St. Joseph Mercy Hospital

What is the size of your cath lab facility and number of staff members? Our cath lab has three dedicated inpatient procedure rooms and a six-bay prep/recovery area within the hospital. One procedure room has bi-plane imaging capabilities. We also have an outpatient swing lab, located in our Michigan Heart & Vascular Institute, which is connected to the hospital. The swing lab has 8 hotel-like prep and recovery rooms. We have 25 staff members, each with one of the following credentials: Registered Nurse (RN), Registered Cardiovascular Invasive Specialist (RCIS), or Registered Respiratory Therapist (RRT). The average length of time staff members have been part of this department is five years. There are 12 physicians in our cath lab. What type of procedures are performed at your facility? We provide both diagnostic and interventional procedures for our patients at St. Joseph Mercy Hospital. Our approximate annual volume is over 4,000 procedures with approximately 80 each week. We will soon be performing peripheral interventions when our new combo room construction is complete. It’s scheduled to open in July 2004. We chose a Philips Allura FD-20 (Andover, MA) large flat detector cardiovascular system for the new combo room. Does your cath lab perform primary angioplasty with/without surgical backup? We perform primary angioplasty 24 hours per day/7 days per week. We have surgical backup on site 24/7, with the cardiovascular OR specialist team available within 30 minutes for emergencies during off shifts and weekends. What procedures do you perform on an outpatient basis? We perform diagnostic cases as outpatients, including left heart catheterization, right heart catheterization, bypass angiography and assessment for valve disease. What percentage of your patients are female? Approximately 37% are female. What percentage of your diagnostic cath patients go on to have an interventional procedure? Twenty-five percent of diagnostic caths go on to have interventions. Who manages your cath lab? The Cath Lab Clinical Manager is Jackie McAninch, RN. The Medical Director is Michael J. O’Donnell, MD. Our Director is Mary Poskie, RN, and she is responsible for the Cardiovascular Service Line at Saint Joseph Mercy Health System. Do you have cross training? Who scrubs, who circulates and who monitors? Cross-training is based on the need of the department and the interest of the staff. Our primary staffing model has the RN monitoring and circulating during cases and the technologists scrubbing. Currently, three nurses are trained to scrub cases. Does an RT (radiologic technologist) have to be present in the room for all fluoroscopic procedures in your cath lab? Our special procedures techs (SPT) run the fluoroscopic equipment under the direction of the 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? In our lab, the SPT can position the equipment, pan the table, and change angles while the physician steps on the fluoro pedal. Does your lab have a clinical ladder? We have a clinical ladder for both RNs and technologists. The Registered Cardiovascular Invasive Specialist (RCIS) credential is required for a Tech III. RN clinical ladder III staff take on additional responsibilities such as quality, education, practice, or leadership. RCIS clinical ladder III staff take on leadership roles and are clinical experts within the department. What are some of the new equipment, devices and products introduced at your lab lately? We are using drug-eluting stents in approximately 40% of our patients (our overall volume has not yet changed as a result of drug-eluting stents). We offer brachytherapy (the Beta-Cath System, Novoste Corp., Norcross, GA) in our cath lab with the assistance of the radiation therapy department. Congenital anomalies such as atrial septal defects (ASD) or a patent foramen ovales (PFO) are closed percutaneously. Another example of a new device that is used in certain situations is the distal embolic protection device. Is your cath lab filmless? Our lab is totally filmless and has been since 1995. We use Philips fluoro equipment in all of our rooms. Images are transferred to the Vericis® system (Camtronics, Hartland, WI) for storage and retrieval if needed at a later date. Having the images at our fingertips has improved our efficiency and the images can be obtained at numerous locations. How does your lab handle hemostasis? We use closure devices in 48% of our patients when indicated. All staff are trained to hold pressure. The staff on the post procedure/nursing units pull sheaths and take care of our 23-hour stay patients. Does your lab have a hematoma management policy? We do have a policy and a very low incidence of hematomas. How is inventory managed at your cath lab? Who handles the purchasing of equipment and supplies? We have a purchasing specialist who handles the purchasing of equipment and supplies. Our Witt system (Melbourne, FL) is utilized for our inventory control. Equipment and supplies used during a procedure are documented and reconciled to established par levels for reorder amounts. How is coding and coding education handled in your lab? How is coding communication handled with the billing dept.? The Health Information Staff (Medical Records department) code our procedures. Our clerical staff process the procedure charge while the patient financial services department completes the bill. Our department, the health information department and patient financial department meet on a monthly basis to reconcile and solve any problematic issues. Has your cath lab recently expanded in size and patient volume, or will it be in the near future? Within the next year, we will be expanding our physical space to add a combination lab that will allow us to do coronary and peripheral work. This will increase the number of procedure rooms to four. Additionally, a state-of-the-art MRI with cardiovascular capabilities and 23 prep and recovery bays will be available to support the work of the cath lab and radiology. As the modalities of interventional cardiology and radiology begin to overlap, we are further developing a multi-disciplinary approach to care for our patients. Is your lab involved in clinical research? Yes, current interventional research includes the PROXIMAL (Proximal Protection during Saphenous Vein Graft Intervention using the Proxis Embolic Protection System) trial and the EMERALD study (Enhanced Myocardial Efficacy and Recovery by Aspiration of Liberalized Debris [PercuSurge]). Both studies involve the concept of distal embolic protection. We are also expecting to begin screening for two IVUS research studies in the near future. Does your lab perform elective cardiac interventions? It is considered an elective cardiac procedure when a patient has a diagnostic procedure at another institution or our outpatient lab and is scheduled for an intervention at a later time. Under that definition, we do perform elective interventions. We have relationships with several diagnostic lab only facilities that transfer their patients to us. Have you had any cath lab-related complications in the past year requiring emergent cardiac surgery? We have a very low incidence of complications. What measures has your cath lab implemented in order to cut or contain costs? Part of our mission is to steward the resources entrusted to us. Therefore, we continuously evaluate opportunities to improve quality and contain costs. One initiative is that our hospital is part of Consortia, a hospital- buying group that negotiates pricing for supplies and equipment. Additionally, we do bulk buys to gain even more savings. We work closely with the physicians for optimum efficiency of scheduling and for supply usage. However, our patients remain our number one priority every opportunity is evaluated with the best interest of our patients in mind. What type of quality control/quality assurance measures are practiced in your cath lab? We are deeply committed to quality at St. Joseph Mercy Hospital. We have continuous quality assurance both internally and are part of a large, 16-center regional database. As a program, we are identified as a Blue Cross Blue Shield Center of Excellence. Our quality measures are the door-to-balloon time, pre-procedure education documentation, complication rates, and appropriateness of procedures. We have a full-time data analyst that assists in collecting this information from our documentation and developing reports. How does your cath lab compete for patients? Has your institution formed an alliance with others in the area? At St. Joseph Mercy Hospital, we are not focused on competition but rather providing the best quality care for the people of our surrounding communities. If patients choose us over another facility, it is probably due to our excellent reputation and customer service. How are new employees oriented and trained at your facility? We draw from a variety of backgrounds and have former special procedure technologists, respiratory therapists, radiology technologists, emergency medicine technicians, and exercise physiologists. Nurses need to have experience in an intensive care or progressive care unit. We offer an intensive three-month orientation for both nurses and technologists. Scrubbing is an additional two months of training. Basic Life Support and Advanced Life Support are a requirement for all staff working in the cath lab. We use a preceptor model for orientation of new staff. What type of continuing education opportunities are provided to staff members? We have Cardiovascular Grand Rounds for staff every week which provides information on the latest technology, research, American College of Cardiology updates, etc. There is an annual cardiovascular conference available for staff. Additionally, we have funding available to send staff to local and national conferences as needed. In our new expansion space, we are building a conference room in the cath lab for the sole purpose of physician and staff education. How do you handle vendor visits to your lab? All vendors must register with the hospital’s Purchasing Department and receive a name badge, which they must wear at all times. We have certain days which we see vendors. How is staff competency evaluated? At St. Joseph Mercy Hospital, all employees are evaluated every two years. How does your lab handle call time for staff members? Our cath lab is staffed Monday through Friday from 7:30 am to 6 pm. Our on-call team covers the other hours and consists of an RN and two Special Procedure Techs. Call averages once during the week and once every six weekends. What trends do you see emerging in the practice of invasive cardiology? Michael O’Donnell, MD, Medical Director, sees an evolution in the types of drugs that are used in drug-eluting stents. The drugs will be able to treat different problems. Also, distal embolic protection devices will become more routine in the future. Has your lab has undergone a JCAHO inspection in the past three years? Yes, the cath lab participated as part of the hospital’s JCAHO inspection. We are also expecting an inspection this fall. During the inspection in 2001, we had good results. Where is your cath lab located in relation to the OR department, ER, and radiology departments? We are fortunate to be ideally located, adjacent to the OR, ER and Radiology. Please tell the readers what you consider unique or innovative about your cath lab and its staff. Research indicates that hospitals that perform the highest number of cath procedures are the best places to seek care. At St. Joseph Mercy Hospital, we have a very high utilization rate, bypassing national benchmarks for procedures per room (we do approximately 10 procedures per room each day). In addition, we are involved in cardiovascular research with access to even larger research centers, thus providing our patients with the latest treatment options. We work with an outstanding cardiology group that allows us to enjoy such a high productivity rate. What’s special about your city or general regional area in comparison to the rest of the U.S.? The Ann Arbor area holds a highly educated population; there are four major colleges in our immediate area and therefore, our patients tend to be knowledgeable about their own health care issues. If you would like more information or to apply, please visit us on the web at www.sjmh.com Jackie McAninch can be reached at: mcanincj@trinity-health.org The Society of Invasive Cardiovascular Professionals (SICP) has contributed two questions to our spotlight: 1. Do you require your clinical staff members to take the registry exam for Registered Cardiovascular Invasive Specialist (RCIS)? Do staff receive an incentive bonus or raise upon passing the exam? The Registered Cardiovascular Invasive Specialist (RCIS) credential is required for a Tech III staff; there is a 10% raise upon passing the exam. Full-time employees receive reimbursement up to $300 for continuing education annually, part time employees receive up to $150 annually. 2. 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? Not at this time.

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