Loyola University Medical Center

What is the size of your cath lab facility and number of staff members? Loyola University Medical Center (LUMC) currently has three dedicated cath labs (2 single plane, 1 bi-plane). There are 22.5 FTEs budgeted for the department. Of these: 12 are procedure room-based; 3.5 are Holding Area (pre and post procedure) based; 1 is an inventory specialist; 5 are secretary and support staff; 1 is a manager. The procedure staff is comprised of: 6 RNs; 1 RT; 1 RCIS; 4 CVTs. The Holding area is comprised of 3 RNs and 1 Patient Care Tech. Most of the staff have been here for 4 or more years. Several of our staff have been in the lab for over 10 years, and some have been here for over 20 years, which collectively brings a tremendous amount of experience to the department. What type of procedures are performed at your facility? We perform a wide variety of procedures, several of which are not offered at the typical community hospital. As a major cardiac facility in the Chicago area, LUMC brings the experience of some of the top interventional cardiologists to our lab. We perform both cardiac and peripheral diagnostic and interventional procedures on adult and pediatric patients. We perform over 4500 procedures annually. These procedures include: angioplasty; atherectomy; rotablation; stents; intravascular ultrasound; intracardiac ultrasound; AngioJet® (Possis Medical, Inc., Minneapolis, MN); vascular brachytherapy; septal ablation; valvuloplasty; percutaneous septal defect closure; atrial septostomy; and transseptal procedures. In the near future, we plan to implement carotid and abdominal aortic aneurysm (AAA) stent procedures. Does your cath lab perform primary angioplasty with or without surgical backup? LUMC is a Level 1 trauma center, so we have surgical backup available 24 hours a day. We perform primary angioplasty without a formally scheduled backup for most cases. On selected high-risk cases, there is formal surgical backup requested, which is arranged with the CV Surgery Case Manager. What procedures do you perform on an outpatient basis? The majority of our procedures are done on an outpatient basis, with patients being discharged from the hospital within 23 hours. With the success of arterial closure devices such as Perclose (Perclose, An Abbott Laboratories Company, Redwood City, CA) many of our diagnostic procedure patients are discharged 2 to 6 hours post procedure. Who manages your cath lab? The cath lab is part of the Cardiovascular Service Line. The Cath Lab Manager (George Simon, RCIS) reports to the CV Services Administrative Director. Do you have cross-training? Who scrubs, who circulates and who monitors? We cross-train all procedure room staff to maximize efficiency. There are 3 staff members involved in the procedure, along with the attending cardiologist and cardiology fellow. Since LUMC is a teaching facility, the cardiology fellow scrubs with the attending cardiologist. The monitoring person and circulator can be either a tech or a nurse. There is always 1 RN for conscious sedation administration, and 1 technologist for each procedure; the third person can be either a nurse or a tech. Does your lab have a clinical ladder? The cath lab does not have its own clinical ladder; however, the Nursing Division at LUMC utilizes a clinical ladder, in which cath lab nurses are invited to participate. It has been in place for a little over a year. RNs who are not new grads are automatically placed at Level 2. With the required documentation, cath lab nurses are able to represent themselves and their practice within the lab. There are specific criteria and a checklist of requirements on the application that must be met in order to be considered for the next level. Utilizing a weighted criteria system, the nurses are able to accumulate points for being involved in various activities such as educational programs and serving on various committees. The cath lab has many opportunities for teaching other departments, staff, patients and their families, all of which provide a way to advance within the clinical ladder program. One cath lab nurse was able to accumulate points by serving as a Polish interpreter. LUMC serves a large Polish population, so this skill was needed to communicate with these patients for pre-procedure education and follow-up phone calls to the patients and their families. At this time, three of the cath lab nurses have been awarded advancement to Level 3. What are some of the new equipment, devices and products introduced at your lab lately? We recently upgraded and rebuilt our bi-plane lab to accommodate AAA stent procedures. The x-ray imaging equipment was replaced with a Philips Integris BH5000 System (Bothell, WA). We also replaced the hemodynamic monitoring equipment in all three labs with GE MacLab 5000s (Waukesha, WI), that are networked with the GE Cardiolink server. In addition, we installed the GE Catalyst (Centricity) database and server, which is also networked with the MacLabs. We are currently in the process of integrating the Philips digital images into the Centricity database so that both the final procedure report and cine images are available from one source. The PercuSurge® device from Medtronic (Santa Rosa, CA) has been added to selected interventional procedures to prevent debris due to percutaneous transluminal coronary angioplasty (PTCA) procedures from migrating distal to the interventional site. The Gore self-expanding covered stent (Flagstaff, AZ) has also been added to our inventory. We also have the AngioJet Power Pulse Spray from Possis, used to force lytic agents into thrombus. Ten to fifteen minutes later, the AngioJet catheter is used to remove the thrombus material. The Amplatzer® Septal Occluder (AGA Medical Corporation, Golden Valley, MN) supplements the CardioSEAL® product line (NMT Medical, Inc., Boston, MA), which we stock for septal defect closure procedures. The AneuRx stent graft (Medtronic, Sunnyvale, California) will also become part of our inventory as we transition this procedure from the OR setting to the cath lab. Is your cath lab filmless? Yes. We recently installed the Philips Inturis Suite to archive digital images from all three labs (2 are Philips labs, 1 is a TREX lab [Littleton, MA]). How does your lab handle hemostasis? We currently use a variety of closure devices and manual methods for hemostasis. Depending on patient needs, we use Perclose, VasoSeal® (Datascope Corporation, Mawah, NJ), FemoStop (RADI Medical Systems, Reading MA), or manual compression. All clinical staff are trained to manually achieve hemostasis. All RNs and some techs are certified to deploy VasoSeal. We have a dedicated Interventional Nursing Unit where the interventional patients go to post procedure, and RNs in this area are also certified to deploy VasoSeal. Does your lab have a hematoma management policy? Yes, as a part of the hospital-wide nursing policy documentation. How is inventory managed at your cath lab? Who handles the purchasing of equipment and supplies? Due to the high volume and complexity of our procedures, our inventory is managed by a dedicated Inventory Specialist. This same individual also implemented the automated inventory system (Omnicell, Palo Alto, CA) in our department. The Omnicell system is interfaced with the LUMC purchasing system, and we now have an automated inventory and ordering system. Has your cath lab recently expanded in size and patient volume? Our lab has experienced continuous growth over the last several years, averaging 8-10% volume increases each year. Is your lab involved in clinical research? Yes. Since our facility is university-based and has a fellowship program, we are continuously involved in clinical trials. We participate in national trials as well as individual research projects that fellows are required to complete as part of their training. We are currently involved in the Gentek trial utilizing adenovirus to stimulate collateral blood vessel growth. Have you had any cath lab-related complications in the past year requiring emergent cardiac surgery? With the widespread use of stents, these events are extremely rare. What measures has your cath lab implemented in order to cut or contain costs? 1. We have made the complete conversion to a filmless lab; 2. Many of our interventional products are on consignment; 3. We have standardized a majority of the products used in our lab. What type of quality control/quality assurance measures are practiced in your cath lab? In addition to following all regulatory agency requirements such as radiation and emergency equipment QC/QA, we have a full QC program for POCT equipment which includes CO-Oximeter, blood gas, and glucometer equipment. How does your cath lab compete for patients? Our institution has one of the largest and most respected cardiac programs in the area. Since we are a university-based institution, we serve as a referral site for many hospitals without full invasive services and for high-risk cases that other sites do not have the capability to handle. How are new employees oriented and trained at your facility? The orientation process is designed to meet the needs of each new employee. Depending on the employee’s prior experience, the orientation process can last from 4 weeks to 3 months. Each new employee is assigned a preceptor who is responsible for completing the orientation program with them. RNs are licensed in the state of Illinois and have critical care experience. Techs are either RT-licensed or CVT credentialed. The highest credential for those who are not RNs is the RCIS credential. What type of continuing education opportunities are provided to staff members? We have an ongoing education program and are competency tested annually. Some examples are IABP, ACT, and ECG interpretation, defibrillation techniques, and other areas that directly affect day-to-day patient care. In-house clinical educators as well as clinical specialists from the various vendors can provide continuing education as new devices are introduced. How do you handle vendor visits to your lab? Vendor visits are limited to appointment only. Only one vendor per day is allowed. The vendors are restricted to particular areas within the complex so as not to interfere with operations. The only time vendors are allowed in the labs is to provide clinical support or education. How is staff competency evaluated? Staff competency is evaluated annually at the time of performance review by means of a checklist that is issued at the start of the year. How does your lab handle call time for staff members? There is 1 weekend and 6 weekdays per month of required call. There are 3 people on call at any one time; at least 1 RN and 1 tech, with the third person being either an RN or a tech. We have multiple shifts to meet the volume demands. The early shift is 7am to 3:30pm; the late shift is 8am to the last patient on the table; the call shift is 9am to last patient completed. Has your lab has undergone a JCAHO inspection in the past three years? JCAHO inspected our facility in May 2001. We were successful, with no type I recommendations. We also successfully completed a Commission on Laboratory Accreditation of the College of American Pathology (CAP) inspection in June of 2002. Can you describe the layout of your lab? Our third lab is remotely located from the 2 main labs. This lab is in another section of the hospital on the same floor, approximately 500 feet away from the main cath lab area. This tends to fragment resources (staff and supplies). Our two main labs share a common control room, which tends to consolidate these same resources. The main block of space for the department occupies about 6200 square feet. These labs are situated on opposing sides of the control room. Immediately to the north of this control room is the Holding Area. On the north side of the Holding area is the main storeroom. At the east end of the cath lab block of real estate are the secretary and support areas. Please tell us what you consider unique or innovative about your cath lab and its staff. We have a relatively small group of clinical staff with respect to our overall volume of procedures. This translates into long hours. As a result, the staff depends heavily on each other. They work well together under high-stress conditions. What’s special about your city or general regional area in comparison to the rest of the U.S.? LUMC borders the west side of Chicago and is close to major expressways. As a result, we have a wide mix of patient populations, ranging from far rural areas to inner city areas.

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