Note: Certain photos in this article were taken prior to the COVID-19 pandemic.

Tell us about your facility and cath lab.

Ochsner Medical Center – Kenner, Louisiana is a 110-bed facility with two cardiac catheterization laboratories (cath lab), a pre-operation department and a post-operation department. As part of the John Ochsner Heart and Vascular Institute, the staff is a diverse group of individuals with international experience and a common goal: to save lives. The team is composed of interventional cardiologists, cardiovascular technologists, and registered nurses (RNs) who possess more than 40 years of combined experience. The team performs approximately 40 procedures a week, including extensive interventions for peripheral artery disease.

How has the pandemic affected your cath lab and facility?

During the COVID-19 pandemic, our team at Ochsner Medical Center – Kenner changed the staffing plan to meet the demands of our patients. We had staff on-call while other staff redeployed to the intensive care unit (ICU) to care for critically ill patients. Our priority has always been our patients. This pandemic has unified our teams and changed our culture. We are no longer defined by our department, but our purpose.

What do you expect will happen with COVID and your local population?

Louisiana remains in phase two, with COVID cases increasing. Louisiana has a high-risk population with most already having a disease or medical condition, so we are anticipating an increase in cases.

Does your cath lab perform primary angioplasty without surgical backup on site? 

Yes, we do, but we have an ambulance on standby for those cases.

Can you describe the use of radial access at your lab?

We are at 80% radial access.

Who manages your cath lab?  

We have a cath lab RN director who manages the cardiology clinic as well as the labs. All staff are oriented to all areas to understand the patient experience and the multiple roles of the physicians. This has removed silos, and helped communication and coordination of care. Cath staff shadow in the clinic and medical assistants shadow in the cath lab. It has helped build teamwork, improved clinical knowledge, and helped us develop a holistic approach to the patient experience.

Who scrubs, who circulates and who monitors? 

All staff are cross-trained to monitor and circulate. Only the cath technologists scrub with the physicians. A registered nurse (RN) gives and documents all medications during the case.

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? 

Cath lab technologists position and pan the table. Physicians step on the fluoro pedal.

How does your cath lab handle radiation protection for the physicians and staff?

All staff have lead aprons and lead glasses. We have a lead skirt on the table and a shield to protect staff. We also drape the patients with Radpads (Worldwide Innovations & Technologies, Inc.). Each staff member has a dosimeter.

Tell us about some of the new equipment, devices, and products recently introduced at your lab.

The use of CO₂ has been very beneficial to our patients with renal disease. Any patient with a creatinine clearance <60 ml/min gets a combination of CO₂, extravascular ultrasound (EVUS), and intravascular ultrasound (IVUS).

How does your lab communicate information to staff and physicians to stay organized and on top of change? 

We have daily team huddles, group messaging, and group email.

How is coding and coding education handled in your lab? 

We have coding team with a physician educator.

Who pulls the sheaths post procedure, both post intervention and diagnostic?  

Our cath techs and RNs pull sheaths, and must be checked off annually for this skill. 

Where are patients prepped and recovered (post sheath removal)? 

Patients are prepped and recovered in the pre/post area. The RNs in this area are also encouraged to cross-train into the intra phase of care once they have mastered these phases of care. We utilize closure devices.

How is inventory managed at your cath lab, and who handles the purchasing of equipment and supplies? 

These tasks are accomplished by our technologists and our dedicated supply chain coordinator.

Has your cath lab recently expanded in size and patient volume? 

Yes, we recently added a second lab. We are expecting to increase our volume to 1,800 cases per year.

Is your lab involved in clinical research? 

Yes, we are involved with the PROMISE II trial (Percutaneous Deep Vein Arterialization for the Treatment of Late-Stage Chronic Limb-Threatening Ischemia), BEST-CLI (Best Surgical Therapy in Patients With Critical Limb Ischemia), and several registries.

Can you share your lab’s door-to-balloon (D2B) times and some of the ways employees at your facility have worked on this issue?

We average 57 minutes. Taking ownership of the care is important. Each person in the team knows their role as well as that of their team member. They support and over communicate. Each ST-elevation myocardial infarction (STEMI) case is reviewed with the team. Strong skills and opportunities are identified and addressed. We also have a tracking board with the fastest times posted.

Who transports the STEMI patient to the cath lab during regular and off hours?

The emergency department (ED) staff.

What do you do when the call team is already busy doing a procedure and a STEMI comes into the ED? 

After hours, the patient will be medically managed, but during operational hours, we have the staffing to run two cath labs.

What measures has your cath lab implemented in order to cut or contain costs?

Preference cards, bulk purchases, and consignment agreements. 

What quality control measures are practiced in your cath lab?

Blood glucose, activated clotting time (ACT), and daily checks of our radiology system prior to use.

How do you determine contrast dose delivered to the patient during an angiographic procedure? 

In advance of the procedure, we use the formula 5 × weight (kg)/cr to determine the max contrast load. During the procedure, the tech announces at each interval our contrast usage. We also utilize only 50 cc bottles of contrast. 

Are you tracking the incidence of contrast-induced acute kidney injury in patients? 

Yes. We participate in the American College of Cardiology’s National Cardiovascular Data Registry (NCDR) and receive a daily report from our cardiology performance improvement (PI) coordinator.

How are you recording fluoroscopy times/dosages? 

In Cupid (EPIC) and measured in Gy.

What is the process that occurs if a patient receives a higher than normal amount of radiation exposure? 

We have a radiation dose tracking system that shows you exactly how much radiation exposure each patient is getting and exactly what part of the body is being exposed. Our interventional  equipment is from Canon Medical Systems and facilitates improved dose management by leveraging low dose modes that maintain high image quality. Their dose tracking system (DTS) provides real-time displays of estimated patient skin dose. Being able to visualize the radiation dose in color on a realistic patient graphic enables dose management and helps minimize radiation exposure to our patients. Any patients who are exposed for extended periods of time are assessed by our nurses post procedure for any signs of radiation burn or injury. Reports are sent to a radiation committee. 

How are you populating NCDR data records? 

We have an independent auditor who tracks all data from our labs. 

Are your physicians dictating their cath procedure reports, or do they use a structured reporting tool?

We use Cupid as a structured reporting tool.

How does your cath lab compete for patients? Has your institution formed an alliance with others in the area?

We are the only STEMI/after-hours lab in the River Region (Kenner is part of this geographical area along the Mississippi River). We work closely with other hospitals in the area, including 4 parishes: Jefferson, St. John Baptist, St. James, and St. Charles, that are not able to accommodate emergent or after-hour cases.

How are new employees oriented and trained at your facility? 

For new intra-lab employees, we have a 2-month orientation process, depending on previous experience, knowledge base, and skill set. After a month of orientation, they can begin taking “buddy call” with their preceptor in order to train for STEMIs and other emergent procedures. For our new pre/post cath lab staff, we have a 6-8 week orientation process, also depending on previous experience. Every new employee is given a primary preceptor. A new hire packet is made with all necessary check-off and educational materials. The new employee and their primary preceptor meet weekly to assess progress and make new goals for the coming week. Huddles are done weekly with preceptor and preceptee leader.

What continuing education opportunities are provided to staff members?

The Ochsner system offers educational opportunities through our online learning network. A few times throughout the year, we also set up continuing educational opportunities with device representatives for our unit-specific equipment/procedures. This allows our staff to stay up to date on the new technology coming out in our specific field. The registered nurses can participate in a clinical ladder program. Ochsner offers a 3-level clinical ladder to nurses that is addressed annually. In addition, our staff does have the opportunity to go to conferences throughout the year. Advanced approval is required and the content must be specific to our unit/patient population. 

How do you handle vendor visits to your lab? 

All vendors must complete the Reptrax attestation and have a picture badge before coming to the lab. They must make an appointment in advance and are limited to certain days a week. We also have a no-gift policy in place for all vendors. 

How is staff competency evaluated? 

Our staff have yearly checkoffs during our hospital-wide annual skills fair in March. We also have yearly unit-specific checkoffs done during each employee’s yearly evaluation period. 

Do you require your clinical staff members to take the registry exam for Registered Cardiovascular Invasive Specialist (RCIS)? 

Although taking the RCIS examination is not required by our lab, it is encouraged. Staff receive a one-time bonus upon successful completion of the examination. 

Does your lab have any physical (layout) bottlenecks or limitations? 

Thankfully, both of our labs and our pre/post area have been newly renovated. The staff had plenty of input in the layout and design of the new spaces to guarantee the easiest possible workflow. 

What do you like about your lab’s physical space?

We have 2 newly renovated labs and a new pre/post area as well. Our pre/post area is cardiac-specific, and was designed to be able to accommodate our specific procedures and patients. We have an extra-large “procedural” bay in our pre/post cath lab that accommodates transesophageal echocardiograms (TEE)/cardioversions and endovascular sclerotherapy procedures. In the intra-cath lab area, we have connecting monitor rooms and we also have windows to look outside. During our recent renovations, our department acquired some New Orleans-specific art that adds a personal touch to our area.  

Is there a particular mix of credentials needed for each call team? 

We normally have 1 RN and 2 RTs on each call team. We do have some RNs who are able to monitor and circulate cases, and are able to assist with some extra call in order to make a 2 RN and 1 RT call team. Staff are permitted to start later after an early morning “call out” when needed. 

How does your lab schedule for call? 

Our lab does self-scheduling for call. We use seniority to decide who gets to sign up first. Our team is always very accommodating with each other when it comes to filling out the call schedule. 

Within what time period are call team members expected to arrive to the lab after being paged? 

We have a 30-minute callback time. 

Do you have flextime or multiple shifts? How do you handle slow periods?

We do not have multiple shifts. During slow periods, we cross-train our staff to work on our sister units, pain management and interventional radiology. We also utilize the time to do mock codes, sedation audits, and online learning through our Ochsner Learning Network.

Has your lab recently undergone a national accrediting agency inspection? 

Our lab had our Joint Commission Survey done in 2019 and was successful. Even though we passed, we still have staff performing tracers monthly to ensure the standard is maintained.

What trends have you seen in your procedures and/or patient population? 

We have had an increase in our peripheral cases over the last few years. We are able to offer zero contrast technique with CO₂ angiography, IVUS, and EVUS. This allows patients with kidney injuries/impaired renal function to have the appropriate imaging and revascularization without harming their kidneys any further from contrast exposure. We have also seen an increase in the amount of critical limb ischemia (CLI) cases. This is something our team feels very passionate about. We aim to “Stop the Chop” and save people from limb amputations. 

What is unique or innovative about your cath lab and staff?

Our lab carries the fastest door-to-balloon time in our region. We also have the lowest acute kidney injuries (AKI) in our region. We attribute this partly to our Poseidon protocol, which adequately hydrates our patients to flush the kidneys before and after contrast dye exposure. The staff at our facility practice open communication and transparency. The entire cath lab team supports, encourages, and motivates each other. They hold each other accountable and have the courage to have a difficult conversation. They see a challenge as an opportunity to learn something new.

Is there a challenge your lab has faced? 

We have undergone multiple different phases of renovations over the past 2 years. We converted from a 1-lab unit to a 2-lab unit. We completely designed a new pre/post cath lab area. We were able to work with our sister unit and use the interventional radiology suite at times when emergency cases had to be done without taking our patient off the table in the lab. We found creative ways to work around the construction. Our team came together and always found a way to provide excellent patient care. 

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”?

New Orleans and the surrounding areas are a melting pot of different people and different cultures from around the globe. We are known for our hospitality and friendliness. We are also known for our amazing food, which tends to be high in sodium and high in fat. Obesity is a problem in many of our patients. The majority of our patients need extensive education on diet modification and healthy eating. 

A question from the American College of Cardiology’s National Cardiovascular Data Registry: 

How do you use the NCDR Outcome Reports to drive QI initiatives at your facility?

We have quarterly meeting where we dissect the data and find ways to get better every day with the delivery of care. 

Tell us about your facility and cath lab.

Ochsner/LSU Health System (OLSU) is a partnership between Ochsner Health and LSU Medical School. There are 3 campuses that comprise the Ochsner LSU Health System. Two campuses in Shreveport, Louisiana (OLSU Medical Center at Kings Highway and St. Mary’s Medical Center at Margaret Street) and one hospital in Monroe, Louisiana (Conway OLSU Medical Center). OLSU is an academic and teaching facility that includes a Level 1 trauma center and multi-discipline fellowship programs that include cardiology. We are currently running 4 lab suites among the facilities with plans to expand services in the future.

Our cath lab is a part of the newly created Heart and Vascular Institute service line under the leadership of Franklin Espanto, AVP, Heart & Vascular Institute (HVI) of Shreveport/Monroe Academic Medical Centers. This service line consists of interventional cardiology, non-invasive cardiology, electrophysiology (EP), echocardiography, and the HVI clinic.

What is the size of your cath lab facility and number of staff members?

Our department consists of a pre/post area for all interventional cardiology and EP inpatients and outpatients. In the cath lab, we are staffed by 4 registered nurses (RNs) and 2 radiologic technologists. Our RNs all came to the cath lab from the medical and surgical intensive care unit (ICU). Our cath lab is open 24/7 and the call team (which consists of 2 RNs and 1 tech) is available after hours and on the weekend. Our pre-post staff is made up of 4 RNs that provide coverage 7 am to 7 pm. The EP lab is comprised of 2 RNs and 2 radiologic technologists. The cath and EP staff have plans to test for the registered cardiovascular invasive specialist (RCIS) certification later in 2021. Our goal is to have all RCIS-certified employees in the cath and EP labs. This will be a tremendous accomplishment for our department. We are excited about the challenge! We meet every other week for our “Cath Academy”, led by our AVP, Heart & Vascular Institute. Franklin has an extensive cardiology background, and has been the catalyst for broadening our knowledge base and challenging us to strive to be a Center of Excellence!

What procedures are performed in your cath lab?

We perform approximately 40 cardiology procedures a week. A few of the procedures we perform are listed below:

• Diagnostic left and right heart catheterizations
• Percutaneous transluminal coronary angioplasty (PTCA), stent deployments
• Chronic total occlusions (CTOs)
• Intravascular ultrasound (IVUS)
• Fractional flow reserve (FFR)/instantaneous wave-free ratio (iFR)
• Rotational atherectomy
• Intra-aortic balloon pump (IABP) insertion
• Impella (Abiomed) insertion
• Laser atherectomy
• Peripheral angiography and PTA
• Balloon aortic valvuloplasty (BAV)
• MitraClip (Abbott Vascular)
• Watchman (Boston Scientific)
• Atrial septal defect (ASD)/ventricular septal defect (VSD)/patent foramen ovale (PFO) closure
• Temp pacers
• Pericardiocentesis

If you are not performing transcatheter aortic valve replacement (TAVR), is your lab planning to do so in the future?

We have plans for performing TAVR in a new hybrid lab in the near future. Our two structural cardiologists on staff, who have an extensive history of performing structural procedures, are currently doing TAVRs at a nearby hospital. There are plans in the next six months to complete a new cardiac hybrid lab suite, as well as additional cath and EP labs. Once our new hybrid lab is complete, TAVRs will become a part of our routine procedures at OLSU.

How has COVID-19 affected your cath lab?

As you can imagine, it has been a challenge. During the early months of pandemic, we were unable to schedule any elective procedures. Because of the dramatic decrease in patient volume, those employees with enough paid time off were allowed to take vacation days as needed or they worked in other units at the hospital to maintain their hours. The cath lab call team remained in-house during those early months of the pandemic. However, as the state of Louisiana opened up, starting in May 2020 and continuing through the present, our outpatient volume has increased. What we have seen over the last few months is a conscious effort by our hospital to be more open and return to full operations, while still maintaining and following the guidelines we have been given to promote a safe working environment for patients and employees.

Can you describe the use of personal protective equipment (PPE)?

All patients, whether an inpatient or outpatient, are masked. The cath lab staff (including physicians) treats all patients as though they are COVID-positive. Varying degrees of PPE are worn by the staff depending on their role and degree of involvement in the procedure. We use digital Bluetooth headsets that are worn by all staff during the procedure, which helps greatly with communication.

Can you describe if/when patients are being tested for COVID-19?

All outpatients are tested within 3 days of their procedure. Inpatients are tested upon arrival and every 8 days if still admitted. All emergent cases (ST-elevation myocardial infarctions [STEMIs]/non-STEMIs) are tested in the emergency department (ED) upon arrival.

Can you describe the extent and use of radial access at your lab?

The use of radial access in our lab is around 80%. We have used left radial/ulnar access for those with left internal mammary artery (LIMA) grafts. We love radial access for peripheral angiograms. Our patients also love the radial approach, for obvious reasons. They want to sit up afterwards, they can eat and drink, and they have the capability for early ambulation.

If you are performing peripheral vascular procedures, do any operators utilize pedal artery access when appropriate?

We have not utilized that access for peripheral cases. We do regularly utilize radial access for peripheral angiograms.

Who manages your cath lab?

The cardiac catheterization laboratory is managed by nurse supervisor Paul Davison, RN.

Do you have cross-training? Who scrubs, who circulates and who monitors?

We do not have cross-training at this time. We have a cardiovascular technologist (CVT) who scrubs and drives the table. The other technologist is in the control booth during cases. Our nurses rotate duties during the cases. Typically, one nurse is documenting the case in our electronic medical record (EMR) and sedating the patient. The other nurse is monitoring and assessing the patient, and the other nurse is circulating.

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?

Our cardiologists and licensed radiologic technologists are allowed to operate the fluoro based on state regulations. Other licensed medical personnel in the lab that have been credentialed on the Azurion Flex System (Philips) can position the image intensifier (II), pan the table, and move the table for patient placement and removal from the table.

How does your cath lab handle radiation protection for the physicians and staff?

Our lab is equipped with a great deal of radiation protection. In addition to the room itself, all staff, fellows, and faculty physicians are measured for personal lead protection. Many choose arm, head, and eye protection as well. All cath lab personnel are issued a radiation dosimeter badge to be worn and sent in every month for evaluation. We have a radiation safety team that meets monthly to review protocol and staff radiation exposure levels.

What are some of the new equipment, devices and products recently introduced at your lab?

We have a brand-new Philips Azurion with FlexArm and ClarityIQ in our remodeled lab. We have the latest Philips Flex Cardio software. We also have integrated SyncVision precision guidance system and Philips Volcano systems that have been incredible additions to our lab. Finally, we have the capability for live camera and video to local and distant locations. As an academic center, this have been an invaluable addition for educational offerings.

How does your lab communicate information to staff and physicians to stay organized and on top of change?

We have bi-monthly staff meetings for cath and EP lab personnel. We also have weekly cardiology service team meetings, as well as an HVI monthly report-out meeting with all the service leaders and physicians (cardiologists and surgeons).

How is coding and coding education handled in your lab?

We perform daily charge reconciliations. Our coding department is always at hand to assist and guide our coding process.

Who pulls the sheaths post procedure, both post intervention and diagnostic procedures?

All sheaths are pulled by the nurses from our pre/post area, RNs from the lab, or the fellows assigned to the lab during that month. Radial sheaths are pulled in the lab by the fellow and a TR Band (Terumo) is then placed. An RN new to the cath lab or pre/post is trained and signed off on sheath removal after being observed pulling 10 sheaths under watchful eye of a sheath removal-credentialed RN (arterial and venous) before being allowed to pull a sheath on their own.

Where are patients prepped and recovered (post sheath removal)?

Our patients are prepped and recovered in our own pre/post area, which has 8 beds for our cath and EP patients. Some of patients return to their ICU beds with sheaths, and in that case, the cath fellow or interventional fellow will pull those sheaths. There was a time when most of our femoral cases were manual pulls. However, with the popularity of radial and frequency of patient requests for radial access, femoral sheath pulls have decreased dramatically. The physicians make a more concerted effort to utilize closure devices when warranted (no peripheral arterial disease, good stick, etc.).

How is inventory managed at your cath lab?

One of the newest members of our department is Dylan Clark, our materials manager. Dylan has been a huge addition to our service line. He sees to it that our entire service line has the products and materials they need daily. It is a tremendous comfort to know that we can let Dylan know about a particular need and he will take it from there. As materials management coordinator, Dylan handles all of the purchasing for our cath lab, but inventory management is a full team effort that includes our nurses and radiologic technologists. We monitor inventory levels to ensure all products stay stocked and above par levels.

We are in the process of establishing an active monitoring, auto-depletion inventory system that will communicate with both our Lawson ordering system (Lawson Products) and our Epic charting system. The system will allow for items to deplete from inventory as used by nursing staff and limit the chances of human error. By analyzing 3-, 6-, and 12-month supply usage sorted by physician and procedure, we are building “Physician Preference Cards” that will allow us to forecast supply usage and take a proactive approach to inventory management, instead of the traditional reactive approach.

Is your lab involved in clinical research?

Yes. Our most recent research work involves an assessment of the VIVO (View into Ventricular Onset) system (Catheter Precision, Inc.) for the non-invasive estimation of left ventricular diastolic pressures as an aid in the diagnosis of heart failure. Participation in this trial began in December 2020.

Can you share your lab’s door-to-balloon (D2B) times and some of the ways employees at your facility have worked together in order to lower D2B times?

We have recently implemented a new STEMI algorithm and pager system. We are also looking to begin using Pulsara in the near future. Our recent pagers were numeric so when paged, we had to call into the switchboard individually. With the current pagers, “one call, pages all”, notifying all STEMI members. This has significantly reduced our D2B times and we can proudly say that we are right on goal. When possible to be activated pre-hospital by EMS, it gives us even more of a head start to get the patient to the lab as soon as possible. We also have monthly STEMI team meeting including EMS, ED, and cardiology leadership to further streamline our STEMI workflows.

Who transports the STEMI patient to the cath lab during regular and off hours?

The algorithm dictates the ED staff transports the STEMI patient to the cath lab as soon as the cardiac cath lab staff notifies that the lab is ready. There are also times when cath lab transports the patient.

What happens when the call team is already busy doing a procedure and a STEMI comes into the ED?

If the cath lab procedure has not progressed to the point of a wire being placed across a lesion, then the cath lab team will halt the progress of this patient, secure the arterial sheath (radial or femoral), remove the patient from the procedure table, and transport the patient to the post-op area for monitoring. The cath lab team cleans the procedure room and prepares for the STEMI patient to be delivered by the ED staff. After the STEMI patient procedure has been completed, the staff will clean the lab and set up to complete the previous patient’s procedure.

If the cath lab patient’s procedure has progressed to the point of a wire being placed across a lesion, then the one of the following options will be chosen:

• If the current procedure can be completed in a timely manner, it will be finished and the patient transported to the post-op recovery area asap. The room will be cleaned and ED called to transport the STEMI patient to the lab. The procedure room will be set up for the STEMI patient’s arrival.
• If the EP lab doesn’t have a patient on the procedure table, then the cath team will call the backup interventional cardiologist to come to the lab and cath the STEMI patient in the EP lab. The back-up interventional cardiologist must stop any work they are currently doing in the hospital or clinic, and immediately assume care of the STEMI patient coming to the EP lab. The ED staff will deliver the patient to the EP lab.
• If both the cath lab and EP lab are occupied and not available in a timely manner, then it is incumbent upon the interventional cardiologist staff and ED attending to make a decision on administering thrombolytics or transferring the patient to another local STEMI center for cath.

What measures has your cath lab implemented in order to cut or contain costs?

The addition of a materials manager has made a huge difference in our ability to cut or contain costs. Primarily, we have implemented lean inventory with JIT (just-in-time) replenishment to minimize capital tied up in inventory on the shelf. We also have completely reworked our Cath Pack to better match the routine items used in each case. We utilize a first-in, first-out (FIFO) stocking and pulling system, which allows us to minimize product expiration.

What quality control measures are practiced in your cath lab?

Additional quality measures have been put in place since arrival of new leadership. We have implemented new practices to capture procedural complications and system process breakdowns. One practice includes our cardiovascular service line complications outcome committee that meets monthly and is overseen by cardiology services and the hospital quality department. We have a standard process to report and review variances. We are improving our National Cardiovascular Data Registry (NCDR) data participation and use the data to further develop our service line.

How do you determine contrast dose delivered to the patient during an angiographic procedure?

We identify key information that is needed for a procedure. One of our focuses is acute kidney injury (AKI) prevention. We document the patient’s creatinine and glomerular filtration rate (GFR), and calculate the maximum amount of contrast that the patient can be given. These data are then included in the time-out process before the start of every procedure. The cardiologists are reminded of the patient’s renal function during the timeout process. The technologist then informs the operators of contrast use and limits during the procedure. We use the data from the NCDR to further track our progress.

How are you recording fluoroscopy times/dosages?

We record fluoro and dosage time in the EMR after every procedure is completed.

What is the process that occurs if a patient receives a higher than normal amount of radiation exposure?

The patient and radiation safety officer are notified. The patient is informed about signs to look for at home and is instructed to call with any issues. The patient is followed up in the clinic one week post procedure and one month post procedure, and as needed after that.

Who documents medication administration during the case?

The RN, who is the documenter, is responsible for all medication documentation.

Are your physicians dictating their cath procedure reports, or do they use a structured reporting tool?

Our physicians use a standard reporting tool in Epic Cupid.

How are you populating the registry data records?

Although our cardiac recording system and EMR has capability to collect registry data, we have not utilized this option, but instead have been collecting data manually. We are switching to a third party shortly, called Q-Centrix.

How does your cath lab compete for patients?

As an academic center in the region, we are a transfer receiving center for the area for patients from other facilities in the area.

How are new employees oriented and trained at your facility?

New employees undergo a standard onboarding process guided by hospital human resources. They attend an orientation session, are trained in the use of our EMR, tour in the facility, and are introduced to the staff and leaders in the hospital. They also have to complete online learning courses before they are fully introduced to the workplace. The new staff member will complete a 6-month training and orientation phase, and must be signed off on all department competencies before talking call in the cath and EP lab.

What continuing education opportunities are provided to staff members?

Ochsner has an online education program called OLN (Ochsner Learning Network). We also send staff to attend national conferences, and have routine inservices in the cath and EP lab.

How do you handle vendor visits to your lab?

Vendors are only allowed to visit our labs on an “as needed” basis (such as checking consignment inventory or offering clinical support during a case). They are required to check in via our Reptrax system (IntelliCentrics) and must wear a badge during their time on campus. Vendors are only allowed in the lab during procedures if they are providing clinical support on items not used on a routine basis by cath lab staff.

How is staff competency evaluated?

Staff competency is evaluated daily during the mandatory 6-week orientation period and is ongoing throughout staff time in the lab. As stated earlier, we try our best to hire nurses with critical care experience. It is not a dealbreaker, but it is our preference. It is our opinion that these nurses possess the critical thinking skills and disposition to be tremendous assets in the cath lab. When that nurse takes his or her first night of call, we want to be confident that they will be up to the task in all those areas that matter most!

Does your lab have a clinical ladder?

Ochsner Health System does have a clinical ladder offered to all employees at this time, but a revised ladder is in the works for the near future.

Can you share more about your lab’s efforts to have staff obtain the RCIS credential?

We currently do not have staff members who are RCIS. However, all staff members of the cath and EP lab have been preparing for the RCIS and registered cardiac electrophysiology specialist (RCES), and are preparing to take the exam in 2021. If we are successful in this challenge, every staff member in both labs will be RCIS and/or RCES certified. We are aware of very few RCIS individuals in the state of Louisiana today. It would be a tremendous accomplishment if we had 9 from one facility!

Does your lab have any physical (layout) bottlenecks or limitations? How do you work around the resulting challenges?

Although we have a newly remodeled lab, they were unable to make it larger in size. It can be a little tight when we have a structural case like a MitraClip that includes anesthesia, transesophageal echocardiogram (TEE), and increased personnel. Because we only have 1 lab currently, heavy case load days are challenging because we must follow ourselves in our room. This spotlights our turnover time. We just wish the room was bigger. Our lab is set up opposite from the EP lab, so when we do devices in our lab, it is a little backwards from what EP team members are accustomed to. This will be remedied when our hybrid/second cath lab is complete.

Is there a particular mix of credentials needed for each call team?

Our call team consists of 2 RNs and 1 CVT, and we usually take a week of call at a time. Sometimes we deviate from that if there are time-off requests that upset the week-on/week-off rotation. We determine the upcoming schedule on 15th of every month. We check the vacation book to see if anyone has requested time off and if so, put those days on the schedule and fill in with the others as needed. Right now, we have 3 nurses taking 21 days of call a month until we get someone hired and trained up.

Within what time period are call team members expected to arrive to the lab after being paged?

The call team is expected to arrive within 30 minutes.

Do you have flextime or multiple shifts? How do you handle slow periods?

We currently do not have multiple shifts. Our volume does not yet warrant multiple shifts, but we have a long-range plan if that does occur. We do have 2 shifts in our pre/post area, which has coverage from 6 am to 7 pm.

Do staff members experience any perks that you might like to share?

Our environment is staff friendly. We have lunches catered in several times a week. Conferences are provided to our staff on a regular basis. Call pay was just doubled for the cath and EP call teams.

Has your lab recently undergone a national accrediting agency inspection?

We are preparing for an inspection in early 2021.

What trends have you seen in your procedures and/or patient population?

The early months of the pandemic affected procedures in 2021 dramatically. We finally noticed our volume increase over the last 6 months.            

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”?

Our academic medical center is located in northern Louisiana region. We treat patients from over a 200-mile radius over a 3-state area. We are the only Level 1 Trauma center and only academic medical center in our region. 

The authors can be contacted via Curtis L. Elkins, BSN, RN, at curtis.elkins@ochsnerlsuhs.org

Tell us about your cath lab. Is it part of a cardiovascular service line?

UnityPoint Health – Trinity Heart Center offers a comprehensive cardiovascular service line that involves the collaboration between our team of cardiologists, cardiac surgeons, nurses and radiologic technologists. UnityPoint Health – Trinity Heart Center harnesses the latest advances in medicine and technology, treating complicated cardiac conditions with minimally invasive surgeries, open-heart procedures, and innovative therapies that help patients live longer, healthier lives. We are also proud to be one of only 52 cardiology programs in the United States to offer our patients the opportunity to participate in Pritikin Intensive Cardiac Rehab.

What is the size of your cath lab facility and number of staff members?

We have over 55 team members in our pre/post area and cath lab, including PRN team members. We have five cath labs: four in Rock Island, Illinois, and one in Bettendorf, Iowa. We also have a pre and post Cardiac Treatment Unit (CTU) in our Rock Island facility with 22 beds and a 5-bed unit in Bettendorf.

What is the mix of credentials at your lab, and how long have staff members been “in residence”?

We have a mix of registered nurses (RNs) and radiologic technologists, (RT[R]s), with varying years of experience. Our most senior person has recently celebrated her 44th year with us.

What procedures are performed in your cath lab?

We perform diagnostic heart caths and interventions, peripheral caths and interventions, implantable cardioverter defibrillators (ICDs), pacemakers (including His bundle pacing and Micra [Medtronic]), ablations (pulmonary vein isolation [PVI], supraventricular tachycardia [SVT], ventricular tachycardia [VT], premature ventricular contraction [PVC]), endovascular aneurysm repair (EVAR), transcatheter aortic valve replacement (TAVR), left atrial appendage (LAA) closure (Watchman [Boston Scientific]), patent foramen ovale (PFO) closures, peripherally inserted central catheter (PICC) insertions, CardioMEMS (Abbott), loop recorders, mechanical and laser lead extractions, sleep apnea phrenic nerve stimulators, and interventional radiology procedures.

On average, 80 procedures are performed in our cath labs each week. In addition, we perform approximately 20 transesophageal echocardiograms (TEEs), cardioversions, and tilt table procedures in the pre and post area on a weekly basis.

Can you share your experience with structural heart interventions?

Our first TAVR case was performed in February 2016 and as of mid-August 2020, we have performed 226 cases. Admission takes place the morning of the procedure to our Cardiac Treatment Unit (CTU). The TAVR case is performed in our state-of-the-art hybrid OR suite in the cath lab with balloon aortic valvuloplasty (BAV) not routinely done unless necessary.

We have a dedicated TAVR team, including a valve clinic coordinator, RNs, and RT(R)s. We have three dedicated RT(R)s who rotate scrubbing and preparing the valve for implantation. An open-heart team presents for all cases to assist with patient and anesthesia setup and room turnover. Setup depends on whether patient is a bailout or a no bailout (for bailout, the open-heart table is opened and bypass pump prepared; for no-bailout cases, the open-heart team is still present and on standby). For anesthesia, we mostly use monitored anesthesia care (MAC). Our patients recover in our CTU for five hours on average with specialized cardiac nursing care, avoiding a stay in the ICU. They are then transferred to our cardiac stepdown unit to stay overnight and are discharged by early afternoon the next day. Patients typically go home on an aspirin and clopidogrel regimen for at least six months. A follow-up visit is scheduled prior to discharge for one week with their primary cardiologist. Follow-up 30 days and one year post includes transthoracic echo and a visit with the procedural cardiologist. Our most recent published Society for Thoracic Surgeons (STS)/American College of Cardiology (ACC) Transcatheter Valve Therapy (TVT) registry data for mortality and stroke risk ranked us above the 75th percentile in both metrics.

How has COVID-19 affected your cath lab and facility?

COVID-19 has had an impact on all workflows ranging from patient scheduling to discharge. We now routinely screen all elective cases for COVID-19 and have implemented procedural changes with donning and doffing personal protective equipment (PPE). Our hospital guidelines require that all patients are masked when medically able. Additionally, we have reorganized supplies and established a dedicated COVID lab. All STEMI cases get a rapid COVID-19 test and are treated as positive until test results return, usually within an hour.

Any helpful tips regarding your process of donning and doffing PPE?

Extra team members are deployed to observe, monitor and assist to ensure proper PPE procedures are being followed by staff and physicians.

How are you improving communication while wearing PPE?

Our team’s ability to be proactive and pay close attention to all details during procedures has greatly benefitted our communication during the pandemic. Utilizing the Vocera Communication System has assisted with communication to one another and simply speaking in a louder tone to overcome barriers in communication that PPE might create has also helped.

Can you describe how you are testing patients and clinical staff for COVID-19?

We are doing everything we can to provide safe care for every patient in the safest possible environment. All patients admitted to our hospital are tested for COVID-19. This testing includes planned admissions and transfers of all ages who have not been tested for COVID-19 in the prior 72 hours. Patients undergoing elective procedures are tested 72 hours prior to their surgery and are asked to self-isolate until their procedure. Patients admitted to the hospital, including those for emergency procedures and labor and delivery, are screened using rapid tests.

UnityPoint Health – Trinity continues to prioritize the safety and health of our patients and team members in light of this pandemic. As such, we screen each physician and team member for fever and signs and symptoms of COVID-19 at the beginning of their shift. Staff experiencing any symptoms are sent home and tested for COVID-19.

How has the pandemic affected your patient population?

We are seeing that patients are waiting longer to get care in the hospital and as a result, our patients’ acuity has increased.

Who manages your cath lab?

Jessica Tapia-Mier, BSN, RN.

Do you have cross-training?

Yes, all staff are trained to be competent in all roles. All staff are cross-trained to scrub and monitor; RNs circulate/administer meds and RT(R)s administer fluoroscopy.

Are there licensure laws in your state for fluoroscopy?

Yes. We are unique in that our organization follows licensure laws for two different states. Both Illinois and Iowa require licensure for RTs through the American Registry of Radiologic Technologists (ARRT) initially before state licensure.

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?

Only RT(R)s, radiologists, or cardiologists.

How does your cath lab handle radiation protection for the physicians and staff?

Radiation safety is overseen by the radiologic technologists. We provide annual education to all staff members and work collaboratively with our radiology department.  All staff take an Image Wisely pledge annually. Staff and physicians are notified if they have received high dosage levels for the month according to badges. All team members have their own individual lead aprons, and we routinely use disposable scatter radiation pads, portable lead shields, and maintain distance — this is easy to do with our large procedure rooms!

Can you describe the extent and use of radial access at your lab?

Approximately 35 percent of cases are performed radially. Our cardiologists have very low complication rates from bleeding issues and over 55 percent of our patients go home the same day post percutaneous coronary intervention (PCI).

If you are performing peripheral vascular procedures, do any operators utilize pedal artery access when appropriate?

Yes, several operators use pedal artery access.

What are some of the new equipment, devices and products recently introduced at your lab?

Some of the new devices include Watchman, the remedē System (a device for patients with central sleep apnea) (Respicardia), Micra pacemakers and subcutaneous ICDs. New equipment includes the Auryon Laser (AngioDynamics), coronary laser, the Viewmate ZS3 Intracardiac Ultrasound Console (Abbott), hand-controlled Rotablator (Boston Scientific). We also recently upgraded our intravascular ultrasound (IVUS) system to IntraSight (Philips) and all labs have this integrated into the room.

How does your lab communicate information to staff and physicians to stay organized and on top of change?

We have regular monthly meetings with the cardiologists, administration and cardiology management team. In addition, we have monthly staff meetings and monthly education meetings, as well as routine huddles. We also have communication posted to our quality and kudos boards located in the pre and post area.

How is coding and coding education handled in your lab?

We have a dedicated RN with expertise in charge/capture and revenue cycle. From physician and staff documentation, she assigns the appropriate Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), and billing codes, which are then entered into patient’s account in Epic. Cath lab staff are educated annually during a skills day regarding their role in being able to code accurately. Staff are also provided feedback and updates during the year if new procedures or processes are added.

Who pulls the sheaths post procedure, both post intervention and diagnostic?

We provide 24/7 sheath pulling with a dedicated sheath pull team. This team pulls all sheaths regardless of the patient’s location in hospital, including the ICU. For training, we initially do a hands-on simulation class, track to make sure the team member has done an adequate volume, and then offer hands-on education. Groin management is a required annual education/competency for all cardiovascular team members.

Where are patients prepped and recovered (post sheath removal)?

In our pre/post treatment area, the Cardiac Treatment Unit. Most inpatients also recover in the CTU, our pre and post unit, until the sheath is removed.

How is inventory managed at your cath lab?

Our Cardiovascular Services Logistics and Product Line Lead oversees all supplies for the lab. We work closely with UnityPoint Health’s Value Analysis Team (VAT) and contracting teams to ensure compliance with all corporate contracts. Being part of a large system like UnityPoint Health allows us to leverage best market pricing and build stronger vendor partnerships. Our inventory of owned and consigned items is cycle counted once every quarter. Items are scanned into our Sensis system (Siemens Healthineers) as each item is used in the procedure rooms, then is decremented from our warehouse system. Based on set reorder points, daily auto purchase orders go out to the vendors to replenish the inventory. We also have a warehouse on site that houses all our commodity items. This warehouse fills our par cart using par levels and handheld scanners that interface with the system.    

Has your cath lab recently expanded in size and patient volume, or will it be in the near future?

We had a major Heart Center addition to our campus in 2015, giving us four extremely large (each is 900 square feet), state-of-the-art cath labs in Rock Island, Illinois. In June 2019, we relocated our Bettendorf Cath Lab to a larger space and reoutfitted with brand new equipment.

Is your lab involved in clinical research?

Yes. Our lab has been heavily involved in clinical research in collaboration with the Midwest Cardiovascular Research Foundation, under the Research Directorship of Nicolas W. Shammas, MD, MS, and with a specific focus on peripheral arterial disease. Several projects have been conducted in the lab. Current research includes the application of the Auryon laser in treating infrainguinal arterial disease. In this project, the focus is on defining the impact of the Auryon laser on deeper layers of the artery, bailout stenting, and the presence of distal embolization. In this prospective cohort of consecutive patients, we are using a quantitative vascular analysis (QVA) and IVUS core labs for dissection analysis. The National Heart, Lung, and Blood Institute (NHLBI) and iDissection classifications are being used for angiographic and IVUS classification of dissections, respectively. Over the past few years, our lab was involved in research related to Shockwave Intravascular Lithotripsy (IVL) (Shockwave Medical), (both registry and randomized trials), the Tack Endovascular System (Intact Vascular) (TOBA II and TOBA II BTK), FLEX Vessel Prep (VP) (VentureMed Group), (FLEX iDissection study), Jetstream atherectomy (Boston Scientific) (JET ISR, JET Ranger), and others.

Can you share your lab’s median door-to-balloon (D2B) times and some of the ways employees at your facility have worked together?

Our median D2B time is 63 minutes. We have worked with our emergency medical services (EMS) coordinators and emergency department (ED) to implement STEMI protocols.

Who transports the STEMI patient to the cath lab during regular and off hours?

Two cath lab team members go to the ED to pick up the patient, one being the circulating nurse. Cath lab staff always goes to the patient.

What do you do when the call team is already busy doing a procedure and a STEMI comes into the ED?

The back-up team is called in.

What measures has your cath lab implemented in order to cut or contain costs?

We monitor productivity daily and flex staff off when necessary. We also consistently review cost/case by case type, as well as supply utilization. In 2019, another innovative strategy involved the creation of a Post Cardiac Care Unit (PCCU) for our outpatients who need an overnight stay. These patients are monitored by our Cardiac Treatment Unit RNs and are discharged early the next day. The PCCU has allowed us to increase capacity on the stepdown unit, as well as decrease length of stay. The patients appreciate not having to go the inpatient unit, as well as being able to go home first thing in the morning.

What quality control measures are practiced in your cath lab?

We utilize data from the National Cardiovascular Data Registry (NCDR) registries and use national benchmarks to identify areas of opportunity. We regularly provide cardiologists with blind results of performance and then provide the detail to each individual cardiologist.

How do you determine contrast dose delivered to the patient during an angiographic procedure?

We use the ACIST CVi Contrast Delivery System (ACIST Medical) that records volume and then is documented in the procedural log. When utilizing the manifold, we verbalize the amount of used contrast to be documented.

Are you tracking the incidence of contrast-induced acute kidney injury in patients?

Yes, by using data provided from registries.

How are you recording fluoroscopy times/dosages?

We document total minutes, total dosage and dose area product (DAP) in our procedural log. This information is also recorded in our CardioPACS (Lumedx) system.

What is the process that occurs if a patient receives a higher than normal amount of radiation exposure?

At 60 minutes or more than 500 mGy, the RT(R) in the room completes a form and submits it to cath lab manager. This form is then sent to the cardiologist’s office, triggering an appointment for follow-up to see the patient in 4-6 weeks to assess the skin.

Who documents medication administration during the case?

The circulating nurse.

Are your physicians dictating their cath procedure reports, or do they use a structured reporting tool?

Our physicians utilize Dragon (Nuance Communications).

Do you use the American College of Cardiology National Cardiovascular Data Registry (ACC-NCDR) or any other outside data collection registry?

Yes, we use the NCDR’s CathPCI, Chest Pain MI, and Left Atrial Appendage Occlusion (LAAO) Registries, the STS/ACC TVT Registry, and AFib IQVIA for the STS Adult Cardiac Surgery Database (ACSD).

How are you populating the registry data records?

For Chest Pain MI, LAAO, AFib, and STS/ACC TVT registry data, we enter directly into NCDR’s data collection tools. For CathPCI, we are using a third-party vendor that coordinates with software used in the cath lab that is uploaded to NCDR’s site. We have two full-time abstractors and one part-time abstractor.

How does your cath lab compete for patients? Has your institution formed an alliance with others in the area?   

We have a large referral network of our own UnityPoint Health and independent primary care physicians. We have built strong relationships and developed a collaborative approach to care that is mutually beneficial to our patients, as well as our providers. We pride ourselves on our high-quality care and responsiveness to patient needs. Our division’s mission is to improve the hearts of our community so they can live happier and healthier lives. We have made a commitment to provide our community with knowledge they can use to improve their health. One initiative we have developed is an education series titled, “Heart to Heart,” where we provide the members of our community the opportunity to hear our cardiologists speak on a variety of heart health topics, followed by question and answer sessions. Since the fall of 2018, we have offered over 10 in-person forums, with average attendance of over 100 people at each session. We are currently developing a plan to offer these same sessions virtually.

How are new employees oriented and trained at your facility?

The cardiology division has a dedicated clinical educator to help onboard new team members to our area. We have a structured orientation process that has been specifically developed to help our new cath lab staff be successful. The orientation is structured for three separate areas of focus. New nurses spend four weeks circulating, four weeks scrubbing, and four weeks monitoring and spending time in the electrophysiology (EP) lab. Radiologic technologists spend their orientation time learning the scrubbing and monitoring role, as well as spending time in the EP lab. Meetings are held on a weekly basis with each new orientee and their preceptor to discuss how they are doing, and develop and review their progress on their personalized education plan.

What continuing education opportunities are provided to staff members?

In addition to an annual hands-on skills lab, team members are provided monthly education opportunities on site. CEU offerings are provided as available and staff are offered attendance at specialized conferences for EP, stroke, etc.

Are your clinical and/or managerial team members involved with any professional organizations that support the invasive cardiology service line?

Various staff and clinicals are members of the Association of periOperative Registered Nurses (AORN), Society for Cardiovascular Angiography and Interventions (SCAI), and the ACC.

How do you handle vendor visits to your lab?

We have a closed lab. Sales representatives are only permitted in the lab on occasions when they are providing product support during procedures or education sessions on products or equipment. All representatives who enter our facility are screened at the front doors and required to sign into SEC3URE Ethos (formerly known as Reptrax) (IntelliCentrics). The SEC3URE Ethos system has policies that representatives must agree to and it tracks all their medical requirements, such as TB, flu vaccines, etc., and the reason for their visit. If all requirements are met, a badge will print out of the system. This badge must always be worn while the vendor is on site and is only valid for that specific visit. In the event representatives need to scan their consignment product, a separate visit must be scheduled with our logistics team.

How is staff competency evaluated?

Staff is expected to be able to pass an annual cardiac rhythm competency. All nurses are required to be sedation certified. All of our pre and post nurses are National Institutes of Health Stroke Scale (NIHSS) certified. We have an environment of continuous learning, and staff are constantly learning new procedures and skills. After each education session, staff complete a competency test administered by the cardiology educator. We also have a “Machine of the Month” where a superuser is identified, and along with the lead and educator, will go through competencies for equipment that may not be used on a regular basis.

Does your lab have a clinical ladder?

Yes, we have a clinical ladder for RNs.

Do you require your clinical staff members to take the registry exam for Registered Cardiovascular Invasive Specialist (RCIS)?

No. Staff who have registered cardiac electrophysiology specialist (RCES) certification are offered a 10 percent increase in base pay.

What do you like about the physical space in which you work?

We have very large rooms, all set up the same for standardized workflow and supply management. Our Bettendorf lab even has a beach scene that welcomes the patient and provides a calming environment!

Is there a mix of credentials needed for each call team?

Each call team is comprised of four staff members, with a mix of at least two RNs and one RT(R). Staff are permitted to leave early or start later after a night of on-call if the schedule allows.

How does your lab schedule team members for call?

We schedule differently for weekdays compared to weekends. During the week, we have one team dedicated to each campus. On weekends, we have a primary team who responds to both campuses. If the primary team is working and another emergency occurs, then the back-up team is utilized.

Within what time period are call team members expected to arrive to the lab after being paged?

After being paged, team members are expected to arrive within 30 minutes to either campus location. Sheath pull call response time is one hour.

Do you have flextime or multiple shifts?

Yes, we have 10- and 12-hour shifts. During slow periods, we will flex staff off.

Has your lab recently undergone a national accrediting agency inspection?

Yes, we underwent a Joint Commission inspection in 2019. Hang your lead up! Also, make sure the IFU is followed for contrast and that ACIST syringes are single patient use. Another recommendation is to make sure patients have appropriate sedation-related instructions on discharge.

What trends have you seen in your procedures and/or patient population?

We have seen younger people needing cardiac care.

What is unique or innovative about your cath lab and staff?

We are fortunate to have blocked anesthesia time for our cardiologists and have a good relationship with our anesthesia department. This has helped with scheduling higher risk patients for receiving procedural sedation. We also have an anesthesia technician on staff every weekday to assist with anesthesia needs and machinery.

What’s special about your city or general regional area in comparison to the rest of the U.S.?

UnityPoint Health – Trinity is multi-state, divided by a river. People generally want to be treated in their home state. We are often dealing with construction issues and bridge traffic concerns.

A question from the American College of Cardiology’s National Cardiovascular Data Registry:

How do you use the NCDR Outcome Reports to drive quality improvement initiatives at your facility?

In addition to discussing the data with the cardiologists during our monthly meetings, we are also able to compare our site to other affiliates within our system, as well as other hospitals across the nation. We evaluate and review the data on a regular basis to identify opportunities for improvement in the cath lab, inpatient units, pre/post treatment area, or with physicians. 

Jessica Tapia-Mier, BSN, RN, Manager Invasive Cardiology, can be contacted at jessica.tapia@unitypoint.org.

Kathy Pulley, BS, Director, Cardiovascular Service Line, can be contacted at kathy.pulley@unitypoint.org

Tell us about your cath lab and facility.

Our cath lab is part of a 390-bed community hospital located in Lowell, Massachusetts. Our mission aligns with that of the hospital: we put “Patients First in Everything We Do”. The staff and cardiologists are patient-oriented, and strive to provide the highest quality care and services. The Heart and Vascular Center is part of a service line that meets quarterly. We look at how we can grow in our region, improve services for our patients, and collaborate with our partnering hospitals under the Wellforce system, which includes Tufts Medical Center and MelroseWakefield Hospital.

What is the size of your cath lab facility and number of staff members?

The Heart and Vascular Center has 4 state-of-the-art cath labs, with 1 room that is shared with interventional radiology and used for our peripheral vascular program. We have a separate, dedicated electrophysiology (EP) room for ablations and implants, and 2 dedicated cath labs for our cath/percutaneous coronary intervention (PCI) cases. We run a 5-bay holding area most days, but have an additional 3 bays if needed for overflow.

We have 10 full-time employees for nursing, with a total 13 registered nurses (RNs), of whom some are cross-trained to cover the stress lab, others to staff the holding area, and 8 who are part of the ST-elevation myocardial infarction (STEMI) call team. We have 7 registered radiologic technologists (RT[R]s), including our per diem. Six of our RT(R)s are part of the STEMI team, with one data coordinator to manage our American College of Cardiology (ACC) National Cardiovascular Data Registry (CathPCI) and statistics, and one utility aide for room turnover and stocking.

We also have additional support staff for scheduling and a cardiology service team that supports echo, stress, monitors, and electrocardiograms.

What procedures are performed in your cath lab?

We perform diagnostic left and right heart catheterizations, primary and elective angioplasty, cardioversions, transesophageal echocardiograms (TEEs), implantable loop recorders, implantable cardioverter-defibrillator (ICD)/permanent pacemaker (PPM) implants, pericardiocentesis, atrial flutter and supraventricular tachycardia (SVT) ablations, tilt table tests, catheter-directed thrombolysis for pulmonary embolism, and peripheral angiography and stenting. Our RT(R)s also support the operating room staff during peripheral hybrid cases. We currently do not perform structural heart interventions. Our team averages between 40-50 cases a week.

Does your cath lab perform primary angioplasty without surgical backup on site?

Yes, since August 2004, we have performed primary angioplasty without surgical backup on site. We also were part of the MASS-COMM trial, a randomized trial to compare PCI between Massachusetts hospitals with cardiac surgery on site and community hospitals without cardiac surgery on site. This trial took place from June 2006 to June 2010 and resulted in the progression to elective angioplasty without surgery on site.

How has COVID-19 affected your cath lab and facility?

At the height of the pandemic in our area, all elective cases were canceled. Our staff was decreased, and only providing care to emergent and inpatients needing cath lab procedures. Our holding area was changed into a “clean” inpatient care floor and our cath lab nurses staffed the area 24/7. Some nurses were also deployed out as COVID-19 “helpers” in the ICU. Our RT(R) staff was utilized as nursing assistants and/or deployed out to our urgent care centers to be greeters and screen patients coming in for testing.

Do you wear personal protective equipment (PPE) with all STEMI cases?

Yes, our staff wears N95s and eye protection with all STEMI cases. Patient COVID-19 status is treated as unknown until the rapid COVID-19 swab result is returned.

Can you describe your process of donning and doffing PPE?

Staff buddy up and monitor each other during the donning and doffing process to ensure the proper process is followed. We also have signage in the room where donning and doffing occurs for reference.

How are you improving communication while wearing PPE?

We are speaking more clearly and using verbal confirmation of orders, equipment, and medications to prevent any errors, and to assure accurate documentation. We have adopted the “Sitting Down Stands Out” communication practice and use eye contact to look for understanding to improve clear communication with our patients. During COVID-19 high-volume periods, visitors and families are not allowed in. We are sure to include them in education via iPad or using the telephone upon discharge.

When are patients masked?

All patients within our organization are masked unless they are alone in their rooms. This includes during procedures in the cath lab.

Can you describe if/when patients are being tested for COVID-19? Physicians/team members?

All patients that are scheduled for a cath lab procedure must have evidence of a negative COVID-19 test within 72 hours of procedure. If a STEMI patient comes in, they get a rapid swab in the emergency department (ED) prior to coming to the cath lab, but this does not delay transfer to the cath lab. The team moves forward without the results and wears full PPE until test results are received.

All employees must fill out an attestation to wellness prior to reporting to work. If you have no symptoms, you sign your initials to be eligible to work. If any staff has symptoms that may be related to infectious disease, the staff member is not cleared for work and must call their manager and the Occupational Health nurse.

What do you expect will happen with COVID-19 and your local population?

We are happy to say we are through the post-holiday peak and have begun to see a steady decrease in COVID-19 admissions. We have had meetings within the state and with our partner hospital, Tufts Medical Center, and managed to transfer patients when census was high in our intensive care units (ICUs) during the peak. We had set up a field hospital in collaboration with the state, at UMass Lowell, to support extra capacity of patients and have been able to decommission the site in March 2021. Recently, we opened the Lowell General Hospital Mass Vaccination Program, a regional vaccine clinic. We are currently vaccinating about 2,000 people a day, with the flexibility to expand up to 3,000 doses a day based on vaccine availability. We have seen a decrease in hospital-wide staff cases since the vaccine rollouts and are hoping for the same results in the community. We will continue to track several metrics including state volumes, local volumes, inpatient admissions and acuity levels to determine if we will need to decrease or cut down on outpatient procedures.

Can you describe the extent and use of radial access at your lab?

We consider ourselves a radial lab. We screen all patients for radial access for cath procedures. We perform Barbeau/modified Allen’s test to assess patency of the ulnar artery. Every case that rolls in the door will be radial access, unless the patient is in severe cardiac shock requiring a support device. Currently our radial percentage is about 77% (includes STEMI cases).

Do any operators utilize pedal artery access for peripheral vascular procedures when appropriate?

Yes, we have a new interventional cardiologist that has a special interest in peripheral vascular disease. Pedal access is not standard, but if unable to access via femoral artery, he will access the pedal artery.

Who manages your cath lab?

Allayne Mendys, MBA, BSN, RN-BC, is the Clinical Manager of The Heart and Vascular Center and Cardiology Services. We have 4 dedicated staff members, either RT(R) or RN, who rotate being in charge each day to oversee the daily workflow in the Heart and Vascular Center.

Do you have cross-training? Who scrubs, who circulates and who monitors?

Our RT(R)s scrub and operate fluoro, and our RNs circulate and administer sedation. The monitor role can be done by either an RT(R) or an RN. During STEMI cases, we staff with 2 RNs and our RT(R) is scrubbed in as first assist. All staff cover the EP lab and the cath lab. Our nurses are cross-trained to the holding room and some are cross-trained to the stress lab.

Are there licensure laws in your state for
fluoroscopy?

Yes, all cases require an RT(R) present to operate fluoroscopy.

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?

Physicians and RT(R)s are the only personnel that can operate the x-ray equipment and perform all listed actions.

How does your cath lab handle radiation protection for the physicians and staff?

All staff/physicians must wear lead aprons and radiation badges while in the room. Anyone scrubbed in at table must wear lead goggles. Lead-lined caps are available for use. We have ceiling- and table-mounted lead shields. Everyone is educated yearly on radiation safety, including time/distance and shielding. All team members are monitored by radiation badges and receive reports on dosing monthly.

What are some of the new equipment, devices and products recently introduced at your lab?

In the past 3 years, we have grown as a community hospital that provides care to the sickest of patients. We are able to implant the left-sided Impella (Abiomed) for left ventricular support and also have an intra-aortic balloon pump. We provide ultrasound-accelerated thrombolysis for pulmonary embolism with catheter-directed tPA (EKOS, Boston Scientific). We have moved from the use of fractional flow reserve (FFR) to diagnose coronary artery disease to instantaneous wave-free ratio (iFR) (Philips), which eliminates the use of adenosine. Our peripheral operators use intravascular lithotripsy (Shockwave Medical) and Jetstream atherectomy (Boston Scientific) for calcified plaque.

How does your lab communicate information to staff and physicians to stay organized?

Monthly staff meetings address departmental issues and updates. Email communication is used for information that is imperative to communicate in real time. We also have a daily huddle in the morning to review cases, staffing, census, and any other pertinent information of the day. We recently obtained Cath Lab Accreditation through the ACC and now have quarterly Heart and Vascular Center interdisciplinary performance improvement meetings where all our quality metrics and policy updates are shared. We have vendor educational training on all new equipment and then periodically on less-used devices to keep everyone proficient. We have monthly cath conferences that frequently include a speaker from a tertiary center to provide updates on new and upcoming procedures, and share case studies and research updates.

How is coding and coding education handled in your lab?   

We have a coding department that works directly with the manager and dedicated RT(R) to review billing and coding questions. We also have a CPT manual and an RT coder book for reference. We work collaboratively with our interventional radiology department on any peripheral billing/coding questions and our vendors are also a great source for coding information.

Who pulls the sheaths post procedure?

Interventional cardiologists, trained cath lab RNs, and RT(R)s pull the sheaths. There is a policy for reference and training requires 5 sheath removals with competency under direct physician oversight. We have a yearly mandatory educational video on our hospital’s learning platform that covers access site management as well.

Where are patients prepped and recovered (post sheath removal)?

We have a dedicated holding area for outpatients or for patients transferred in from our other hospital campus. If inpatients require closer monitoring, prior to returning to their room, they may transfer to the holding area to be monitored. Since we are mainly a radial access lab, we use TR Bands (Terumo) for compression. We also have Angio-Seal (Terumo), Starclose, and Perclose (both Abbott Vascular). If a closure device is unable to be used, manual compression is done on the table, when able, or in the holding area. We have the FemoStop device (Abbott Vascular) available as well.

How is inventory managed at your cath lab?

Lowell General’s inventory management is manual, and all RT(R)s assist in reordering and outdates. There is one dedicated RT(R) that oversees the overall process. Angioplasty items such as stents and balloons are on consignment using par levels. Diagnostic products are ordered twice monthly as needed, while maintaining stock in a common area and par levels within each procedure room. To reduce product inventory and costs, peripheral supplies are utilized from interventional radiology inventory. EP supplies are ordered by use of the Kanban system.

When new products are required or requested by a cardiologist, Lowell General has a form request that is completed and reviewed by management, and then reviewed by a new product committee comprised of purchasing agents and the purchasing director of our health system, Wellforce. The cath lab has ongoing communication with a designated purchasing representative to assure support around supply management.

Has your cath lab recently expanded in size and patient volume, or will it be in the near future?

We have been growing our peripheral vascular services. Two of our interventional cardiologists currently perform occasional peripheral angiography/intervention, as well as our vascular surgeons. We recently hired a new interventional cardiologist that has an interest in peripheral vascular disease. Our staff also assist the vascular surgeons with hybrid peripheral cases in the operating room (OR). Due to COVID-19, our cardiac volume has decreased slightly this year, but since we have opened back up, volume is quickly returning to normal. We do expect an overall increase in procedures with our new interventionist.

Can you share your lab’s door-to-balloon (D2B) times and some of the ways employees at your facility have worked together in order to lower D2B times?

We are very proud of our STEMI D2B times: our median door-to-balloon time is 43 minutes and well above the national benchmark according to the ACC’s national data registry. The ACC accreditation team, at our recent review, said, “This is a noteworthy accomplishment, as the vast majority of your cases are performed via radial approach.” To accomplish these times, we have collaborated with our paramedics and have yearly STEMI Continuing Education programs. Paramedics are able to activate the STEMI system with any potential STEMIs. The electrocardiogram is sent via protected health information (PHI) file to the interventional cardiologist, who can then make a decision on the spot. This allows our team to get a head start to the hospital before the patient arrives. This process also takes place at our outside hospitals. Another process in place allows the patient to bypass the ED and go directly to the cath lab, per the interventionalist’s decision (any transfer in or field activation).

Who transports the STEMI patient to the cath lab during regular and off hours?

The ED staff nurse/paramedic and interventional cardiologist transport all STEMI patients to the cath lab during regular and off hours.

What do you do when the call team is already busy doing a procedure and a STEMI comes into the ED?

First, we inquire about mobilizing a second call team (frequently, a second interventionalist will call in). We determine (if possible) how long before the room would be freed up; if it is more than the time it would take to transfer, we communicate for immediate transfer to a close tertiary facility.

What measures has your cath lab implemented in order to cut or contain costs?

The cath lab is very involved in containing costs. We are part of a health system (Wellforce) with several partnering hospitals, which give us better contracted pricing from our vendors on many supplies, including our devices for implants and stents.

All management and staff have undergone education on lean processes (how to eliminate waste and work more efficiently together) and have participated in projects such as setting up our EP lab on the Kanban system for inventory management and going through our supply room to assure we have appropriate par levels for our supplies. One of our RT(R)s came up with a great idea for soon-to-expire balloons and stents called the “blue light special.” We put them together in a section on the counter that can be reviewed before looking at the regular supply carts as an attempt to use these devices first (if appropriate). We have also looked at our workflow processes and are trying to get some projects done between cases if possible, rather than saving them for the end of the day, which makes the overall day more efficient.

What quality control measures are practiced in your cath lab?

We have several ongoing quality projects, including bleeding risk screening, renal protection protocol, medication scanning, radiation safety protocol, contrast allergy protocol, diabetic patient management, universal timeout, and a Surgical Care Improvement Project (SCIP) protocol for our device implants, and we track all adverse outcomes for our invasive procedures.

How do you determine contrast dose delivered to the patient during an angiographic procedure?

We calculate max contrast dose on all patients. We look at comorbidities, prior renal history, glomerular filtration rate (GFR), and any prior doses of contrast within their hospital stay.

Are you tracking the incidence of contrast- induced acute kidney injury in patients?

Yes, we have a nurse that follows all patients that fall into the renal protocol based on GFR and comorbidities. She also gets data on creatinine rise from our ACC registry reports and from a custom report created through our electronic medical record (EMR). She then abstracts data on prior history and lab work, medications, amount of contrast, and fluids ordered. She presents this information at the Heart and Vascular Center interdisciplinary performance improvement meetings and to the nursing quality committee meetings.

How are you recording fluoroscopy times/dosages?

We have Philips x-ray equipment that produces a dose report on every patient. This report is placed in the medical record for future reference.

What is the process that occurs if a patient receives a higher than normal amount of radiation exposure?

We include on our pre-procedure checklist any prior radiation dosing within a year and during the procedure, we notify the cardiologist when we are at 2 Gray (Gy) and then update at 5-minute increments. If a patient receives >2Gy, the case gets reviewed at the radiation safety meeting. If any patient receives >5Gy, the patient receives an educational sheet about how to monitor, and is scheduled for an in-person follow-up with the cardiologist within 7-10 days. This is also reported at radiation safety committee meeting. The physician performing the procedure and patient’s primary care physician are also notified.

Who documents medication administration during the case?

The RN or RT(R) monitoring the case documents all medications. All meds are then reviewed at the end of procedure and confirmed with the circulating RN.

Are your physicians dictating their cath procedure reports, or do they use a structured reporting tool?

Our GE Healthcare system has a built-in structured reporting system that is used by all physicians for procedural reports.

Do you use the American College of Cardiology National Cardiovascular Data Registry (ACC-NCDR) or any other outside data collection registry?

We participate in the ACC-NCDR for all emergent/elective PCIs and ICDs.

How are you populating registry data records?

Our GE system has an interface with the registry so there is some data migration from our GE reports directly into the registry. We also have a dedicated data coordinator who oversees the overall data, with support from some of the cath lab staff. We have one RN dedicated to the ICD registry.

How does your cath lab compete for patients? Has your institution formed an alliance with others in the area?

Our cath lab receives patients based on physician practice referrals. We have a position dedicated to physician retention and recruitment. The largest cardiology service in our area is hospital-owned, which ensures the majority of market capture for the service line. We have a featured magazine that does occasional spotlights on the cardiac service line and we have recently obtained Cath Lab with PCI Accreditation from the ACC, which helps promote our service. Being the closest PCI-capable hospital, we have an understanding with another close facility and their fire departments (not in our hospital system) to accept transfer of patients in need of STEMI.

How are new employees oriented and trained at your facility?

Staff that are orienting new employees must attend a mandatory preceptor class in order to precept new employees. All new staff are given an orientation packet to be signed off during their orientation that includes all the required competencies. The new employee is teamed up with a main preceptor for several months (unless they have prior cath lab experience), with incremental check-ins on progress with the manager. We have learning video tutorials on important requirements, and schedule vendor inservices on important equipment and devices.

What continuing education opportunities are provided to staff members?

Prior to COVID-19, staff was able to attend one local conference a year, of their choice. The Heart and Vascular Center organizes a biannual cardiovascular nursing conference that is a full-day conference and includes presentations from our own cardiologists and/or vascular physicians, including our affiliated tertiary site physicians. There are also opportunities to obtain CEUs at our monthly cath/echo conferences. RNs can access our online CE library for additional CEUs and RT(R)s are offered the availability for Category A CEs twice yearly.

Are your clinical and/or managerial team members involved with any professional organizations that support the invasive cardiology service line, such as the Alliance for Cardiovascular Professionals (ACVP) or regional organizations?

The manager of our Heart and Vascular Center is an associate member of the American College of Cardiology (ACC), a member of the Organization of Nurse Leaders (ONL), and a member of the American Society of Echocardiography (ASE). After obtaining our Cath Lab/PCI Accreditation from the ACC, all staff members have access to the ACC’s CardioSmart.org, the Clinical Toolkits, and Quality Campaigns.

How do you handle vendor visits to your lab?

All vendors are required to have a scheduled appointment and check-in via Vendormate (GHX) to ensure all requirements are up to date. This system supplies them with a paper badge. In addition, due to COVID-19, vendors are screened at the entrance using our COVID-19 screening tool. Prior to COVID-19, we would have a vendor lunch once weekly for staff/physician education and updates with cardiac medications or equipment. These were booked through our data coordinator. Our procedural vendors are present by physician request to assist during a procedure/device implant, but follow the same process as above. We do not allow vendors who are not required for equipment/device support into the cath labs during procedures.

How is staff competency evaluated?

Staff competency is evaluated by yearly manager reviews. Peer reviews are also taken into account by the manager at the yearly review. We have skill-specific learning videos that are required each month, including topics such as arterial site management, no reflow, dissection, tamponade, anaphylaxis, Impella, IABP, and stroke, to name a few.

Does your lab have a clinical ladder?

The hospital has an RN clinical ladder, but this is not specific to the cath lab.

Do you require your clinical staff members to take the registry exam for Registered Cardiovascular Invasive Specialist (RCIS)?

Not at this time.

Does your lab have any physical (layout) bottlenecks or limitations? How do you work around the resulting challenges?

Our holding area only allows 5 outpatients to be in the area at one time. This can limit the amount of outpatients that are scheduled daily or slow the day down waiting for a discharge in order to accept another patient into the holding area. We have all become very creative with workflow, including recovering patients in the cath lab itself, bypassing the holding room on transfers in, opening an overflow holding area with additional staff, and arranging the schedule to allow for quicker procedures early to free up beds later in the day.

What are some things you enjoy about your physical work space?

We have a large Heart and Vascular Center area that is on the first floor of the hospital. We also have large windows to the outdoors in our hallways to the procedure rooms. Most of the time you can catch a great sunrise (if you are there on call) or sunset at night. We also have a bird’s eye view in our holding area to view the ED ambulance bay and our on-site helipad. Being directly next to the ED allows for quick transport of STEMI patients.

Is there a particular mix of credentials needed for each call team?

Our call team is comprised of 1 interventional cardiologist, 2 RNs, and 1 RT(R). If the call team is in a case that goes past midnight, they are permitted 4 hours of “sleep time” the following day, if the schedule allows. The team staggers their sleep time with one RN coming in at the start of the shift and leaving 4 hours early, and the other coming in four hours late. The RT(R) bases their 4 hours off on the next day’s schedule as not to stress the staffing for the following day.

How does your lab schedule team members for call?

We have a dedicated RN that schedules call for the RN staff and a dedicated RT(R) for the RT staff. We chose to have a dedicated call night during the week and are required to do one weekend a month from Friday night until Monday morning. We submit our request to the call scheduler for weekend availability. We have a rotating call schedule for our summer/winter holidays as well. Holidays are grouped under letters, each staff member is assigned a letter, and each year, staff members take call during a different set of holidays based on how their individual letter rotates.

Within what time period are call team members expected to arrive to the lab after being paged?

The team must be ready to start the case within 30 minutes of being paged. The hospital has a contract with a few local hotels and covers the cost for any staff that stays on their call nights.

Do you have flextime or multiple shifts? How do you handle slow periods?

Flextime is granted on a rotating basis. We keep track in a binder of who has taken it recently. If the schedule is slower, each staff member has departmental projects that they are assigned to complete.

Do staff members have any perks that you might like to share?

Prior to COVID-19, we used to have some staff lunches, and the hospital often sponsored meals and snacks for staff appreciation. We were all granted a conference day to be used during the year to attend one conference. We have excellent tuition reimbursement and hold collaboration agreements with a few local colleges for discounts. We have close, free on-site parking and the call team has a pass that allows for parking directly outside the door for emergency calls.

Has your lab recently undergone a national accrediting agency inspection?

Our cath lab received Cardiac Cath Lab Accreditation with PCI from the ACC in October 2020. It was a great experience and required collaboration with all our team members (cardiologists, nurses, and RT[R]s) to streamline protocols, ensure we were following the latest evidence-based care, and review and share our registry data consistently and use these data to develop quality projects to improve patient care. Our hospital also earned its 3rd consecutive Magnet designation for nursing excellence in June 2020, an achievement reached only by 2% of hospitals nationwide.

What trends have you seen in your procedures and/or patient population?

Cardiovascular disease is increasing along with obesity, resulting in an increased incidence of atrial fibrillation and the need for cardioversions. Patients are getting younger and presenting sicker due to COVID-19, as they have delayed needed care. This is demonstrated by the fact that the myocardial infarction volume was down during the height of COVID-19 in our area. Now our numbers are back to and exceeding baseline.

What is unique or innovative about your cath lab and staff?

We are a small, tight-knit staff with many long-term employees who have been in the cath lab for over 15 years. We are very patient-focused, as our hospital’s mission is “Patients First in Everything We Do” and we live by that mission statement! We developed a committee called the Cardiac Cares Task Force that holds events to raise money for cardiac needs in the community, such as educational programs and support groups. We try to do social gatherings outside of work, as we all know it can get stressful in the workplace. We would do a yearly post-Christmas party. We adopt a family during the holidays as well to benefit a couple of local charities. Every year during Nurses Week, the RT(R)s and physicians collaborate to provide breakfast and lunch every day during the week. The RNs reciprocate during RT week.

Is there a problem or challenge your lab has faced?

The challenge our team experiences the most is the need for hospital beds. This problem is not unique to the pandemic, but obviously is now much more pronounced. With such a small staff, it is difficult to manage a holding area, moving patients out on time and also covering STEMI call. It is difficult having to stay late and then having to come back in for a STEMI. We work through these challenges by trying to rotate late stays and relieving each other when call in has been heavy. We also ask for volunteers for a second call team if holding is running late or if the ICU is at capacity. The hospital currently stopped elective surgeries and is opening our post-anesthesia unit (PACU) as another ICU. We all know these are tough times and we will get through it together, as we always do.   

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”?

Lowell General Hospital is a community hospital located in Lowell, Massachusetts, one of the largest cities in the state. Back in the early 1990s, there were three hospitals serving the community. Today, the two inpatient campuses of Lowell General Hospital serve the entire region. Lowell is only 30 miles north of Boston, making it convenient to transfer our patients who require more specialized cardiac care to some of the most renowned tertiary facilities in the country.

Our area is both economically and culturally diverse. The city of Lowell is known as the birthplace of the Industrial Revolution and has a long history of being a melting pot of ethnicities and cultures. Today, Lowell has the second largest Cambodian refugee population in the United States, after it became a destination for immigrants fleeing the Khmer Rouge regime. In order to best serve our community, it is important to understand and respect diversity and social determinants of health. Lowell General Hospital’s Organizational Strategic Plan includes a People Pillar (strategic goal) to be the best place to work and practice medicine. One of our multiyear objectives is to “cultivate and support our workforce with skills and perspectives that ensure diversity, equity, and inclusion.” In addition to this strategic goal, we work hard to establish strong partnerships with local organizations focused on serving diverse and historically underserved populations. In addition to providing access to interpreters on-site, we also provide interpreter services remotely through electronic communication tools and resources. The hospital has also recently expanded our DEI (Diversity, Equity and Inclusion) Council with employee and provider representation across the organization to better create a culture of belonging for all at our organization, and the Wellforce system has hired a Chief Diversity Officer. We celebrate recognition and awareness months for all cultures and have ongoing diversity education programs for leaders, staff and providers.

A question from the American College of Cardiology’s National Cardiovascular Data Registry:

How do you use the NCDR Outcome Reports to drive QI initiatives at your facility?

We have quarterly Heart and Vascular Center interdisciplinary performance improvement meetings that include the cath lab medical director, non-invasive cardiologists, interventional cardiologists, the cath lab manager, cath lab RNs and RT(R)s, an inpatient unit nurse manager, and the ACC data coordinator. This committee reviews ACC-NCDR outcomes reports and uses these data metrics (trending data) and evidence-based guidelines to develop quality improvement plans. Once these plans are implemented, the data is again monitored for improvement to ensure continued quality care. Ongoing performance improvement projects are also presented bi-annually to the hospital-wide quality council. 

The authors can be contacted via Allayne Mendys, MBA, BSN/RN, CV-BC, AACC, Clinical Manager, at allayne.mendys@lowellgeneral.org