What Do You Think?

December 2002 Question: On-Call Teams Do any of you have access to statistics related to cath lab teams and acute interventions? Specifically, I am looking for a survey showing the number of nurses/techs composing the team. The reason is this; currently, we have a 3-member acute cath lab team.. The protocol states the patient can come to the procedure room off hours when 2 members of the team are there to receive the patient. One of our physicians believes this is too time-consuming, and has proposed that the patient may be brought to the lab and the case initiated with one member of the team is present, with a nurse from the CCU. Anyone have the stats related to on-call team members? Kenneth A. Gorski, RN, RCIS, FSICP, Clinical Instructor/Technical Coordinator, Cleveland Clinic Cardiac Catheterization Laboratories gorskik@ccf.org A Catch-22 Situation I do not have any knowledge of a survey being completed on the acute team structures. At Emory University Hospital, our call team consists of either two technologists (RCIS or RT(R)) and one RN, or 2 RNs and one technologist (RCIS or RT(R)). An acute case is never brought to the cath lab from the ER or from the CCU unless all team members are present. There is a misnomer that exists that a cath lab can function as a critical care unit. I would not entertain an idea that one CCL member along with an RN from the CCU is adequate to start a case. I have had a couple experiences with physicians who went against policy to attempt to do an acute patient with this type of crew. Each time it was nearly a catastrophe. The CCU RN does not know where any of the supplies are located and where any ancillary equipment is located. The CCL member then has to function triple time to accomplish the scrub needs, the medication needs and the monitoring needs. The stress factors are bizarre. And then the physician does not know where the supplies are located, where the meds are located and where the ancillary equipment is located. This scenario is a true Catch-22. With 2 team members, it is a hassle to accomplish the basic needs of setting up an acute patient for a cath. If the patient experiences an adverse event such as VT or VFib, the reduced staff situation only enhances the stressors. I would ask the MD to come and function as the technologist or the RN when the acute patient arrives. Most MDs command their needs without regard to the summation of stressors caused to the involved staff. Thanks for the opportunity to respond to this Catch-22 situation. Chuck Williams, RT(R)(CV), RCIS, CPFT, CCT, codywms@yahoo.com Safety First My background is over ten years as an RCVT in several high-volume cath labs, both military and civilian; and eight years as a CCRN in cath labs. Patient safety must come first; the time saved can prove more hazardous to the patient than the event. I’ve been involved in tens of thousands of cases. Even in teaching hospitals, where cardiology fellows are available for assistance, I don’t allow a patient in a room under any circumstances unless two or more staff are available. No matter how good the CCU RNs, unless they’ve been thoroughly cross-trained to know locations of supplies, etc., they’re no more useful with a crashing patient than a janitor. Unfortunately, I have no statistics to back up my opinion, so good luck. J. McMurtry, BSN, RCVT, jcathlabrn@cs.com

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