Cath Lab Spotlight
Robert Wood Johnson University Hospital
February 2006
What types of procedures are performed at your facility?
We perform diagnostic procedures (right and left cath, intravascular ultrasound, myocardial biopsy), percutaneous coronary intervention (PCI) (stenting, rotoblator, thrombectomy, and brachytherapy), and cardiac electrophysiology procedures [EPS, ablation, cardioversion, tilt table test, implantation of pacemakers, event monitors, automatic intracardiac defibrillators (AICDs) and biventricular devices, and post-implant defibrillator testing]. We perform an average of 110 diagnostic caths, 60 PCIs, 6 EPS studies, 2 ablations and 14 device implants per week. We began a peripheral intervention program in 2005.
Adjacent to the cath lab is our dedicated cardiac MRI unit. The cardiac MRI, run by a cardiologist, is used for a full range of diagnostic testing. It provides accurate functional and volumetric information and is a valuable tool in assessing the course of coronary arteries with an anomalous origin. One newer indication is the assessment of myocardial viability, which helps guide the decision about whether to revascularize. This is becoming of increasing importance in our routine clinical practice. We perform about 10 cardiac MRI procedures per week. Does your cath lab perform primary angioplasty with surgical backup? Our hospital has 22 OR suites, three of which are dedicated to cardiac surgery. Should a patient need to be transferred for emergency surgery, an on-call faculty attending or a community cardiac surgeon is paged to evaluate the patient. When the surgeon accepts the patient, the OR staff makes ready the next available OR suite. There is no formal scheduling for surgical backup. What procedures do you perform on an outpatient basis? We perform diagnostic cardiac catheterizations, myocardial biopsies, AICD checks, tilt table tests, EPS, PPM/AICD generator changes, as well as stress tests, on an outpatient basis. What percentage of your patients is female? In 2005, we found that 34% of our patients were female. What percentage of your diagnostic cath patients go on to have an interventional procedure? Every patient who has a diagnostic catheterization is able to receive PCI in the same visit. Fifty percent of our patients have cath and PCI in the same visit. Who manages your cath lab? Our administrative director, Eileen Algeria, has over 30 years of cardiology and ambulatory care management experience. Anna Kuchinski, RN, BSN, is our head nurse with over 10 years of cath lab experience. Our medical director is Abel E. Moreyra, MD. He is an interventional cardiologist with 30 years of experience and the Chief of Cardiology at UMDNJ-R.W. Johnson Medical School. Mark Preminger, MD, Associate Professor of Medicine at UMDNJ-R.W. Johnson Medical School, is the Director of the EP Laboratory as well as Director of the Cardiac Electrophysiology and Arrhythmia Program. He has over 14 years of experience in the field of cardiac electrophysiology. Do you have cross-training? Who scrubs, who circulates and who monitors? We have cross-training in our lab. Nurses and respiratory therapists scrub, circulate and monitor cases. The radiology tech and cardiovascular tech scrub on cases, monitor patients, but do not circulate or administer medications. Does an RT (radiologic technologist) have to be present in the room for all fluoroscopic procedures in your cath lab? The RT need not be present in the room for fluoroscopic procedures in the lab; however, our RT functions in a clinical capacity as well. Which personnel can operate the x-ray equipment (position the-I, pan the table, change angles, step on the fluoro pedal) in your cath lab? Only physicians and the RT can operate our x-ray equipment. Does your lab have a clinical ladder? Yes, cath lab nurses can participate in the Hospital’s Professional Advancement System (clinical ladder). We do not have a cath lab-specific clinical ladder. What are some of the new equipment, devices and products introduced at your lab lately? Our newest lab has the ability to perform rotational coronary angiography (Philips Medical Systems, Bothell, WA). Robert Wood Johnson University Hospital is the one first cath labs in the country to have this state-of-the-art capability. Rotational angiography is especially beneficial, because multiple views of the coronary arteries can be taken per cine run. This method allows the cardiologist to reduce radiation exposure and the amount of contrast administered.
We are also trialing the Philips Allura 3D-CA. The 3D-CA system generates 3-D images of lesions, which allows physicians to measure lesion length and diameter without the limitation of foreshortening imposed by 2-D imaging. 3D-CA also provides physicians with a more precise tool to guide stent placement.
The electrophysiology lab has two mapping systems: CARTO (Biosense Webster, a Johnson & Johnson company, Diamond Bar, CA) and ESI (St. Jude Medical, Minnetonka, MN). We also routinely use the Siemens AccuNav Intracardiac Echo System (Malvern, PA) for transseptal catheterization and left atrial procedures. Can you describe the system(s) you utilize and how they work in cath lab daily life? Our lab is fully digital. After each case, all images are stored on a digital archiving system, which allows our physicians to retrieve current and past studies from our central viewing room, throughout the hospital and even in their offices. Viewing stations are also present in our open-heart operating rooms. How is coding and coding education handled in your lab? The staff member who monitors each case fills out a charge slip identifying the procedure and equipment used. Data entry personnel collect the charge slips and enter the charges into our computerized billing system. How does your lab handle hemostasis? We use manual pressure, clamp pressure, and closure devices to obtain hemostasis. The closure devices that we stock include VasoSeal® (Datascope Corp., Mahwah, NJ), Angio-Seal (St. Jude Medical, Minnetonka, MN), and Perclose® (Abbott Vascular Devices, Redwood City, CA). We also have the Clo-Sur PAD (Scion Cardio-Vascular, Miami, FL) and ChitoSeal (Abbott Vascular Devices). In general, we only use the hemostasis pads in case of refractory bleeding. Post-PCI sheath removal is done on the telemetry units. We do not routinely draw ACT prior to sheath removal. Does your lab have a hematoma management policy? Yes. How is inventory managed at your cath lab? We have an inventory technician who orders equipment based on established par levels. We periodically update par levels by compiling usage data from our case documentation system.
Cath lab staff, physicians and administrators play an integral role in evaluating all new equipment prior to its purchase. The Materials Management Department and cath lab administration negotiate consignment, pricing, and par levels for the new products. Prior to initial patient use, vendors provide inservices for the cath lab staff and physicians. Has your cath lab recently expanded in size and patient volume, or will it be in the near future? In 2003, our lab expanded in size from five cath lab suites to seven. The holding area doubled its capacity as we expanded it from 6 patient bays to 12. At present, we are the largest cath lab in New Jersey. Is your lab involved in clinical research? Our cath lab is currently involved in industry-sponsored interventional drug and device trials, as well as investigator-initiated studies. Our industry-sponsored trials include those testing gene therapy, anticoagulants, GP IIb/IIIa inhibitors, and embolic protection devices. Members of the clinical faculty have original research studies underway looking at the role of inflammatory markers in PCI and thrombectomy in acute myocardial infarction (AMI). We also participate in the CRUSADE Registry (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the American College of Cardiology and AHA Guidelines). What other modalities do you use to verify stenosis? We use intravascular ultrasound (Galaxy, Boston Scientific Corp., Maple Grove, MN), WaveWire® (Volcano Therapeutics Corp., Rancho Cordova, CA) and automated coronary analysis in our Digital Cardiac Imaging (DCI) System (Philips Medical Systems) to verify stenosis. These modalities are only used in case of questionable lesions. What measures has your cath lab implemented in order to cut or contain costs? We have changed our nurse/tech ratio to include more techs in our staff mix. Up until quite recently, we were almost an all-RN lab. We are now striving to balance the mix of nurses and technologists. We have also implemented consignment on many products, including drug-eluting stents (DES). What type of quality control/quality assurance measures are practiced in your cath lab? The cath lab staff documents all peri-procedural complications. The cath lab head nurse and cath lab performance improvement (PI) representative review these complications on a monthly basis. We have quarterly PI meetings, as well as monthly morbidity and mortality meetings, to address quality control issues. The cath lab PI representative is also a member of the hospital’s PI committee. Our administrative director is also a member of the hospital’s overall PI committee. How does your cath lab compete for patients? Has your institution formed an alliance with others in the area? We compete by providing our community high-quality patient care coupled with the latest technology. Our success is demonstrated by our excellent patient satisfaction scores, as measured by Press-Gainey surveys. Our 2005 Press-Gainey scores were in the 90th percentile or better for the entire year. Our institution has also formed alliances with other area hospitals that are equipped to only perform diagnostic cardiac catheterization and emergency PCI procedures. Robert Wood Johnson University Hospital is the flagship hospital for one of the largest hospital networks in the state. How are new employees oriented and trained at your facility? What licensure is required for all professionals who work in your lab? New employees have a two-week classroom orientation followed by 10 to 14 weeks of hands-on orientation with a dedicated preceptor. Our professional staff is required to maintain their NJ state licensure in the area of their expertise. Staff nurses are licensed registered nurses (RN). Licensed cardiopulmonary techs are either registered respiratory therapists (RRT) or registered radiology techs (RT). What type of continuing education opportunities are provided to staff members? We frequently provide staff with continuing education at lunch in-services. These in-services are done either by cath lab vendors or our own cath lab staff. Vendors educate staff whenever they introduce new equipment and on an ongoing basis. Cath lab staff also writes and presents their own CEU-accredited in-services. Recent topics have included hemodynamics, assessing heart sounds, administering contrast, and managing ventilators. How do you handle vendor visits to your lab? Two vendors per day are allowed to enter the cath lab. They are not limited to any specific area of the lab. Representatives sign up in advance for either an afternoon or evening time slot. This assures we will not have an overlap of competing vendors. We have complete control of vendor visits. How is staff competency evaluated? Our head nurse evaluates staff competencies yearly. Does your lab utilize any alternative therapies (such as guided imagery, etc.)? Our hospital has an Integrative Healing program, where services such as therapeutic massage, reflexology, Reiki, guided imagery, and music therapy are offered to patients free of charge. We are planning a research project to see how these therapies can be used in the cath lab. How does your lab handle call time for staff members? For weekday call, the call team consists of 3 nurses or 2 nurses and one tech. On weekends, there is a fourth on-call staff member who gets called in the event of concurrent emergency cases. Weekend on-call rotates every eight weeks and weekday on-call rotates every two weeks. For holiday call, each staff member takes one holiday call every other year. Our staff works either an eight- or ten-hour shift. What trends do you see emerging in the practice of invasive cardiology? With advancing technology, we have been seeing more PCIs and less coronary artery bypass grafts (CABGs) every year. With the evolution of DES, our physicians have been doing PCI on more lesions and using it to open more difficult ones. Patients who would have gone to coronary artery bypass graft surgery in the past are now being treated with PCI using DES. Has your lab undergone a Joint Commission on Accreditation of Healthcare Organizations (JCAHO) inspection in the past three years? We underwent JCAHO inspection in the spring of 2004 with no citations. Our advice is to develop an ongoing inspection readiness plan. Where is your cath lab located in relation to the OR department, ER, and radiology departments? Our cath lab is on the second floor of the hospital’s Acute Care Building, in close proximity to the OR department. Our ER and radiology departments are located two floors below the cath lab. Nearby elevators make the transfer of patients between departments quick and easy. Please tell the readers what you consider unique or innovative about your cath lab and its staff. As anyone who has worked in a cath lab knows, it’s a place that can go from calm to chaos in just a few seconds. No matter what the situation, our cath lab staff has a cohesive, team approach to patient care. For emergency cases and on days when the schedule seems unending, our staff always supports each other and gets the job done. Our staff mix of nurses, respiratory therapists, a radiology tech, and cardiovascular techs provides a good balance. Since our staff cares for high-acuity patients on a daily basis, we are constantly learning and sharpening our skills. Our cardiologists value the fact that we are well-trained and educated. They frequently ask for our opinions on how to proceed in different situations. Is there a problem or challenge your lab has faced? The most recent challenge that the cath lab has faced was how to improve our door-to-balloon time for ST-elevation MI (STEMI) patients. In October of 2003, our hospital began a primary PCI program. Though we were able to drastically reduce the use of thrombolytics (only 1 case), just 41 percent of our patients had PCI within 90 minutes. To remedy this, in August 2004, our hospital implemented the Code MI Program, modeled after our trauma protocol already in place. While the patient is still in the field or upon arrival to the hospital, the ED physician makes the diagnosis of acute MI and alerts the Code MI team via a special text beeper. The Code MI team consists of the interventionalist (either faculty or private) and the 3 on-call staff members. Since the inception of Code MI, we have cut our time to reperfusion significantly (80% of our STEMI patients in 2005 received PCI within 90 minutes and 95% within 120 minutes) and have minimal thrombolytic use. One of the reasons for our success is that we have very productive biweekly meetings between hospital administration and staff from the cath lab, EMS, and ED. At each meeting, we review each Code MI case to find better ways to streamline the door-to-balloon process. 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 Brunswick’s nickname is the Healthcare City. Midway between New York City and Philadelphia, it is the home of two academic hospitals, a cancer institute (the Cancer Institute of New Jersey), Robert Wood Johnson Medical School (campus of the country’s largest medical school, University of Medicine and Dentistry of NJ) and the site of Johnson & Johnson’s world headquarters. Because of our location and high volume, our cath lab is often first to receive the latest drugs, devices, and equipment. This is especially attractive to our physicians and staff. We are eager to learn about new technology.
New Brunswick is a multicultural community and our hospital reflects that in its staff. RWJUH embraces our diversity with its Multicultural Diversity Program. This program puts together festivals throughout the year, highlighting the culture, religion, dance, and cuisine of various ethnic groups. The focus on educating staff on diversity helps us to better understand and care for our patients. Knowledge about cultural preferences gives staff an extra tool to enhance the healing process and boost patient satisfaction.
Our cath lab celebrates its own diversity with our lunchtime gathering called The Rice Club. Staff members chip in to provide rice for a rice cooker that is a permanent fixture in the staff lounge. A few times per week, Rice Club members will make special dishes from their own cultural heritage to go along with the rice. The Rice Club exposes the cath lab staff to Filipino, Italian, Latin-American, Chinese, and American cuisine. It’s a fun way that we share in each other’s culture and something we enjoy doing each week. The Society of Invasive Cardiovascular Professionals (SICP) has added two questions to our spotlight: 1. Do you require your clinical staff members to take the registry exam for Registered Cardiovascular Invasive Specialist (RCIS)? Do staff receive an incentive bonus or raise upon passing the exam? No. 2. Are your clinical and/or managerial team members involved with any professional organizations that support the invasive cardiology service line, such as the SICP, ACVP, or regional organizations? Yes, the AACN and SICP. Michael Cargill, RN, BSN, CCRN, Cardiology Research Coordinator, can be contacted at Michael.Cargill @ rwjuh.edu
Adjacent to the cath lab is our dedicated cardiac MRI unit. The cardiac MRI, run by a cardiologist, is used for a full range of diagnostic testing. It provides accurate functional and volumetric information and is a valuable tool in assessing the course of coronary arteries with an anomalous origin. One newer indication is the assessment of myocardial viability, which helps guide the decision about whether to revascularize. This is becoming of increasing importance in our routine clinical practice. We perform about 10 cardiac MRI procedures per week. Does your cath lab perform primary angioplasty with surgical backup? Our hospital has 22 OR suites, three of which are dedicated to cardiac surgery. Should a patient need to be transferred for emergency surgery, an on-call faculty attending or a community cardiac surgeon is paged to evaluate the patient. When the surgeon accepts the patient, the OR staff makes ready the next available OR suite. There is no formal scheduling for surgical backup. What procedures do you perform on an outpatient basis? We perform diagnostic cardiac catheterizations, myocardial biopsies, AICD checks, tilt table tests, EPS, PPM/AICD generator changes, as well as stress tests, on an outpatient basis. What percentage of your patients is female? In 2005, we found that 34% of our patients were female. What percentage of your diagnostic cath patients go on to have an interventional procedure? Every patient who has a diagnostic catheterization is able to receive PCI in the same visit. Fifty percent of our patients have cath and PCI in the same visit. Who manages your cath lab? Our administrative director, Eileen Algeria, has over 30 years of cardiology and ambulatory care management experience. Anna Kuchinski, RN, BSN, is our head nurse with over 10 years of cath lab experience. Our medical director is Abel E. Moreyra, MD. He is an interventional cardiologist with 30 years of experience and the Chief of Cardiology at UMDNJ-R.W. Johnson Medical School. Mark Preminger, MD, Associate Professor of Medicine at UMDNJ-R.W. Johnson Medical School, is the Director of the EP Laboratory as well as Director of the Cardiac Electrophysiology and Arrhythmia Program. He has over 14 years of experience in the field of cardiac electrophysiology. Do you have cross-training? Who scrubs, who circulates and who monitors? We have cross-training in our lab. Nurses and respiratory therapists scrub, circulate and monitor cases. The radiology tech and cardiovascular tech scrub on cases, monitor patients, but do not circulate or administer medications. Does an RT (radiologic technologist) have to be present in the room for all fluoroscopic procedures in your cath lab? The RT need not be present in the room for fluoroscopic procedures in the lab; however, our RT functions in a clinical capacity as well. Which personnel can operate the x-ray equipment (position the-I, pan the table, change angles, step on the fluoro pedal) in your cath lab? Only physicians and the RT can operate our x-ray equipment. Does your lab have a clinical ladder? Yes, cath lab nurses can participate in the Hospital’s Professional Advancement System (clinical ladder). We do not have a cath lab-specific clinical ladder. What are some of the new equipment, devices and products introduced at your lab lately? Our newest lab has the ability to perform rotational coronary angiography (Philips Medical Systems, Bothell, WA). Robert Wood Johnson University Hospital is the one first cath labs in the country to have this state-of-the-art capability. Rotational angiography is especially beneficial, because multiple views of the coronary arteries can be taken per cine run. This method allows the cardiologist to reduce radiation exposure and the amount of contrast administered.
We are also trialing the Philips Allura 3D-CA. The 3D-CA system generates 3-D images of lesions, which allows physicians to measure lesion length and diameter without the limitation of foreshortening imposed by 2-D imaging. 3D-CA also provides physicians with a more precise tool to guide stent placement.
The electrophysiology lab has two mapping systems: CARTO (Biosense Webster, a Johnson & Johnson company, Diamond Bar, CA) and ESI (St. Jude Medical, Minnetonka, MN). We also routinely use the Siemens AccuNav Intracardiac Echo System (Malvern, PA) for transseptal catheterization and left atrial procedures. Can you describe the system(s) you utilize and how they work in cath lab daily life? Our lab is fully digital. After each case, all images are stored on a digital archiving system, which allows our physicians to retrieve current and past studies from our central viewing room, throughout the hospital and even in their offices. Viewing stations are also present in our open-heart operating rooms. How is coding and coding education handled in your lab? The staff member who monitors each case fills out a charge slip identifying the procedure and equipment used. Data entry personnel collect the charge slips and enter the charges into our computerized billing system. How does your lab handle hemostasis? We use manual pressure, clamp pressure, and closure devices to obtain hemostasis. The closure devices that we stock include VasoSeal® (Datascope Corp., Mahwah, NJ), Angio-Seal (St. Jude Medical, Minnetonka, MN), and Perclose® (Abbott Vascular Devices, Redwood City, CA). We also have the Clo-Sur PAD (Scion Cardio-Vascular, Miami, FL) and ChitoSeal (Abbott Vascular Devices). In general, we only use the hemostasis pads in case of refractory bleeding. Post-PCI sheath removal is done on the telemetry units. We do not routinely draw ACT prior to sheath removal. Does your lab have a hematoma management policy? Yes. How is inventory managed at your cath lab? We have an inventory technician who orders equipment based on established par levels. We periodically update par levels by compiling usage data from our case documentation system.
Cath lab staff, physicians and administrators play an integral role in evaluating all new equipment prior to its purchase. The Materials Management Department and cath lab administration negotiate consignment, pricing, and par levels for the new products. Prior to initial patient use, vendors provide inservices for the cath lab staff and physicians. Has your cath lab recently expanded in size and patient volume, or will it be in the near future? In 2003, our lab expanded in size from five cath lab suites to seven. The holding area doubled its capacity as we expanded it from 6 patient bays to 12. At present, we are the largest cath lab in New Jersey. Is your lab involved in clinical research? Our cath lab is currently involved in industry-sponsored interventional drug and device trials, as well as investigator-initiated studies. Our industry-sponsored trials include those testing gene therapy, anticoagulants, GP IIb/IIIa inhibitors, and embolic protection devices. Members of the clinical faculty have original research studies underway looking at the role of inflammatory markers in PCI and thrombectomy in acute myocardial infarction (AMI). We also participate in the CRUSADE Registry (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the American College of Cardiology and AHA Guidelines). What other modalities do you use to verify stenosis? We use intravascular ultrasound (Galaxy, Boston Scientific Corp., Maple Grove, MN), WaveWire® (Volcano Therapeutics Corp., Rancho Cordova, CA) and automated coronary analysis in our Digital Cardiac Imaging (DCI) System (Philips Medical Systems) to verify stenosis. These modalities are only used in case of questionable lesions. What measures has your cath lab implemented in order to cut or contain costs? We have changed our nurse/tech ratio to include more techs in our staff mix. Up until quite recently, we were almost an all-RN lab. We are now striving to balance the mix of nurses and technologists. We have also implemented consignment on many products, including drug-eluting stents (DES). What type of quality control/quality assurance measures are practiced in your cath lab? The cath lab staff documents all peri-procedural complications. The cath lab head nurse and cath lab performance improvement (PI) representative review these complications on a monthly basis. We have quarterly PI meetings, as well as monthly morbidity and mortality meetings, to address quality control issues. The cath lab PI representative is also a member of the hospital’s PI committee. Our administrative director is also a member of the hospital’s overall PI committee. How does your cath lab compete for patients? Has your institution formed an alliance with others in the area? We compete by providing our community high-quality patient care coupled with the latest technology. Our success is demonstrated by our excellent patient satisfaction scores, as measured by Press-Gainey surveys. Our 2005 Press-Gainey scores were in the 90th percentile or better for the entire year. Our institution has also formed alliances with other area hospitals that are equipped to only perform diagnostic cardiac catheterization and emergency PCI procedures. Robert Wood Johnson University Hospital is the flagship hospital for one of the largest hospital networks in the state. How are new employees oriented and trained at your facility? What licensure is required for all professionals who work in your lab? New employees have a two-week classroom orientation followed by 10 to 14 weeks of hands-on orientation with a dedicated preceptor. Our professional staff is required to maintain their NJ state licensure in the area of their expertise. Staff nurses are licensed registered nurses (RN). Licensed cardiopulmonary techs are either registered respiratory therapists (RRT) or registered radiology techs (RT). What type of continuing education opportunities are provided to staff members? We frequently provide staff with continuing education at lunch in-services. These in-services are done either by cath lab vendors or our own cath lab staff. Vendors educate staff whenever they introduce new equipment and on an ongoing basis. Cath lab staff also writes and presents their own CEU-accredited in-services. Recent topics have included hemodynamics, assessing heart sounds, administering contrast, and managing ventilators. How do you handle vendor visits to your lab? Two vendors per day are allowed to enter the cath lab. They are not limited to any specific area of the lab. Representatives sign up in advance for either an afternoon or evening time slot. This assures we will not have an overlap of competing vendors. We have complete control of vendor visits. How is staff competency evaluated? Our head nurse evaluates staff competencies yearly. Does your lab utilize any alternative therapies (such as guided imagery, etc.)? Our hospital has an Integrative Healing program, where services such as therapeutic massage, reflexology, Reiki, guided imagery, and music therapy are offered to patients free of charge. We are planning a research project to see how these therapies can be used in the cath lab. How does your lab handle call time for staff members? For weekday call, the call team consists of 3 nurses or 2 nurses and one tech. On weekends, there is a fourth on-call staff member who gets called in the event of concurrent emergency cases. Weekend on-call rotates every eight weeks and weekday on-call rotates every two weeks. For holiday call, each staff member takes one holiday call every other year. Our staff works either an eight- or ten-hour shift. What trends do you see emerging in the practice of invasive cardiology? With advancing technology, we have been seeing more PCIs and less coronary artery bypass grafts (CABGs) every year. With the evolution of DES, our physicians have been doing PCI on more lesions and using it to open more difficult ones. Patients who would have gone to coronary artery bypass graft surgery in the past are now being treated with PCI using DES. Has your lab undergone a Joint Commission on Accreditation of Healthcare Organizations (JCAHO) inspection in the past three years? We underwent JCAHO inspection in the spring of 2004 with no citations. Our advice is to develop an ongoing inspection readiness plan. Where is your cath lab located in relation to the OR department, ER, and radiology departments? Our cath lab is on the second floor of the hospital’s Acute Care Building, in close proximity to the OR department. Our ER and radiology departments are located two floors below the cath lab. Nearby elevators make the transfer of patients between departments quick and easy. Please tell the readers what you consider unique or innovative about your cath lab and its staff. As anyone who has worked in a cath lab knows, it’s a place that can go from calm to chaos in just a few seconds. No matter what the situation, our cath lab staff has a cohesive, team approach to patient care. For emergency cases and on days when the schedule seems unending, our staff always supports each other and gets the job done. Our staff mix of nurses, respiratory therapists, a radiology tech, and cardiovascular techs provides a good balance. Since our staff cares for high-acuity patients on a daily basis, we are constantly learning and sharpening our skills. Our cardiologists value the fact that we are well-trained and educated. They frequently ask for our opinions on how to proceed in different situations. Is there a problem or challenge your lab has faced? The most recent challenge that the cath lab has faced was how to improve our door-to-balloon time for ST-elevation MI (STEMI) patients. In October of 2003, our hospital began a primary PCI program. Though we were able to drastically reduce the use of thrombolytics (only 1 case), just 41 percent of our patients had PCI within 90 minutes. To remedy this, in August 2004, our hospital implemented the Code MI Program, modeled after our trauma protocol already in place. While the patient is still in the field or upon arrival to the hospital, the ED physician makes the diagnosis of acute MI and alerts the Code MI team via a special text beeper. The Code MI team consists of the interventionalist (either faculty or private) and the 3 on-call staff members. Since the inception of Code MI, we have cut our time to reperfusion significantly (80% of our STEMI patients in 2005 received PCI within 90 minutes and 95% within 120 minutes) and have minimal thrombolytic use. One of the reasons for our success is that we have very productive biweekly meetings between hospital administration and staff from the cath lab, EMS, and ED. At each meeting, we review each Code MI case to find better ways to streamline the door-to-balloon process. 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 Brunswick’s nickname is the Healthcare City. Midway between New York City and Philadelphia, it is the home of two academic hospitals, a cancer institute (the Cancer Institute of New Jersey), Robert Wood Johnson Medical School (campus of the country’s largest medical school, University of Medicine and Dentistry of NJ) and the site of Johnson & Johnson’s world headquarters. Because of our location and high volume, our cath lab is often first to receive the latest drugs, devices, and equipment. This is especially attractive to our physicians and staff. We are eager to learn about new technology.
New Brunswick is a multicultural community and our hospital reflects that in its staff. RWJUH embraces our diversity with its Multicultural Diversity Program. This program puts together festivals throughout the year, highlighting the culture, religion, dance, and cuisine of various ethnic groups. The focus on educating staff on diversity helps us to better understand and care for our patients. Knowledge about cultural preferences gives staff an extra tool to enhance the healing process and boost patient satisfaction.
Our cath lab celebrates its own diversity with our lunchtime gathering called The Rice Club. Staff members chip in to provide rice for a rice cooker that is a permanent fixture in the staff lounge. A few times per week, Rice Club members will make special dishes from their own cultural heritage to go along with the rice. The Rice Club exposes the cath lab staff to Filipino, Italian, Latin-American, Chinese, and American cuisine. It’s a fun way that we share in each other’s culture and something we enjoy doing each week. The Society of Invasive Cardiovascular Professionals (SICP) has added two questions to our spotlight: 1. Do you require your clinical staff members to take the registry exam for Registered Cardiovascular Invasive Specialist (RCIS)? Do staff receive an incentive bonus or raise upon passing the exam? No. 2. Are your clinical and/or managerial team members involved with any professional organizations that support the invasive cardiology service line, such as the SICP, ACVP, or regional organizations? Yes, the AACN and SICP. Michael Cargill, RN, BSN, CCRN, Cardiology Research Coordinator, can be contacted at Michael.Cargill @ rwjuh.edu
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