St. Mary`s Medical Center

We have two suites with a team of approximately 10 people six RNs and four technologists, plus an additional per diem staff that we call in when needed. Presently, we are recruiting an RT or an RCIS to join our team. Fifteen cardiologists utilize our lab. What type of procedures are performed at your facility? We perform angiograms, PTCAs, stent placements (AngioJet®, Possis Inc., Minneapolis, MN), Rotablator® (Boston Scientific, Maple Grove, MN), electrophysiology, permanent pacemaker insertion, bi-ventricular pacemaker insertion, AICD insertion. There are approximately 25 procedures per week or 100 per month. Does your lab perform peripheral interventions? Yes, 2-3 per month. We perform angioplasty and stent placement in the iliac, femoral and popliteal arteries. The procedures are performed by cardiologists and radiologists at St. Mary’s Medical Center. Does your lab utilize brachytherapy? We do not currently use brachytherapy. Does your cath lab perform primary angioplasty in acute MI without surgical backup? We usually perform primary angioplasty in acute MI with surgical backup. Our average door to percutaneous coronary intervention (PCI) from July to December 2001 was eighty-two (82) minutes. In comparison, mean door to PCI time ranged from 104 to 111 minutes for California and the rest of the nation. Do you have cross-training in the cath lab? ICU nurses are cross-trained for backup. According to the regulations for the state of California, RNs are required to be in the cath lab for patient monitoring and medication. Lab technologists are not permitted to handle those procedures. What are some of the new equipment, devices and products introduced at your lab lately? Our suites are equipped with digital equipment. We are currently using the GE Innova System (Waukesha, WI), which is an entirely digital system. The cath lab also offers AngioJet and PercuSurge® (Medtronic, Inc., Santa Rosa, CA) which is primarily used for thrombus removal. Moreover, the lab is now using heparin-coated stents and two new closure devices, Angio-Seal (St. Jude Medical, Minnetonka, MN) and Duett (Vascular Solutions, Inc., Minneapolis, MN). We currently use intravascular ultrasound and we are anticipating/utilizing the following: Bi-ventricular pacing was launched May 22, 2002 (InSync® by Medtronic, Santa Rosa, CA); Brachytherapy is under consideration; Jometrics SmartWire pressure guide wire, initiated July of 2002 (JOMED, Helsingborg, Sweden). Is your cath lab filmless? Yes, the cath lab is filmless. We are entirely digital, including archiving. The only films we have are from previous years and we use them only when it is necessary to evaluate earlier cases. Who handles your procedure scheduling? The cardiac cath lab has a dedicated secretary and she schedules all of our inpatient and outpatient procedures. We use MS Office as our computer application (scheduling is done in Outlook Calendar). We try to be flexible to accommodate physicians, but we are currently getting ready to adopt the block scheduling method to have a more consistent staffing routine. The previous method was a board (graphic) with the scheduled patients entered by time. What processes does your lab use for pulling sheaths post diagnostic and interventional procedures? Depending on the patient, the following methods are used: Angio-Seal; Duett; FemoStop® (RADI Medical Systems, Inc., Reading, MA); Manual holds; Clamp (rarely). Our entire staff has completed competency training and sheaths are removed either in the cath lab procedure room or in the Holding Room. We try to use an implantable closure device on all of our patients to expedite discharge from the hospital. How does your lab handle hemostasis? A technologist or physician will deploy a closure device while the patient is on the cath lab table. If lines are left in overnight, then the ICU nursing staff are responsible for closures and use FemoStop, manual hold and rarely, the clamp. How is inventory managed at your cath lab? Our Lead Tech, Alex Chan, takes care of the evaluation and purchasing of new products through face-to-face meetings with the vendors after conferring with the cardiologists and the staff. Additionally, there are three cross-trained people, either CVRTs or RNs, to handle ordering. A large portion of our products are on consignment, and these are handled by the purchasing department. Has your cath lab recently expanded in size and patient volume? Yes, our new department opened in April 2001. We have two new cath labs, built to include: Separate admit/discharge and holding areas; A patient-waiting area; Cath lab conference room; Cine/CD viewing/dictation room; Lounge and staff/physician locker rooms. Physician offices for members of the Department of Cardiovascular Medicine. Adjacent to the cath lab area is the non-invasive cardiology department, which includes: Two echo rooms; Two patient exam rooms; An editing/control room; EKG/HOLTER monitor room; Echo reading room. Our vascular lab and EEG have recently merged with non-invasive cardiology. The vascular lab consists of two combined rooms and an office. EEG consists of one treatment room. How has managed care affected your cath lab and the care it provides patients? Our cath lab care does not distinguish a managed care patient from a non-managed care patient. What measures has your cath lab implemented in order to cut or contain costs, and improve efficiencies in patient throughput? We participate in the Premier Purchasing Agreement/Plan with Catholic Healthcare West and work very closely with vendors to try to identify areas of opportunity to decrease costs and streamline services. How does your cath lab compete for patients? We advertise through our partnership with the San Francisco Giants baseball team, on television, radio, print advertising in the San Francisco Chronicle and the San Francisco Medical Society magazine, and articles in local Catholic Newspaper. Contracts are currently being negotiated with other hospitals for St. Mary’s to provide backup to their cardiovascular programs. We are currently negotiating contracts with other facilities (we do the Kaiser overflow). We have a very aggressive physician recruitment program underway and recently recruited a cardiovascular specialist to the hospital. Does your lab have an outpatient program? Yes. We do outpatient transesophageal echocardiograms, elective cardioversions, and dobutamine stress tests. All outpatient procedures are performed in the cath lab holding area or non-invasive cardiology. How are new employees oriented and trained at your facility? Each employee is required to undergo hospital orientation. Nurses renew nursing competencies through a hospital-wide education program, and nurses and technologists are required to complete competencies annually for the department. New hire employees undergo an extensive orientation process and are not released for on-call duty for the first 90 days (experienced) or 120 days (non-experienced.) What type of continuing education opportunities are provided to staff members? All nursing personnel are encouraged to participate in continuing education programs six paid days off are given to nursing staff each year. Multiple continuing education opportunities arise throughout the year and staff members are encouraged to attend whenever possible. Every attempt is made to honor educational request days. How is staff competency evaluated? Staff is tested annually in the form of written tests, return demonstrations and simulation studies. How does your lab handle call time for staff members? The cath lab is covered 24 hours, 7 days per week by three staff MDs, two RNs/one tech, or one RN/two techs. How often is each staff member on call? Call is rotated daily. The RNs take call 2-3 days/week and technologists cover call 3-4 days per week. How frequently do they have to come in, on average? Two to three times every 2 weeks. Do they still maintain a full schedule the next day if they had to come in the night before? Yes, but they are allowed to leave early if the schedule and staffing permits. What type of quality control/quality assurance measures are practiced in your cath lab? We participate in point-of-care testing. The iSTAT is used for ACTs, O2 sats and H/Hs. The equipment is monitored regularly, and this includes quarterly proficiency testing. Additionally, for blood glucose testing, we use the Sure-Step Pro (LifeScan, Milpitas, CA), and it is also monitored on a regular basis. What trends do you see emerging in the practice of invasive cardiology? Drug-eluting stents are on the horizon for percutaneous coronary interventions and bi-ventricular pacing for chronic heart failure. Has your lab has undergone a JCAHO inspection in the past three years? We had a JCAHO inspection in June of 2002. We are a component of the general hospital survey that received an initial score of 93 and a revised score of 95. Please tell the readers what you consider unique or innovative about your cath lab and its staff. We have state-of-the-art equipment like the GE Innova 2000, which is a totally digital system. St. Mary’s is a beautiful facility with quick and easy access for patients. Parking is located just outside the facility. We have wonderful, caring, compassionate and cohesive staff who excel under pressure. We offer patients educational video presentations pre and post cardiac intervention SMMC was recognized as a Top 100 cardiovascular facility in the U.S. in 1999. (Rankings provided by HCIA-Sachs in their study 100 Top Hospitals: Cardiovascular Benchmarks for Success, published May 2000.) Is there a problem or challenge your lab has faced? Yes. Due to the shift in the market share and the shift in cardiac contracts, patients in the San Francisco community were redirected to other facilities. St. Mary’s Medical Center was among the hospitals which experienced a decline in its volume of patients. This change in patient number came at an untimely moment when St. Mary’s Medical Center had just unveiled its new cardiac cath lab facility. We addressed this challenging situation by first assessing the market needs. We looked at trends in Medicare, HMOs, and patient demographics, and physician recruitment. Through collaboration with physicians and with the assistance of a cardiology/cath lab staff and the hospital’s Marketing Director, Linda Gillespie, we were able to form an approach that would promote the new cath lab. The initial promotion included multiple open houses for community, professional and internal audiences, along with several press conferences. Our staff worked together to establish various programs such as an annual conference on interventional cardiology and to actively recruit cardiologists. Visiting physicians in their offices and working closely with them helped to ensure that these physicians would make St. Mary’s their primary site. Staff also helped to increase exposure of the St. Mary’s cath lab in the surrounding community by participating in various outreach activities. This year, St. Mary’s participated in the annual Cherry Blossom Festival. Community involvement was an important part of showing our commitment to the patient community. However, it was also a way of gaining more visibility and showing the public that the St. Mary’s Cath Lab is a center of excellence, in keeping with a tradition of nearly 150 years of patient and staff-centered quality healthcare!