Gettysburg Hospital Heart Center

What type of procedures are performed at your facility? We perform only low-risk, diagnostic caths. We refer all of our interventions to our sister hospital, York Hospital. We care for approximately 8 patients a week, operating only Monday, Wednesday, and Friday. Of course, we do the occasional temp pacer insertion and cardioversion. We are moving down the road toward peripheral interventions but do not perform them currently. Is your cath lab nursing- or radiology-managed? How does this impact your lab’s operating style? Our cath lab is technologist-managed with complete cooperation from nursing and radiology when needed. We have a very efficient and cooperative operation. Your lab is 9 months old. What have been some of the challenges working in such a young lab? I was involved with this lab from the architectural plans on up. I had input into the layout, purchased all of the equipment, wrote the policies, and put together the team. What an experience! Not only is our lab new, but I am also new to management. Probably the biggest challenge has been learning to be a leader hands-on. I'm currently an MBA student, but you don't really put all of the pieces together until you deal with the day-to-day decisions and problems that arise. Needless to say, I learned a lot in the past year. How many physicians currently utilize your lab? The four cardiologists that perform procedures here are part of a 10-physician group in York, Pennsylvania, called Cardiac Diagnostic Associates. The four rotate to Gettysburg to see patients in consultation and perform catheterizations. It is a closed lab and those cardiologists have an exclusive contract with WellSpan Health. How does your facility encourage staff to obtain the Registered Cardiovascular Invasive Specialist (RCIS) credential? If not credentialed when hired, successful completion of the RCIS exam is expected within 18 months of employment. One of our technologists as well as our nurse is currently preparing to sit for the exam. Do you have cross-training in the cath lab? The four of us function interchangeably from a technical standpoint. We each have our strengths and weaknesses and we function within those boundaries. Our nurse is the only person who administers narcotics. The rest of us administer all other meds under the direct supervision of a physician. What are some of the new equipment, devices and products introduced at your lab lately? We are using the Prevail prep wands made by Allegiance for skin prep (McGaw Park, Illinois). They are fabulous. The wand has a reservoir of betadine/alcohol in the handle and breaking the pressure seal releases the solution. It’s a quick application that we do just before draping the patient. There’s no sloppy mess as created by traditional prep kits. Is your cath lab filmless? We are completely filmless and use the Philips Inturis system (Bothell, Washington). The system is as old as the cath lab (9 months). How does your lab handle hemostasis? We’ve been very successful with our hemostasis method. We use the FemoStop® device (RADI Medical Systems, Inc., Reading, MA) for the majority of our patients. After obtaining initial hemostasis (typically 30 minutes), we leave the FemoStop on the patient at 20mmHg for the remainder of 2 hours. After that period, the FemoStop is removed and a band-aid and 10lb sandbag is applied. Two hours later, they’re discharged. We’ve only had 3 hematomas out of 175 patients, and all of those had contributing factors making them prone to hematomas. We’ve also started doing more frequent radial procedures, making hemostasis a lot easier and our patients much more comfortable. Does your lab have a hematoma management policy? I am preparing a hematoma management policy at the present time. How is inventory managed at your cath lab? Each member of our team is responsible for monitoring inventory levels. I keep a list of what is needed and order when appropriate. Will your cath lab be expanding in the near future? Our cath lab is new to Gettysburg Hospital and we look forward to growing our business and expanding our market reach as we move along. Have you had any cath lab-related complications in the past year requiring emergent cardiac surgery? None. What measures has your cath lab implemented in order to cut or contain costs? We have been vigilant about making supply changes that save us money, yet do not compromise patient care. Switching from prep kits to the Allegiance prep wands saved us almost $6 per patient. Switching to less expensive digital CDs saved us another $3.50 per patient. I maintain tight par levels on all equipment and clearly communicate cost/benefit to my team and physicians. How does your cath lab compete for patients? We are part of WellSpan Health, a large and growing health system in south central Pennsylvania. We compete for patients by providing high quality care in a friendly, comfortable, environment. The combined cardiology experience of Gettysburg and York Hospitals makes us hard to compete against. Gaining, and maintaining, the confidence and cooperation of our referring physicians is of paramount importance. Does your lab have an outpatient program? We perform approximately 65% of our caths on an outpatient basis and the remainder are inpatients. How are new employees oriented and trained at your facility? None of our team is new. All are experienced staff contracted from York Hospital with combined experience of more than 75 years in healthcare. Even our PRN staff have years of experience. What type of continuing education opportunities are provided to staff members? WellSpan Health offers many CEU opportunities throughout the year. We try to each attend one national meeting each year. Vendors are always willing to sponsor educational programs as well. How is staff competency evaluated? We have set competencies required of each team member each year and, for the most part, we peer-evaluate each other. If a piece of equipment falls under a specific hospital department, then the director of that department performs the evaluation. Does your lab utilize any alternative therapies (such as guided imagery, etc.)? We play classical music for our patients or a radio station that they prefer. Our team avoids any music that might prompt my singing along! What type of quality control/quality assurance measures are practiced in your cath lab? We perform daily equipment QC. Each patient is given a quality-of-care questionnaire before going home so that we can get feedback. We send every patient a thank-you letter, thanking them for entrusting their care to us and inviting calls with comments or complaints. I get many calls and visits from patient appreciative of our care. What measures has your cath lab employed to improve efficiencies in patient throughput? We try to get our cardiologists to see their inpatient first thing in the morning so that we can get them to the cath lab early. Sometimes they are just too busy to do it, but they try. What trends do you see emerging in the practice of invasive cardiology? Cardiologists are most certainly stenting lesions that would have bought patients a bypass a short time ago. It also seems as though every other article concerns radiation therapy or coated stents. Has your lab has undergone a JCAHO inspection in the past three years? No, but we’re due in November. Please tell readers what you consider unique or innovative about your cath lab and its staff. We are fortunate to have a great relationship with our docs. This allows us to work with them more as a team than just as a technical component of their responsibilities. They trust us to take care of problems as they arise and to come to them when needed. Is there a problem or challenge your lab has faced? When we first opened, we noticed that many of our patients were feeling a bit syncopal upon ambulation. We discovered that instead of our usual 500cc of saline via IV, our NPO patients benefited from 1000cc or greater during their stay with us, as long as their EF is good. We haven’t had a single episode since we made the change. What's special about Gettysburg, Pennsylvania that distinguishes it from the rest of the U.S.? Gettysburg is a historical landmark, as I’m sure your readers are aware. From battlefield tours, to antique shopping, to wax museums, Gettysburg has something for everyone. July is especially busy for the town due to frequent Civil War reenactments. A short drive from this small town in any direction brings you to beautiful countryside with apple orchards and rolling hills. The apple orchards draw many immigrant workers during the picking season and this raises our Spanish-speaking population. I’ve had to create Spanish versions of most of our paperwork.

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