The Ten-Minute Interview with...Todd Chitwood, RCIS, FSICP

I am a Navy-trained Cardiopulmonary Technologist with 18 years experience in the invasive cardiovascular field. I recently earned my fellowship with the Society of Invasive Cardiovascular Professionals (SICP). In 2002, I designed and developed the Oregon Cardiology Diagnostic Center, a physician-owned freestanding cardiac cath lab located in Eugene, Oregon. I am currently the manager of this facility. Why did you choose to work in the invasive cardiology field? I attended the Navy's CPT (Cardiopulmonary Technologist) School in the mid-80's. I was fortunate to be trained in all aspects of respiratory, pulmonary, and invasive and non-invasive cardiology. During training, the cath lab seemed the place for me; it was exciting and challenging, as well as highly technology-driven. I would not have worked in any other modality. What do you like best about it? Doing diagnostics in a freestanding center with an exceptionally motivated staff has been a tremendously rewarding experience for physicians, staff, and patients. We have dedicated ourselves to serving our patients and physicians in an extremely caring and efficient environment. Patients are constantly telling us that they have never been treated with this level of warmth and care They are pleased that we offer an alternative an alternative to the hospital setting where they can get their procedure done and are discharged within four and a half hours. And once the lights go down in the lab, it's all business. It's a team environment with clear goals, and an immediate reward system. Where do you see yourself professionally when it is time to retire? I hope to be an instrument to the profession, inspiring further positive growth and change. After taking economics courses while completing my BS degree in finance, I tend to look at situations in supply and demand terms. Drawing on this analogy to assess our field within the healthcare system in America, it is clear we will experience drastic increases in patient volumes (supply) kicked off by the aging baby-boomer population. At the same time, the supply of labor is not keeping pace with demand. We will be forced to design and undertake drastic change of great proportions, very rapidly. This will require building bridges amongst professions, regulators, legislators, and educators. I would like to be a positive influence and facilitator within an infrastructure aimed at meeting the demands and challenges of the future. Why did you choose to get involved with the SICP? The people involved and what they have accomplished as a professional body impresses me. The SICP has developed a recognized scope of practice for the cath lab professional. The most exciting places I have worked have been fully cross-trained, so ideologically it is a great fit with my own philosophies. Considering the previous question, the SICP is exactly the type of leadership body needed to take our profession into the future. As a profession, we lack standardization that is globally accepted. There is a lot of fragmentation depending on which licensure or credential we hold, as well as the state in which we operate. I believe that there has been such a flood of device technology and fast-paced growth to keep pace with over the last 25 years, that as a professional body we have not had the time (nor strength) to fully develop our professional infrastructure. I believe that to deliver a minimum standard of care as a cath lab professional, there must be widespread standardization accepted nationwide. I think the SICP is an excellent organization to develop this much-needed change. How did it (getting involved with the SICP) happen? I have known Darren Powell, the Director of the Cardiovascular Program at Spokane Community College, for about 12 years now. He is the Education Committee Chair for the SICP. Darren and I put together a weekend training program based on his Cath Lab Blitzkrieg, to teach the basic fundamentals to the staff of local area cath labs. Darren's program includes the fundamentals of the cath lab: fundamental science, anatomy and physiology, diagnostic procedures, hemodynamics and LV function, interventional procedures, specials diagnostic and interventions, and surgical procedures. Also in the program's content were several hands on labs simulating vascular access with an aorta model, building coronary trees, prepping and deploying PTCA balloons and stents, evaluating catheters and wires as to desirable properties, and evaluation of hemodynamics. It was a huge success in that we had about 45 people attend from four different facilities. Darren next offered me the opportunity to do some presentations at the 2nd Annual Ohio River Valley Cardiovascular Symposium in Louisville this past year. I jumped at the opportunity to serve the profession and to work with a respected network of individuals whom I hold in high regard. Can you describe your role with the SICP? I earned my fellowship with the SICP for accomplishments directed at ongoing education, and I am also a member of the SICP's speakers bureau. I am not on the board or any committees at this time. I am working on developing a local regional chapter for our area here similar to what Lynn Jones and Scott Hardin have developed in Houston. I believe that getting this "grass roots" chapter established will provide the platform for excellent educational opportunities for the professionals in our area, and also serve to increase the membership base of the SICP. I would like to grow the chapter to be able to establish an annual event for managers and cath lab staff for the greater Northwest. I like to think of this growth as spreading the religion. Your role with the SICP is voluntary. What motivates you to continue? Pride. I am proud to do what I do. I also have a strong sense of giving back to the professional community that has been such a large influence on who I have become. I ask myself, when (and if) it comes time for my cardiac crisis, who will be there to take care of me and how will I know that they are qualified to do so? I think that supporting the SICP and helping to further our profession will ensure that we will continue to have highly qualified professionals well into the future. Everyone gains, including the cath lab professional, patients, physicians, and the local communities served. What is the biggest challenge you see regarding your role with the SICP? I think it is educating people to gain understanding as to what we are facing in healthcare and getting everybody on the same page as a cath lab professional. In many cases, the division that exists between radiology, nursing, allied healthcare, and cardiovascular professionals restricts our delivery system. Too often, we are going in different directions regarding scopes of practice, etc., in our different professional organizations. I think that building trust and respect amongst the diverse disciplines in the cath lab is the largest obstacle we face. If we cannot move beyond this and work together to utilize everyone's background and skills, we will remain very inefficient as healthcare providers. As caseload volumes escalate and staffing continues to decline over the coming years, we may find that we have done a disservice to our patients and ourselves by not uniting our professions. This will be evident by not having adequate qualified staffing to deliver care. This creates barriers to access for patients, and we will find ourselves having to work harder and longer to meet the needs of our communities. If you could send a message back to yourself at the beginning of your cath lab career, what advice would you give? Be a sponge. Learn everything you can about device technology its capabilities and its limitations. Observe how one physician or peer does something as compared to another, as there are tricks to be learned from different approaches. If you can become an expert on the devices and different ways to approach any given interventional objective at hand, you will become well respected by your peers and physicians alike. And don't be afraid to speak up and share your thoughts or ideas, as this often invites a great learning experience. I think this demonstrates to the physician and the cath lab team that your head is in the program and you're not just running wires and collecting a paycheck. And finally, always be motivated and project a can-do attitude. It may seem like you might work harder than anyone else, but that's because your managers and physicians know they can depend on you to get the job done, and done well. You will become the go-to person. When you began working in the cath lab, what were the devices, technology, and procedures at the time? The devices consisted of early balloon technology - balloon on a wire was still fairly common. Stents were not in our vocabulary at the time. Valvuloplasty was just beginning to emerge. As I recall, Dr. Dorros came out to the San Francisco Heart Institute at Seton Medical Center (Daly City, CA) in the late 80's and worked with Drs. Myler and Stertzer with performing valvuloplasties on mitral valves. That was really something at the time. It was an exercise in breath-holding while waiting for the pulse rate and blood pressure to return post dilation. The E for M hemodynamic monitoring system was the Cadillac of the era. You really felt like you were doing something, flipping all the switches to get a LVEDP/PCW at different scales and paper speeds. The monitoring person's job really began after the cases when you had to hand calculate valve areas, etc. Having to build your own cath trays and flushing catheter lumens overnight to then be sent for resterilization the following morning was quite common. Looking back, it was like being a diesel-powered submarine in a nuclear Navy when compared to today. The nature of the cath lab team depended on where you were. At various facilities it included some (or all) CVTs, RTs, and RNs. I have worked in places where the techs were responsible for everything as there were not any nurses in the cath lab. Some cath labs had only nurses scrubbing and techs monitoring, or visa-versa. The composition of the cath lab team is the area that has changed the least when compared to devices and technology. What is the most bizarre case you've ever been involved with? Looking back it is not that bizarre. During my cathlab rotation as a student, we had a patient come in with tamponade. I thought this poor fellow was going to die right there. He was sitting upright and gasping for air. We tapped him and he left the lab talking and joking like nothing had happened. To me it was a miracle and I was very impressed. Who is someone you have learned a great deal from in invasive cardiology? I would certainly have to say that my Navy Cardiopulmonary instructors and proctors taught me a tremendous amount of knowledge as a student. But I cannot say that there is any one individual. There have been a number of cardiologists, technologists, and nurses from different facilities including the San Francisco Heart Institute, Carolina's Medical Center (Charlotte, NC), Sacred Heart Medical Center (Eugene, OR), and Oregon Cardiology (Eugene) who have taught me different things and been an influence on me. Are there any websites or texts you would recommend to other labs? Oregon Cardiology Diagnostic Center's educational library is modeled after the text requirements for the Navy's cardiovascular program. Of the 25 or so texts, Kern's The Cardiac Catheterization Handbook and Grossman's Cardiac Catheterization and Angiography are our most utilized. I also rely a great deal on the ACC/SCA&I Clinical Expert Consensus Document on Cardiac Catheterization Laboratory Standards, and being a freestanding facility, the Comprehensive Accreditation Manual for Ambulatory Care (CAMAC). Recommended websites include cathlab.com, theheart.org, and medscape.com. What changes do you think will occur in the field of cardiology in the coming decades? It is clear that lesser invasive therapies are on the short horizon. Within the next ten years, diagnostic cath, echo, and nuclear will likely be replaced by a single imaging modality such as cCT and/or cMR. Diagnostic caths will likely decline or disappear altogether; however, the interventional caseloads will actually increase due to earlier and better detection of disease, new device technologies, and the aging population. If you look back over the last 25 years, (at what was once referred to as the devil's playground) the cath lab has become the primary platform of choice for the diagnosis and treatment of coronary artery disease. The most challenging change I see coming is how we will have to staff and operate within the cath lab and the increasing responsibilities that will be thrust upon each of us. Not only is there a shortage of qualified nursing and technical staff, there is also a shortage of cardiologists. We see the writing on the wall now with labs starting to have techs and nurses gain venous and arterial access, close pacemaker pockets, and deploy closure devices to free up the cardiologist's time. Will we eventually see staff performing basic diagnostic studies? I can't answer that, but it is clear everyone is going to have to increase his or her knowledge and capabilities, do more with less, and keep us afloat.

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