Pinnacle Health Hospital

What is the size of your cath lab facility and number of staff members? Pinnacle Health System is a 700-bed hospital. We currently have 2 EP labs and 5 cardiac cath labs. One cath lab can also be used for specialty peripheral procedures. We have approximately 60 staff members. Cath lab staff are comprised of 50% RNs and 50% techs. Our Cardiac Processing Unit (pre/post care) staff members are made up of 70% RNs and 30% non-RNs. EP staff are 75% RN and 25% technical. What type of procedures does your facility perform, and how many per week? We perform approximately 150 procedures/week. We are doing a lot of research studies in both the cath lab and EP labs, and perform all types of invasive and diagnostic studies. We also perform peripheral procedures. Our peripheral procedures seem to be increasing every month. We do approximately 50 procedures per week (diagnostic and interventional). We recently started performing carotid stenting in a research capacity. We are in a carotid registry program with Cordis, allowing us to be included in larger carotid research programs. Vascular surgeons as well as cardiologists perform procedures in the department. Does your cath lab perform primary angioplasty in acute MI with/without surgical backup? We do perform about 15% primary angioplasty without surgical backup and having been doing so for about one year with no problems. However, the availability of a cath lab suite right away is crucial. We do feel this percentage will continue to increase. How is your cath lab managed? The director of invasive cardiology is an RTR/RCIS and is responsible to the VP of Cardiac Services, who is a nurse. Our lab is non-segregated and cross-trained in every aspect of the job, ensuring a more efficient lab. The technical staff is cross-trained to administer medications under the direct supervision of the physicians. The nursing staff is cross-trained to operate x-ray equipment. What are some of the new products or procedures introduced at your lab lately? Recent products have been AngioJet® (Possis Medical, Inc., Minneapolis, Minn.), the PressureWire (RADI Medical Systems Inc., Reading, Mass.), and the Cutting Balloon (Boston Scientific Scimed, Inc., Maple Grove, Minn.). We use all 4 French diagnostic catheters with ACIST devices (Bracco Diagnostics, Inc., Princeton, NJ). We have also been involved in the Cordis drug-coated stent trial, numerous device trials with Guidant, and many pharmaceutical trials. Our cardiology department is heavily involved in research. Is your cath lab filmless? Yes, we are filmless and use the GE GEMnet system (Milwaukee, Wisc.) for all labs. How does your lab handle hemostasis post-procedure? Our nursing floors are responsible for pulling arterial and venous lines on interventions. The Cardiac Processing Unit outside the cath/EP labs are responsible for pulling immediate lines. We mainly use manual pressure and clamps on all diagnostics. Interventions are either clamps or Perclose (Redwood City, CA). How is inventory managed at your cath lab? The Director has budgetary responsibility and orders capital equipment. We have a specific supply person in the lab responsible for re-ordering supplies. All new supplies are agreed upon through a Cardiac Cath Lab Committee. This committee meets monthly, and is composed of physicians and administration staff. Any new product requests are looked at and we decide at that time whether to bring the product in or not. We make it a condition that the APC codes and pricing are loaded into our system before we use any new product. Has your cath lab recently expanded in size and patient volume? We consolidated two area hospital cath/EP labs as of December 2000. We also gained a 21-bed pre/post processing unit. We are currently expanding the beds in the Processing Unit by six more and are enlarging some support areas for that unit (i.e., waiting room, supply rooms). We are looking at future expansion to create a true Vascular Institute on one floor. How has managed care affected your facility? Managed care continues to keep us on our toes with regard to any opportunities for savings and patient care efficiencies. We maintain excellent quality care to patients in a difficult time in healthcare. We keep current with any changes to APCs and new product codes to ensure proper reimbursement. What measures has your cath lab implemented in order to cut or contain costs? We renegotiate supply vendors on a yearly basis with regard to stents, balloons, ICDs, and pacers. We also take advantage of bulk orders. Staff hours are flexed to decrease overtime. Currently, we have 6:30am-3:00pm, 7:00am-3:30pm, and 9:00am-5:30pm shifts, with the call staff coming in from 11:00am-7:30pm daily. If the schedule is light or heavier than normal, we adjust the call team arrival time to be later or earlier, which helps with overtime. How does your cath lab compete for patients? Currently, we are one of the state™s largest, in regard to cardiac cath and EP procedures. Our challenges in the future will be area competitors implementing their own heart programs, which could pull business from our institution. Does your lab have an outpatient program? We do have an outpatient program. We recover diagnostic patients in two hours and also discharge most of our peripheral and EP procedure patients the same day. How are new employees oriented and trained at your facility? We have an orientation program which lasts about 3 months. Employees learn the basics, after which they go on a limited on call program. They stay with a preceptor from the beginning, until they are comfortable with procedures and measured by competencies. For the most part, a new employee can be on their own after 3 months, but when the niche procedures or more extensive procedures come up, these can take up to a year to learn. We also have a Staff Development Instructor in our department who helps with training and competencies, as well as a yearly System Education Day where new employees undergo a broader, hospital-based orientation. What type of continuing education opportunities are offered to your staff members? Everyone is ACLS/BLS-certified. System Education Days are available through the hospital. Staff are encouraged to take advantage of annual seminars such as the Transcatheter Cardiovascular Therapeutics meeting (TCT), and our own yearly Cardiac Symposium. Self-study for the Registered Cardiovascular Invasive Specialist (RCIS) registry is also supported. Currently, we strongly encourage all staff to obtain the RCIS credential. We have many staff who have obtained it already, and several who will be sitting for the exam this spring. We are also working on a clinical ladder which identifies the RCIS at the base level and as a requirement for moving up the ladder. Does your lab utilize any alternative therapies (i.e., guided imagery, etc.)? No alternative therapies are currently utilized, but we are interested in pursuing possibilities. How does your lab handle call time for staff members? Our on-call staff maintains call responsibility for one day per week and approximately one weekend per month. They have flex hours when on call to come in later and accommodate the cases at the end of the day with reduced overtime. We have at least one RN on call with technical staff. What type of quality control measures are practiced in your lab? We have a hospital-based QA program where we provide monthly statistics. Our physicians and administrators have monthly mortality and morbidity conferences. We also follow American College of Cardiology (ACC) guidelines. What measures has your cath lab employed to improve patient throughput? We use 4 French diagnostic catheters, which allow us to recover patients in two hours without the use of a closure device so we continue to realize supply savings and patient comfort and efficiencies. What trends do you see emerging in the practice of invasive cardiology? The trend we see at our facility is an increase in peripheral volumes in the cardiology department. Has your lab undergone a JCAHO inspection in the last 3 years? We recently had our JCAHO inspection and passed with a remarkable score. What is innovative or unique about your cath lab and its staff? The invasive cardiology staff is always eager to learn and maintain a teamwork atmosphere. Many staff share ways to improve efficiencies and show initiation with regard to new procedures or research studies. We maintain longevity with our staff. Is there a challenge your lab has faced? The biggest challenge to our labs was consolidating two unlike departments into one department. We had two hospitals which merged approximately one year ago, and with the merger, two very different practicing cath labs, which we brought together. We took the best of both programs and instituted a new one, which works very well. Probably the biggest challenge was cross-training everyone to all aspects of the cath lab role (i.e., pharmacy, scrub, x-ray, etc.) where it had been separated into individual roles at one institution before the merger. Overall, however, we consolidated very well and continue to take the best ideas from both departments and make improvements in our new facility. What is unique about your regional area or city that affects your cath lab culture? Harrisburg, Pennsylvania, is a multi-cultural city where we must provide a wide range of services with regard to religious beliefs, language barriers, etc. As a result, cath lab staff are diverse and adaptable.

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