aprons with defects are removed. We monitor radiation exposure through collar and whole-body radiation badges that are evaluated monthly, and yearly exposure reports are given to all staff involved. In addition, all cases that have resulted in prolonged fluoro times are reviewed by our medical director, Dr. Gupta, and at the institutional radiation safety committee meeting.
What are some of the new devices and products introduced at your lab lately?
Our lab has gone under dynamic change over the last five years, with the introduction of a fourth procedural room, as well as replacement of almost all of our equipment. We currently have two rooms with Siemens fluoroscopic units, two rooms with GE fluoroscopic units, and all monitoring is done via GE console systems. In our electrophysiology lab, we also have a 0.8 Tesla magnet for magnetically guided catheters. In terms of devices and products, we have been introduced to the Melody Valve and TandemHeart within the past year. Two years ago, we were introduced to the Impella system (Abiomed), which was to replace/work in conjunction with the IAB, but we don’t utilize it often. Recently we have been approved as a site for the Edwards transcatheter valve and plan to start performing TAVR (transcutaneous aortic valve replacements) later this year.
Where are patients prepped and recovered (post sheath removal)?
Our inpatients are typically prepped and recovered on their units by their nurses; there are some exceptions to this rule. Certain patients require a higher level of care post procedure than the unit they came from is prepared to provide, and those patients are typically sent on to intensive care units (ICUs) or a post-procedural recovery unit such as our interventional recovery unit (IRU) or a post-anesthesia care unit (PACU). We share an IRU with interventional radiology, and our outpatients are admitted through this unit, which typically recovers them as well. Certain units within our hospital have been trained in sheath removal in addition to the IRU. Outside of those particular units, we perform sheath removal within the lab, and although we occasionally utilize vascular closure devices, the majority of our sheath removal involves manual pressure. We use the TRBand (Terumo) in radial cases.
Who pulls the sheaths post procedure, both post intervention and diagnostic?
Sheath removal happens in the cath lab and in recovery units/ICU. In the sheath removal that occurs in the cath lab, the scrub tech is typically the individual who removes the sheaths and holds pressure until hemostasis. In cases where a sheath is pulled in the recovery unit or on the floor, nurses pull the sheaths, except in our ICU, where the on-call fellow is responsible for sheath removal. All personnel responsible for sheath removal are supervised until deemed capable of independent sheath removal, even first-year fellows.
What is your lab’s hematoma management policy?
To be quite honest, we haven’t had the need for a hematoma management policy. As we shifted from cath lab staff-only sheath removal to unit removal of sheaths, our training was incredibly intense and thorough, and we haven’t seen a complication rate to warrant a policy.
How is inventory managed at your cath lab?
Inventory is managed by the Pyxis system (CareFusion) and the hospital’s logistics department. All items removed from the Pyxis are logged automatically by using Pyxis JITrBUDs (a wireless documentation device), and the information is transferred to the logistical department for reordering purposes. All major equipment purchases involve the upper administration of the cath lab, as well as hospital administration.
Our Pyxis system is basically a computerized inventory that communicates with our logistics and central warehouses. The logistics department then prepares stock from the warehouses to bring to our department during post-procedure hours and also orders from most, but not all, of our vendors based on our usage. While the system is not without its limitations, as it is dependent on our staff pressing JITrBUDs and also logging out of the Pyxis in order for the information to be transmitted, it has helped us with inventory and cost control.
There are still certain items that we do not use consistently enough to maintain in our inventory, and the lead techs typically arrange for those items to be present when needed, if the information is communicated to them by the physician. We’ve had some form of this arrangement for at least ten years, but it has been upgraded as technology becomes available, so that we are better able to reconcile our supply costs in a much more timely fashion. Our current system is through Cardinal Health.
How does your lab communicate information to staff and physicians to stay organized and on top of change?
Due to our cath lab size, and the fact that we primarily have on-site physicians, most of our communication is done verbally or via email. We do have a board in which the day’s schedule is posted. Changes to the board are typically made by the lead techs or physicians. Full-time staff also meets with the Cath Lab Medical Director, Dr. Gupta, once a week, for educational opportunities as well as updates in regards to policy/procedural changes.
How is coding handled in your lab?
We have, on site, a cath lab coding and reimbursement specialist, who codes each case with the appropriate CPT (current procedural terminology) codes, and then the CPT charges are entered for both inpatient and outpatient accounts. This information is then sent to either HIM (health information management) coders (for outpatient procedures) or to the inpatient coders. Coding education involves an assortment of webcasts, webinars, conferences and membership coding websites, and our coding and reimbursement specialist works with the physicians and fellows in enhancing their knowledge of coding rules.
Has your cath lab recently expanded?
Yes, OHSU recently acquired its fourth procedural room. Not only has our patient volume increased in the past three years, but we believe it will continue to do so in light of advancements in technology and a growing congenital population.
Do you have a hybrid cath lab, or are you planning to build one?
We are in the planning stages for a hybrid OR that would involve cath lab staff, scheduled for completion in 2013.
Is your lab involved in clinical research?
Yes. As part of an academic institution, clinical research is a routine component of what we do. Some of the studies currently in progress involve the heart failure/heart transplant cardiovascular services, such as research on quality of life, economics, and caregiver burden. We are also institutional review board (IRB)-approved for the HeartWare Ventricular Assist System (HVAD). Our Congenital Lab is part of C3PO (Congenital Cardiac Catheterization Project on Outcomes), which also includes hospitals such as Boston Children’s, Ohio State, and Washington University. We also continue research on the Melody Valve and its efficacy. Electrophysiology Services is currently involved in CABANA, an atrial fibrillation study, as well as the EchoCRT trial with Biotronic, which involves randomized pacing trials.
Have you had any cath lab-related complications in the past year requiring emergent cardiac surgery?
Within the past year, we have had a single experience involving a valvuloplasty in our Adult Cardiovascular services that necessitated emergent cardiac surgery.
Can you share your lab’s average door-to-balloon (D2B) times?
Our average D2B time from September 2010 through May 2011 was 41 minutes. This time represents minutes from arrival at our facility. We continue to work with our emergency services in regards to earlier recognition, and EKG and consults. Support staff is expected to be in hospital no more than 30 minutes post page.
Who transports ST-elevation myocardial infarction (STEMI) patient to the cath lab during regular and off hours?
STEMI patients are transported by a Rapid Response Team or by the cath lab staff. This is our practice for all STEMIs, whether occurring during our regular operating hours or otherwise.
What do you do when the call team is already busy doing a procedure and a STEMI comes into the ED?
When confronted with a STEMI patient during another procedure, it basically comes down to triaging. Depending on where we are in the procedure, we can sometimes finish the study or send the patient back to the recovery unit until the STEMI has been completed. But it comes down to prioritizing the patients and tending to what needs to be accomplished immediately. If we have two patients that are both very sick, unfortunately, it is a matter of first come, first serve.
What other modalities do you use to verify stenosis?
We do use physiology for lesion assessment with fractional flow reserve (FFR), and we also routinely utilize intravascular ultrasound (IVUS) for coronary stenosis verification.
What measures has your cath lab implemented in order to cut or contain costs?
Our new director/acting manager of the cath lab has implemented a strong program to control costs in the supply chain arena. Prior to 2011, supplies were ordered by many different staff members and achieving consistency in supply chain costs was quite problematic. In 2011, a Value Analysis Committee was formed and organized around supply chain opportunities. We also hired a supply coordinator exclusively for cath lab/EP services. This individual resides in the department and coordinates all of the ordering and supply chain issues for the department. Ensuring pars are consistently standardized and out-of-date stock is rotated out of the lab netted improvements of greater than $250,000 in 2010.
What quality control/quality assurance measures are practiced in your cath lab?
Clay Allen, RN, is our quality control person, and all members are responsible for daily quality control checks regarding our Hemochron (ITC Medical), ABL80 Flex (Radiometer), and Avoxmeter 1000 (ITC Medical) equipment.
We participate in the National Cardiovascular Data Registry (NCDR) as well as the University Hospitals Consortium (UHC). We routinely analyze data from these registries and have a robust QA process to review all complications.
How does your cath lab compete for patients?
Our institution has formed alliance with others in the immediate area and has also implemented outreach programs in rural areas across the state of Oregon, as well as in southwest Washington State, Idaho, Alaska and Northern California. Quite simply, our cath lab serves patient populations that other labs in the immediate area do not serve. It’s not a matter of competition, but rather word-of-mouth and the respect earned by our physicians. Patients within the Portland area have a choice in outstanding hospitals for routine cardiac care, but in regards to the patients suffering from heart failure, cardiomyopathy, congenital heart disease, or more complex coronary disease, OHSU has the reputation of being the place to go when in need. We have superb outcomes and are one of the few nationally accredited chest pain centers in the region.
How are new employees oriented and trained at your facility?
Most employees are first oriented to the hospital as a whole, and undergo Epic electronic medical records training and such outside of the lab. Once a member has completed hospital orientation, that person is assigned a preceptor, depending on his/her scope of practice. Learning begins within that defined scope, then gradually adapts to roles not defined by discipline of study. There is a learning curve for all personnel coming into our cath lab, whether or not they have had prior cath lab experience, simply due to the attention-to-detail mentality that is required within our lab. The information we gather on a daily basis can make the difference between an intervention, a patient being referred to surgery, or a diagnostic procedure, and our physicians expect us to assist them in gathering the information that will determine the patient outcome. A simple error of incorrect gauge height can require an entire study to be repeated. At the same time, we have a great relationship with our physicians, because we take a lot of pride in what we do and understand the importance of such detail. We currently have four staff members that have joined our team and have less than a year’s experience in our department. We acquired two radiologic technologists from another hospital that was downsizing their lab, a registered nurse (RN) who was returning to work after a few years sabbatical, and an RN from our emergency department. Licensure requirements are state-based, for both RNs and radiologic technologists, and as previously stated, all our support staff is required to have PALS and ACLS certification, as our lab calls and performs its own codes.
What continuing education opportunities are provided to staff members?
As an academic institution, informal education occurs on a daily basis within our department, as we have cardiology fellows within each specialization, ranging from first-year fellows (and thus, catheterization being a brand-new procedural experience) to third-year pediatric cardiology fellows. OHSU, as a hospital, also provides a wide variety of certificate of eligibility (CE) classes within its organization and its subsidiaries. We have also recently organized a weekly format of staff meetings, with CE offerings for the cath lab staff members, each Thursday at 0730, which is also the day when every full-time staff member that works in the department is scheduled to work (excluding paid time off, etc.). We have educational offerings for device-related care issues (IABPs, catheters and balloon therapy), as well as nursing and technical care associated with the patient types we care for within our cath lab/EP services. We also have seminars and educational opportunities outside of OHSU. For example, the Oregon Chapter of the American College of Cardiology conference takes place each year in Portland and numerous staff members are scheduled to attend. OHSU is a key sponsor for the conference. Five staff members from across the cardiovascular service line have been given free scholarships. We send a staff member to Boston for the Pediatric & Adult Interventional Cardiac Symposium (PICS & AICS). In 2011, we sent the staff member early to afford her the opportunity observe at the Boston’s Children Hospital cardiac cath lab services, in order discover learning opportunities by observing operations in another cath lab. We also send members of our staff to the Society for Cardiovascular Angiography and Interventions (SCAI) conference in Baltimore, for the most up-to-date information regarding state-of-the-art care in angiography and interventional care. These are only a few of the educational opportunities that are afforded to our staff members within the lab.
How do you handle vendor visits?
OHSU has a strict policy. Scheduled appointments are the only way vendors can visit the lab. Some vendors provide clinical representatives for certain procedures; however, they are only invited into the lab based on physician and patient need. Once the procedure is completed, the vendors are not allowed to maintain a presence within the lab. It is required that they wear radiation badges for procedures using fluoroscopy, and they follow the same process as OHSU regarding radiation exposure.
How is staff competency evaluated?
Staff competency is an area under considerable redevelopment. The current competency-based orientation program is a paper trail, and therefore thought to be an unwieldy system for tracking and improving staff competency. The current director/acting manager of our service is embarking on a new initiative to move the process into the 21st century by implementing an online orientation program that is more “digestible,” providing a format and process for guiding new employees through the orientation program, as well as supporting the preceptor with conference prompts and feedback loops. The online program is scheduled for development and release this year.
Does your lab have a clinical ladder?
There is not a clinical ladder in place at this time, but a program is currently being considered for FY2012.
Is there a particular mix of credentials needed for each call team?
Call is currently divided among eleven full-time staff members and supported by the two flex-staff members, making it one of the biggest challenges we face as a team. Our call team consists of four members at all times, due to handling our own codes, and requires that one member be an RN and one member a radiologic technologist, to support the legal requirements in the state of Oregon. Call begins at 1600 and runs through until 0730 the next morning, Monday through Friday. Weekend coverage extends the full 24 hours of each day.
Within what time period are call team members expected to arrive to the lab after being paged?
Unless otherwise specified by the physician, call team members are expected to arrive no later than 30 minutes post page. Although the attending cardiologist may not be on-site at the time of the page, they usually arrive before or at the same time as the support staff. We do not allow the patient to be brought to the cath lab before the attending has arrived.
Do you have flextime or multiple shifts?
We currently have two shifts in place, with half the staff working five 8-hour shifts, and the other half working four 10-hour shifts. Due to staff shortage, there is currently an expected amount of mandatory overtime, which we are trying to eliminate as much as possible. We do have two members of a flex-staff pool, but often they work to cover shifts rather than a relief status in regards to overtime.
Has your lab recently undergone a national accrediting agency inspection?
In 2010, our hospital underwent a Joint Commission inspection, as we do every three years. It is best to keep in mind the intent of such inspection, and to utilize team effort in implementing improvements. In our case, one of the things our lab takes very seriously is the “Team Pause.” It is usually done before the patient enters the procedure room, with all the staff involved in the case by the patient’s side, verifying patient information and allergies. This pause is also used as a communication opportunity in regards to patient access and the supplies expected to be used.
Where is your cath lab located in relation to the operating room and ED?
The cath lab is located on the eleventh floor of the South Hospital, and the emergency department is on the eighth floor of the same. We have operating rooms on the sixth floor of the South Hospital, but also in the North Hospital and Kohler Pavilion, which is adjacent to the South Hospital. Doernbecher Children’s Hospital is actually a separate entity on campus, but is accessible through hallways on the eighth and ninth floors of the South Hospital. One of the common patient complaints is that our facility is very complex, and it is easy to get lost, but we have great staff in administration and many hospital volunteers that assist patients and their families getting around the complex.
Can you tell us about your layout?
Our lab occupies the “C” wing of the eleventh floor of the South Hospital. We have four labs, each approximately 20’ x 20’. Three of our labs have biplane imaging, and our electrophysiology lab also has a 0.8 Tesla magnet. For the most part, our labs are on the large side, and there is definitely room to move around. We all are very happy with the imaging of our new fluoroscopic units, but some of the heads are quite large and create difficulty in getting proper angles on very obese patients.
What trends have you seen in your procedures and/or patient population?
Our procedures have definitely grown more complex, due to technology and the patient population itself. We see more very sick patients, whether due to obesity, diabetes, or simply a lack of insurance preventing them from seeking care earlier. As technology improves, we also have a growing congenital population. Patients once considered untreatable are now being served. In the congenital lab, we also have a number of return patients, due to the nature of congenital defects. We can upsize a conduit/vessel/stent or may treat recurring issues not involving the first presentation.
What is unique or innovative about your cath lab and staff?
What is most unique about our lab is the patient population we serve. We do incredible things at our facility. We see things that are not seen elsewhere, especially within our congenital lab, but definitely not limited to it. Our staff is incredibly knowledgeable and dedicated. We have been through a lot together, and at times we are more like family to each other than co-workers, especially if we have seen too much overtime.
Is there a problem or challenge your lab has faced?
I would say the biggest challenge our lab has faced has been a high turnover the past three years. We lost some members that had been part of our team for quite some time. We also have had three managers in less than three years. As an academic institution, we have to say goodbye to our cardiology fellows every two to three years. We’ve hired on new members only to have them leave after training, primarily due to the intensity of our job and the hours we put in. However, we currently have new recruits that show a great deal of promise, and the smaller group has definitely grown closer as we have had to overcome obstacles, take on more responsibilities, and commit more time. We have an excellent working relationship with our physicians, and they have definitely been our advocates.
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”?
Our hospital rests atop Marquam Hill in Portland, which is one of the highest elevations in the city limits. We have a tram that runs from the South Waterfront Campus to the Marquam Hill campus, and from this tram one can see Mt. St. Helens, Mt. Hood, Mt Adams, and Mt. Jefferson on a clear day. It is a beautiful view overlooking all of Portland, and has become a tourist attraction as well as a mode of transportation. Portland prides itself on being a bike-friendly city, and also has an incredible public transportation system that has served as a national model. Portland is home to outdoor enthusiasts, and our staff definitely supports that reputation. Many of our staff members are avid cyclists, marathon runners and mountain climbers. Portland also has a reputation for its food carts and local microbrew culture.
The Society of Invasive Cardiovascular Professionals (SICP) has added two questions to our spotlight:
Do you require your clinical staff members to take the registry exam for Registered Cardiovascular Invasive Specialist (RCIS)?
The registry exam for Cardiovascular Invasive Specialist is not currently required by our administration, and there is no incentive being offered in regards to passing the exam. However, we are currently re-evaluating potential incentives in regards to passing the registry exam for the RCIS.
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?
We do have staff who are members of the American Nurses Association (ANA).
Constance Jones can be contacted at cdweed2001@yahoo.com.
