The Cardiovascular Center at St. Joseph Hospital

The Center also has one dedicated electrophysiology lab (the only one in the region); two dedicated vascular ultrasound rooms, two dedicated echocardiography rooms and one shared ultrasound room; a cardiac non-invasive testing room; a 10-bed dedicated cardiac recovery unit and a patient/family education resource room. The Center is used as a show site for Philips Medical Systems. The Cardiovascular Center staff is a mix of RNs, radiology techs and cardiovascular techs. Specifically, the staff includes eight nurses, eight technologists, two data analysts, one director, one buyer and one administrative assistant. Staff tenure ranges from 37 years with St. Joseph Hospital to six months at the Cardiovascular Center. Along with an experienced staff, the Center had experienced patients offer input on the design and flow of the Center when it was being built. For example, prior patient Bob Swindle and his wife Sue sat on the Center's implementation team, which dealt with all aspects of the Center, from patient care to design and maintenance. St. Joseph Hospital is an award-winning 253-bed facility with more than 1,800 employees. We are a not-for-profit, full-service Catholic hospital sponsored by the Sisters of St. Joseph of Peace. Other services include a Level II trauma center, emergency helicopter, heart surgery, neurosurgery, orthopedic surgery, cancer center, rehabilitation center and obstetrics. Founded more than a century ago, St. Joseph is part of the PeaceHealth health care system with locations in Oregon, Washington and Alaska. What type of procedures are performed at your facility? In 2004, 2,200 procedures were performed. Our newest facility, with two new labs, did not open until October 2003, and since then, we have seen rapid growth in volumes. Procedures we perform include: Drug-eluting stents Intravascular ultrasound (IVUS) Bare metal stents Brachytherapy FilterWire EX (Boston Scientific Corporation, Maple Grove, MN) WaveWire (Volcano Therapeutics, Inc., Rancho Cordova, CA) Intra-aortic balloon pump (IABP) therapy Rotablator® (Boston Scientific) Implantable cardiac defibrillators Pacemaker implantation Diagnostic caths Peripheral angiography and interventions, including atrialography, renal, superficial femoral artery (SFA), iliac and popliteal Patent foramen ovale (PFO) closures Does your cath lab perform primary angioplasty with surgical backup? Our surgical backup is implied. We have two dedicated heart surgery rooms one floor above the Cardiovascular Center. A dedicated trauma elevator connects the Cardiovascular Center, surgery and the emergency department (one floor below). What procedures do you perform on an outpatient basis? Diagnostic caths are performed on an outpatient basis. All PCIs and device implantations generally require an overnight stay. What percentage of your patients is female? Females accounted for 37 percent of our 2004 patients. What percentage of your diagnostic cath patients go on to have an interventional procedure? Thirty-four percent. Who manages your cath lab? Jerry Marschke is Executive Director of Cardiovascular Services and manages all aspects of the Cardiovascular Center. Peter Beglin, MD, FACC, is Medical Director of Cardiovascular Services. William Lombardi, MD, FACC, FSCAI, is Medical Director of the cath labs and cardiac recovery unit. The Cardiovascular Center reports to Steve Omta, the hospital's Chief Operating Officer. Dave Scarborough, RN, is team lead of the cath lab RNs. Jerry Smith, CVT, is the team lead of the cath lab technologists. Julie Landy, RT(R)(M) is interim manager for cath labs, electrophysiology and the cardiac recovery unit. Do you have cross-training? Who scrubs, who circulates and who monitors? Yes, our techs monitor and scrub. Our nurses circulate, scrub and are being cross-trained to monitor. Staff are assigned to another staff member who is already has the proficient skill set. It varies by skill and case as to how many cases someone must cross-train in before her or she is deemed proficient. Does an RT (radiologic technologist) have to be present in the room for all fluoroscopic procedures in your cath lab? They are present, but it is not required. 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? All physicians, nurses and techs operate the x-ray equipment in all positions. Does your lab have a clinical ladder? No, we do not have a clinical ladder. What are some of the new equipment, devices and products introduced at your lab lately? The Cardiovascular Center opened in 2003 with the latest state of-the-art equipment, including: GE Mac-Lab® 7000 Hemodynamic System (Waukesha, WI) Philips’ Integris Allura Flat Detector cath lab (Bothell, WA) Philips’ Xcelera Cath Lab Management system (PACS) Procedures we’ve introduced in the last two years include drug-eluting stents, brachytherapy, implantable cardiac defibrillators, FilterWire, PFO closures and peripheral angiography and angioplasty. How does your lab handle hemostasis? We use both manual and assisted compression, as well as closure devices. We use Perclose® (Abbott Vascular Devices, Redwood City, CA), Angio-Seal (St. Jude Medical, Minnetonka, MN) and the SyvekPatch® (Marine Polymer Technologies, Inc., Danvers, MA). Patients are cared for by a dedicated cardiac nursing staff in our 10-bed recovery unit, which features enhanced amenities such as televisions and personal sound systems. Does your lab have a hematoma management policy? Yes, it is part of a groin management protocol. In general, we track all vascular complications. How is inventory managed at your cath lab? Who handles the purchasing of equipment and supplies? We have a dedicated central supply and dedicated buyer for the Cardiovascular Center. Has your cath lab recently expanded in size and patient volume, or will it be in the near future? Yes, we doubled our cath lab capacity with the opening of the Center in October 2003. Our volumes are up over 20 percent and we are planning to add a third cath lab by the end of 2005. The Center was built with convertible space to support an additional lab. Is your lab involved in clinical research? Yes, we are participating in heart surgery trials and invasive cardiology research studies. Have you had any cath lab-related complications in the past year requiring emergent cardiac surgery? No, and our data management team follows all clinical outcomes for both surgery and invasive cardiology. What modalities do you use to verify stenosis? Stenosis is verified visually by the cardiologists and a WaveWire is used to assess significance. What measures has your cath lab implemented in order to cut or contain costs? We have an ongoing product cost review to define par levels. A full-time buyer and a consolidated inventory area that all Cardiovascular Center departments use help us contain costs. We also do focused reviews on coding and reimbursement to assure proper contract maintenance. As part of the PeaceHealth system we are able to optimize buying power through vendors like Premier as well. What type of quality control/quality assurance measures are practiced in your cath lab? The Cardiovascular Center has two full-time quality analysts who maintain ongoing reports on a variety of measures, including PCI, surgical outcomes, door-to-balloon time and door-to-EKG time. Our 2004 door-to-balloon was 104 minutes; our door-to-EKG was 18 minutes. Our Clinical Data manager maintains ongoing quality assurance for interventional cardiology and cardiac surgery. We also participate in the Society of Thoracic Surgeons, American College of Cardiology, National Registry of Myocardial Infarction and Clinical Outcomes Assessment Program. In addition, the Center participates in hospital core measures related to acute myocardial infarction and heart failure. How does your cath lab compete for patients? Has your institution formed an alliance with others in the area? We are in the unique position in that we are the only hospital in our county and have more than 95 percent of the market share in our primary service area. We also began marketing The Center via an advertising campaign and community outreach in our secondary service area. The campaign educates potential patients that they can receive the same leading-edge care at The Cardiovascular Center as they can at the hospitals in the Seattle-metro area, and our facility is new designed specifically for patient and family comfort. To that same end, we are working with a local cardiology group to visit primary care physicians in the secondary service areas to inform them about the Center's services and capabilities and how they can refer their patients. How are new employees oriented and trained at your facility? What licensure is required for all professionals who work in your lab? New employees go through a two-day hospital orientation. Nurses and techs then have one-on-one orientation in the lab with an experienced nurse or tech where they go through the full range of procedures and then a return demonstration. New employees work for an average of a month or more before they are on call. Nurses must have an RN and an ACLS certification. Techs must have an ARRT or RCIS credential. What type of continuing education opportunities are provided to staff members? We have several continuing education opportunities. We offer monthly grand rounds that are led by physicians, monthly Education Tuesdays led by staff, and vendors regularly provide us with inservices. We also send staff to national conferences as the budget allows. Employees also receive education reimbursement from St. Joseph Hospital-approved courses or certificate/degree tracks. How do you handle vendor visits to your lab? We maintain a formal registration process. Vendors must phone to make an appointment and receive a badge upon arrival. Vendors are allowed in the control areas of the lab but not in the procedure area. We also limit vendors to one visit per month. How is staff competency evaluated? St. Joseph has annual web-based review process for staff that includes peer and management evaluations. Unit-specific competencies are in development. Does your lab utilize any alternative therapies (such as guided imagery, etc.)? No. How does your lab handle call time for staff members? We have off-hour and weekend call for two techs and one RN. Once our cross-training is completed, we will have the option to modify that mix to two RNs and one tech. What trends do you see emerging in the practice of invasive cardiology? For the cath lab specifically, we are looking at incorporating more peripheral angiography and angioplasty. We've seen a community need to focus on peripheral vascular disease. We have a peripheral vascular committee that includes cardiologists, interventional radiologists and vascular surgeons to create a more prospective than retrospective approach to peripheral vascular disease. For the Cardiovascular Center as a whole, we expect to participate in more clinical vendor trials. Has your lab has undergone a JCAHO inspection in the past three years? Yes, we were inspected in 2002 and JCAHO will be back in 2005. Our position is to set the standard and be proactive rather than reactive. Where is your cath lab located in relation to the OR department, ER, and radiology departments? Our OR department is one floor above; our ER is one floor below via a trauma elevator and our imaging radiology department is (also) one floor below. Please tell the readers what you consider unique or innovative about your cath lab and its staff. We have a dedicated cardiac facility with a dedicated cardiac staff that is one of the first of its kind in Washington State. We are committed to being a patient-centered and family-centered facility as well. Patients and their families collaborated with us in developing The Center and our staff remains avid patient advocates. On the physician side, our local cardiologists are evolving from a generalist model to a more academic model, with specific areas of expertise. Is there a problem or challenge your lab has faced? How it was addressed? The move and transition from one cath lab to two cath labs, as well as adding an electrophysiology lab (a new service for us) was challenging. Adjusting to the new space required us to restructure our roles and flow of care. Also, our volumes have grown so rapidly that we are already looking at expanding again. 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? The Bellingham area has been named as the best place to retire by various magazines and organizations. People, retirees and non-retirees alike, truly relocate to Bellingham because of the quality of life. This means we see less employee turnover at St. Joseph Hospital and the Cardiovascular Center than at comparable facilities in the state. Questions from the Society of Invasive Cardiovascular Professionals (SICP): 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? This is a goal for us, but is not currently required. We offer a bonus incentive to staff who pass the Registry exam. 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? Staff members belong to a variety of organizations, including: American College of Cardiovascular Administrators American Association of Radiology Nurses American College of Cardiology Clinical Outcomes Assessment Program National Registry of Myocardial Infarction Society of Thoracic Surgeons American Healthcare Radiology Administrators Jerry Marschke can be contacted at JMarschke@peacehealth.org CLD

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