Satilla Regional Heart Center

What is the size of your cath lab facility and number of staff? We have one Philips Inturis Suite (Andover, MA) with a peripheral table. We perform both cardiac and special procedures, and we also have a 5-bed patient prep/recovery area. Any outpatient procedure performed in the Heart Center that requires a nursing assessment and conscious IV sedation recovery can be recovered and discharged from this area. Our staff demographics are as follows: 5 RNs, 1 RT(R) in the cath lab 3 RNs in patient prep/recovery 1 RT(R)(CV), RCIS as Supervisor CCL What type of procedures are performed at your facility? Our cath lab operates within the Heart Center department at Satilla Regional Medical Center, a 231-bed facility. We have three cardiologists who perform the following procedures: Diagnostic coronary angiography Right heart studies Intra-aortic balloon pump (IABP) insertion Temporary pacing wire insertion Special procedures Elective cardioversions Approximately 125 heart cath procedures and 40 special procedures are performed each month, making us one of the busiest non-open heart programs in the state of Georgia. What procedures do you perform on an outpatient basis? All of our procedures, with the exception of IABP, may be done on an outpatient basis. Does your cath lab perform primary angioplasty with /without surgical backup? Georgia’s regulations do not allow hospitals to perform such procedures without surgical backup; therefore, we do not currently perform any PCIs. We have been granted permission to perform open heart surgery; however, we’re being challenged by competitors and are currently in legal processes. Our case was heard by the Georgia Court of Appeals on October 20, 2003, with a ruling expected in the next few months. Who manages your lab? Our lab is managed by Jonathan Abbott, Product and Technical Coordinator (RT[R] [CV], RCIS) who functions as the assistant manager of the Heart Center. He oversees: Stock supplies Budget management Staffing levels Adherence to hospital policy and procedure Evaluation of new products Maintenance of all radiographic equipment and safety Liaison between physicians and staff Patient flow In his absence, a senior staff member is assigned to oversee the daily routine in the cath lab. Within the hospital structure, the cath lab supervisor answers to the Heart Center Manager, Harmon Raulerson, RN, BSN. The Heart Center is part of the Imaging Division of our hospital. Do you cross train in your lab? We utilize cross-training in the three positions within the cath lab. Conscious IV sedation and medicine distributions are handled by RNs. Throughout the day, we rotate all of these positions to help with the continuity of the team and with staffing levels and scheduling. Our staff is also cross-trained in other areas of the Heart Center. These areas include Nuclear Cardiology, Echocardiography (Stress) and Patient Prep/Recovery Area. Rotation is on an as-needed basis, depending on staff schedules and patient volume. Does your lab have a clinical ladder? We are in the process of designing and implementing a clinical ladder at this time. Our cath lab will actually be the pilot for clinical ladders at our hospital. We will be glad to share after we pilot the program. Considering budget approval, the clinical ladder will be implemented in 2004. We have organized a small team, including representatives from cardiology, human resources, and a HR consultant, to analyze the feasibility and develop a plan for implementation. Is your cath lab filmless? Our cath lab has been filmless since July of 1998. Upon implementing the filmless system, we stored each patient’s data on a medical grade CD-ROM; however, we recently upgraded to a deep archive system. How does your lab handle hemostasis? The vast majority of our hemostasis is by manual pressure. We utilize an external device (Chito-Seal, Abbott Vascular Devices, Redwood City, CA) depending on anticoagulants, degree of hypertension, French size of catheter and physician preference. We also use the Perclose vascular closure device (Abbott Vascular Devices) on occasion. What percentage of your patients are female? During calendar year 2002, approximately 52% of our patients were female. Does your lab have a hematoma management policy? We document hematomas and perform a periodic review as part of our ongoing performance improvement process. How is inventory managed at your cath lab? Inventory is performed by two staff members under the direction of the cath lab supervisor. All equipment purchases are approved by the Heart Center Manager. Any purchase over $500 must be submitted through the capital budget process. Has your lab recently increased in size and patient volume? Fortunately, our Heart Center was included in a recent $31 million expansion. We moved into this new facility in January of 2003. Considering all of our cardiology services, we are now in a space that is 2.5 times larger than the previous cath lab location. Patient volume has increased yearly since 1992. What measures has your cath lab implemented to cut or contain costs? All healthcare institutions are faced with rising costs and lower reimbursement, so cost containment is an ongoing project. Specifically, we look at several like items and negotiate prices with vendors, utilizing companies such as ECRI (www.ecri.org). We belong to a major purchasing group and this helps to get the best price on most items. Our cardiology group works with us to maintain a limited number of vendors, which serves to keep inventory smaller and shelf costs down. Our Medical Director, Dr. Willie Bell, is cost-conscious and very active in major equipment purchases. What type of quality control/quality assurance measures are practiced in your cath lab? We participate in a hospital-wide performance improvement program (PI). This allows us to continually evaluate and reevaluate our processes to help better serve our patients. Have you had any cath lab-related complications in the past year requiring emergent cardiac surgery? Fortunately, we have not and we think this is a credit to our physicians and staff. But it can happen to anyone and we are fully equipped and trained to react if we experience such an incident. How does your cath lab compete for patients? Currently we are the only cath lab within a 60-mile radius. We have a long-term alliance with a neighboring institution for our patients that require intervention and open heart surgery. Prior to opening our cath lab in the late 80’s, patients were referred to other institutions for caths. We have had the same cardiologists since that time, so continuity of care has always been consistent. Our staff and cardiologists are very dedicated professionals and our patients have come to trust and appreciate the quality and compassionate care that we strive to provide. The majority of our patients prefer the personal care that they receive at our institution verses the impersonal care that is found in so many larger institutions. How are new employees oriented and trained at your facility? All new employees must attend a mandatory hospital orientation followed by a departmental orientation. After this is complete, they are assigned a preceptor and spend several weeks in the patient prep/recovery area. This allows them to check off on a basic skills checklist and review CCL policy and procedures. Next, they are moved into the CCL to begin training. As an individual moves through training, they complete a competency checklist with their preceptor. Each individual is then checked off annually on competencies. Staff must have the RN or RT(R) credential. All of our staff are required to complete an ACLS program. What type of continuing education opportunities are provided to staff members? Satilla Regional greatly values continuing education at all levels and is committed to creating an environment that will stimulate its employees and physicians to reach their maximum potential. All staff are encouraged to attend continuing education opportunities locally and out of town, with funding provided during the annual budgetary process. How do you handle vendor visits to your department? Vendors are seen by appointment and are required to obtain a visitors pass from our Materials Department prior to arriving in our department. How is staff competency evaluated? Staff competency is evaluated by a series of defined performances that fit the need of our cath lab. Because of the extensive knowledge needed to work in a cath lab, these competencies are very detailed. Staff competencies are required annually. How does your lab handle late cases and call time for staff? We have a late team that consists of 4 team members assigned to stay late if needed due to patient load. This allows other staff members to leave on time and makes keeping appointments much easier. One of the late team members is on call until the next morning for response to after-hour problems with a patient. Also, someone is assigned on call each weekend. What trends do you see emerging in the practice of invasive cardiology? You don’t have to be around a CCL for very long to see change. Technology is driving our industry at near light speed. I think some of the bigger changes that will impact cardiology as we know it are the drug-eluting stent, cardiac MRI/CT, and the use of PCI without surgical backup. Has your lab has undergone a JCAHO inspection in the past three years? We successfully completed a JCAHO Inspection in 2001 and are preparing for one in 2004. Is there a problem or challenge your lab has faced? How it was addressed? Our biggest challenge faced this year was the moving of our entire Heart Center into our new building. Moving the equipment, computers, offices, and staff while also arranging patient schedules was difficult and stressful; however, it was accomplished in two days with minimal complications. It was a perfect time to exercise team effort and test how well our group works together in a non-clinical scenario. Please tell the readers what you consider unique about your cath lab and its staff. Because of the layout of our Heart Center, patients are exposed to our staff prior to having a heart cath (during visits for EKG, stress thallium and echo). We believe that this adds to our continuity of care and makes the patient/family feel more at ease by providing familiar surroundings. We are also one of the first of four sites in the U.S. to install the Xcelera Cardiology Image and Information Management Solution by Philips Medical. This represents a major step toward the integration of the cardiology department by allowing clinicians to access, review, distribute and archive multiple imaging sources on one workstation. Can you describe your city or general regional area in comparison to rest of the U.S.? Waycross, Georgia started out as a sawmill, turpentine and farming town. At present, it holds various manufacturers, including forest and tobacco products. The city is the headquarters for many state and federal agencies. Waycross is also home to the Okefenokee Swamp, a National Wildlife Refuge of almost half a million acres.

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The following question is courtesy of the Society of Invasive Cardiovascular Professionals (SICP): 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? We currently do not require it, but plan to include this in our clinical ladder. 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? Some of our staff are members of various organizations and all are encouraged to join.

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