An Update on the Transradial Lounge at Saint Joseph’s Hospital of Atlanta

Saint Joseph’s Hospital of Atlanta built a unique post procedure lounge for transradial patients that opened in March 2010. CLD catches up with the originator of this project, radialist Dr. Jack Chen, to discuss its impact on the hospital and patients. Can you describe the radial lounge at Saint Joseph’s? The lounge was designed with a café atmosphere in mind. It has no beds, simply 8 lounge chairs, each with its own high-definition TV, so patients can select their own programs or watch DVDs. Many patients bring laptops, because the lounge also has a wireless internet connection. Transradial patients are there both before and after the procedure. Post procedure, patients are free to walk about. We have found that because lounge chairs take much less space than beds and all the accompanying equipment, we can actually just assign one nurse to the area. Given the lack of access site complications associated with transradial procedures, we believe less nursing attendance is necessary. After 30 minutes, patients put on their street clothes. They can have some coffee, work on their laptop, check their email, and in a few hours, go home. Our plan was, of course, to have an area that did not feel very clinical, offering a relaxing and hopefully less stressful experience for the patient. The radial lounge opened during the March 2010 American College of Cardiology meeting. We had a very nice cocktail reception with a live band, held right after we had conducted a roundtable discussion at Saint Joseph’s Hospital on the benefits of radial access (See CLD’s June 2010 report on the transradial roundtable at tiny.cc/trroundtable). Dr. Sunil Rao, Dr. Morton Kern, Dr. Spencer King, Dr. Tift Mann, and a number of other physicians, as well as our hospital CEO, were present for the discussion. It was the perfect time for some of the national experts in the field to discuss this technique and approach. Is usage at capacity? Most of the time it is at three-quarters capacity, because there are now other physicians who have increased their use of radial access. More and more patients also see the advantage of transradial. The femoral patients can actually see the transradial patients in the lounge since there is one common entrance and exit; they not infrequently ask about it — why do those patients get to go over there, where it is all nicely decorated and they can walk around? Has the presence of the lounge encouraged radial access at Saint Joseph’s? Yes. One of the hurdles this particular technique experiences in the U.S. is physicians who are well trained and very skilled in the transfemoral approach. They need a good reason as to why they should learn something new and change what they have done for many years, which has worked very well for them. Obviously, safety is the paramount reason, but the bottom line is that while serious vascular complications from transfemoral procedures do occur, they are not very frequent events. Obviously, we would like that number to be zero; but it doesn’t happen every day; and the mentality is that it is accepted as sort of a necessary evil. The thinking is that vascular complications are simply an accepted adverse outcome of diagnostic or interventional catheter-based procedures. Thus, physicians may not necessarily think about it that much on a daily basis. But if we have a way to actually cut the risk of complications to essentially zero, then I think it needs to be stressed. After safety, patient satisfaction and the cost savings in ambulatory discharge are the second and third advantages to gaining access transradially. The patients clearly love the benefits of radial access. They also rave about the design of the lounge and the fact that they really didn’t feel like they were in the hospital. We often hear that they didn’t anticipate such a nice atmosphere. The friendly lounge atmosphere, coupled with same-day discharge, has really, in some respects, changed the paradigm of how our patients think about their procedures, taking much of the anxiety out of the experience. Patients perceive it as not being quite as serious if you let them walk around and drink coffee afterwards. It all goes toward an impression that this is not a very scary thing for them. It gives patients more confidence. Right, and the whole experience becomes a much less intimidating scenario than it previously was. Of course, the reality is that we have, in fact, decreased their bleeding and vascular complication risk by about 70%. What have you seen as word has spread about the lounge? It was recently featured in the local news, which has given us a great deal of publicity. The hospital has received calls from viewers wanting more information. The time is right to further promote the radial technique, and patients can be your best advertisements. Two of my patients were featured in the local news story on the lounge. One was actually a live case, a patient with a heart attack who was interviewed before and after the case; and another patient was interviewed who had undergone a transradial procedure some time ago (you can watch the news story at www.radialcathatlanta.com). Periodically, I will receive emails from other physicians with questions about performing transradial procedures. One physician emailed me recently about a minor complication he had. It’s very nice to be able to have an informal exchange where people don’t have to feel embarrassed about asking questions in front of a large audience. When people hear a lecture, I think they absorb probably less than half of what the lecturer is talking about; but when you have an email dialogue about a specific issue or topic, then that’s very worthwhile. I think that daily practitioners don’t necessarily need all the theoretical advantages or disadvantages. They want to know what to do when a complication happens. Saint Joseph’s runs a radial training course through Terumo. Anyone who is interested in coming just needs to contact their local Terumo representative. It is an observational course and we limit it no more than three physicians, because we also invite attendees to bring a tech or nurse from their team to learn the set up. Physicians learning this technique will tell you that how well everything is set up and whether the staff is responsive to their needs can make or break their initial experience. It helps with the frustration factor in the beginning. You are working on a study evaluating the cost savings of same-day discharge after transradial interventions. Where does that stand now? We have completed our enrollment. The safety of transradial interventions as well as same-day discharge for uncomplicated patients is now well established. The cost savings of not only ambulatory discharge, but also of avoidance of vascular complications and surgical repair, has become increasingly relevant in today’s economic healthcare climate. The lounge has played a major role, because rather than going back to the telemetry floor or to the ICU, the patients come here to relax after their procedure prior to discharge. ———————————————————— Learn more about transradial procedures at Saint Joseph’s Hospital of Atlanta at www.radialcathatlanta.com and www.nscatl.com. Dr. Chen can be contacted at: jchen@sjha.org.