St. Thomas Outpatient Cath Center

What is the size of your cath lab and number of staff members? We have only one room presently, but with the current patient volume and expected growth, there are plans for a second lab in the future. There are 9 total staff members, including the manager and secretary. The mixture of expertise includes are 2 LPNs, 4 RNs, and one CVT taking her RCIS exam this fall. We are looking to hire another full-time RT in the next fiscal year. We have a position open for an RT(R) which I may have filled at by the time of publication. What type of procedures are performed at your facility? Our lab only performs outpatient diagnostic cardiac caths, and fluoroscopy of pacer leads. This lab does not perform cardiac or peripheral interventions. What percentage of your patients are female? Our patient breakdown is approximately 55% male and 45% female. Do you have cross-training in the cath lab? Since the opening of the lab, cross-training has been standard practice. The RNs perform all three roles: scrub, circulate and monitor. The techs monitor and scrub. This cross-training has enabled our lab to operate very efficiently. What kind of equipment does your lab use? Our lab uses the Philips Integris V5000 x-ray system (Andover, MA), which is filmless. We have the Witt hemodynamic monitoring system (Melbourne, FL) and the Acist contrast management system (CMS) (Acist Medical Systems, Eden Prairie, MN). How does your lab handle hemostasis? Since we are an outpatient lab, we use 4 French catheters and hold manual pressure. Our use of the Acist device allows us to eliminate the need for closure devices. Our patients generally are discharged 90 minutes after hemostasis is obtained through manual pressure. We monitor QA on all our patients. Our complication rate is very, very low and we have had no cath lab-related complications requiring emergent surgery. How is inventory managed at your cath lab? Our inventory is managed by assigned staff members. We order relevant to our patient volume and projected volume. Due to storage constraints, we order frequently. Catheters are ordered once a week and supplies perhaps twice a week. Contrast is ordered perhaps once every two weeks, depending on volume. What measures has your lab implemented in order to cut or contain costs? The use of our Acist device has been very helpful in controlling our costs. It has helped us save contrast, eliminate closure devices due to the 4 French catheters and given the lab improved efficiencies, allowing rapid turnover time between patients. If the patients are ready, there is less than a 3 minute turnover. When the patient is returned to recovery, one of the room staff assists the recovery staff in placing the patient on the monitoring equipment, and gives a report while the other room staff is taking the next patient to the procedure room. The third room staff person has been cleaning the room and setting it up for the next procedure. Our scope of practice affords us short recovery times and hospital stays. With the small size of our lab, we have a team approach to keeping costs down. The entire staff is aware of what the supplies cost and how the money is spent. The staff share this duty to ensure there is always someone here capable of ordering in the event of illness, etc. The staff does an exceptional job of communicating. I am always here to provide assistance or fill in if needed. Many times staff members in larger facilities can fail to see the whole picture. Our mindset seems to be different than in an inpatient setting. All the staff members have a sense of ownership in the lab and take the necessary measures to ensure waste is almost eliminated. How do you handle vendor visits to your lab? They must wear an ID, of course. The visits are arranged through the director. Has your lab has undergone a JCAHO inspection in the past three years? No. We comply with our Local Medical Review Policy. We have also successfully been through on-site inspections from various insurance payors which have the same, if not more, stringent surveys than JCAHO. How does your lab handle orientation for new employees and what continuing education opportunities are offered? New staff member orientation starts with the staging/recovery area. In this area, the new employee learns all the necessary paperwork, and how to handle patient transfers, discharges and how to properly educate patient family members. They also begin to learn the Witt hemodynamic monitor and how to hold arterial pressure. Next, the new employee is taught how to circulate cases, depending on licensure, and then onto scrubbing and monitoring. Continuing education is offered through in-services by reps, and through a local group called Cardiac Cath Professionals (CCP) that was started by St. Thomas Heart Institute. This group meets once a month and is usually sponsored by a representative of one of the medical device companies. There is a different speaker and topic at each monthly meeting. How is staff competency evaluated? We do have an annual review, but staff evaluation is an ongoing process. I observe the staff perform their various roles and I make changes to processes to improve staff performance and patient flow, etc. Suggestions for change come from staff as well. Is there a problem or challenge your lab has faced? The creation of this lab began from the ground up. It was a challenge to develop a lab that could meet all the expectations of the physicians who would use the facility, along with developing a new type of relationship with the physicians’ offices. The entire process of paperwork, Medicare compliance, policy and procedure manuals and hiring staff that would blend well, all had to be addressed. The finished product had to be one that would allow for easy scheduling and allow the patient to experience the same level of care as they would in a hospital setting. The entire process had to be seamless to the patient and all parties involved. This required, in some cases, a change in physician thinking. They had to think outside of the box. Without question, our physicians, their office staff and the cath lab staff have more than risen to the occasion. The physicians and staff are very devoted to our lab and its success. The following question is courtesy of the Society of Invasive Cardiovascular Professionals (SICP): Do you require your clinical staff members to take the registry exam for the Registered Cardiovascular Invasive Specialist (RCIS)? Do you receive an incentive bonus or raise upon passing the exam? Our staff is encouraged to take the RCIS exam, although it is not a requirement. There is not currently a bonus associated with passing the examination, but all expenses related to preparing and taking the exam are reimbursed to staff. As our program grows, there may be a requirement for the RCIS in the future. Working at The St. Thomas Outpatient Cath Center has proven to be enjoyable for our staff. We take care of the patient from the moment they walk through our door until they are discharged. We are completely self-contained and don’t rely on any outside departments to function. The staff especially likes the fact that there is no on call. Our day starts at 6:30am and ends around 3pm. If we were to change anything, we would like to have more square footage to allow for a larger waiting room and storage area. Otherwise, the lab seems to flow very well. We foresee this concept of free-standing outpatient cath labs becoming a trend across the country, as more hospitals and physician groups look to find ways to take care of patients in a cost-saving and efficient manner. Our success is due to the excellent teamwork among our staff and physicians. Patricia Cox can be reached at: pcox@heartgroup.net

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