Children’s Healthcare of Atlanta Sibley Heart Center

Children’s Healthcare of Atlanta is the largest pediatric provider in Georgia and is one of the largest in the country. Children’s sees more than half a million pediatric patients annually at its three metro Atlanta hospitals.

Children’s is the recipient of several accolades that honor its focus on making kids better today and healthier tomorrow:

• In 2013, Children’s was ranked No. 12 among the country’s top pediatric hospitals by Parents magazine.
• Children’s also recently received two awards from the Georgia Hospital Association (GHA) in recognition of its exceptional work in quality and patient safety. 
• The Children’s Sibley Heart Center is one of the top pediatric cardiac programs in the country. It ranked No. 4 among pediatric heart centers nationwide in the U.S. News & World Report’s 2013-14 edition of Best Children’s Hospitals and No. 5 among pediatric cardiac programs in a list released by Parents magazine in 2013. 
• The Michael P. Fisher Cardiac Intensive Care Unit (CICU) at Children’s was awarded the Gold Level Beacon Award for Excellence, a national award given by the American Association of Critical Care Nurses. 

In addition, Children’s has earned a spot on FORTUNE magazine’s “100 Best Companies to Work For” for nine consecutive years.

Tell us about your cath lab.

Our facility is comprised of three labs: one dedicated electrophysiology (EP) lab and two diagnostic/interventional labs. Construction of our new hybrid lab began in the first quarter of 2014. We have worked hand-in-hand with our interventional cardiologists, the cath lab staff, and the cardiac operating room team on the layout, design, and selection of equipment to be used in this lab. By working in collaboration with all disciplines, we believe we have considered the needs of the stakeholders and will have a stellar lab. 

An eight-bed pre/post cardiac cath recovery unit is adjacent to our cath lab. This unit was designed to provide patients and families with a family-like environment while meeting the medical needs of the patient. Each private room is set up with the same capabilities as our cardiac intensive care rooms. We partner with a child life specialist who sees our patients on the day of admission, and orients them to the cath lab using pictures and play therapy. For those patients who are nervous or frightened, she accompanies them to the lab and stays with them until they are asleep. 

Our staff consists of: 

• A manager, eleven registered nurses (RNs) and three registered cardiovascular invasive specialists (RCISs) in the cath lab;
• Six RNs and two patient care techs who staff our pre/post cardiac cath recovery unit; 
• A support staff consisting of our lab buyer, operation assistants, a coder, a cath lab-dedicated pediatric nurse practitioner (PNP), cardiac service line information services and technology (IS&T) professionals, and service line quality manager. 

Staff is a beneficial combination of long-term veterans and new grads. All bring important and varied competencies to the table that strengthen the team. Our veteran staff has pediatric cardiology/pediatric cardiac intensive care unit (ICU) backgrounds with a combined total of 200 years of cath lab experience in our lab. Each RN is required to hold pediatric advanced life support certification. 

What procedures are performed in your cath lab? 

In 2013, we cared for 1361 patients. Since ours is a dedicated pediatric lab, the majority of our procedures start with a complete right/left cardiac catheterization to confirm a suspected defect. We then rule out associated defects, determine the exact anatomy and operability of the defect, and then perform an appropriate intervention procedure, if warranted. These interventional procedures include valuloplasty of the aortic or pulmonary valves, angioplasty and/or stent of narrowed vessels such as peripheral pulmonary arteries or the aorta, closure of atrial septal defects (ASDs), ventricular septal defects (VSDs) or patent ductus arteriosus (PDAs), transcatheter pulmonary valve replacement, balloon or blade atrial septostomy, mechanical thrombectomy, pulmonary hypertension assessment, and pre-transplant workups. We also perform myocardial biopsies, EP studies, radiofrequency and cryoablation, pacemaker/ implantable cardioverter-defibrillator (ICD)/loop recorder insertion, cardioversion, syncope studies, occasional central line insertions, drug challenges, and pericardial or pleural taps. 

Approximately how many are performed each week? 

The patients that we treat range in size from 450 grams to 136 kilograms. Given the wide range of patient size, the complexity of our cases and length of the procedures, we average between 25–30 cases per week. Our procedure time per case ranges from two to six hours. The majority of our cases are done with anesthesia. 

If your cath lab is performing transcatheter aortic valve replacement (TAVR), can you share your experience? 

At this time we do not offer TAVR to our pediatric patients. We do perform transcatheter pulmonary valve replacement (TPVR). We began our program in 2012 and we are the first pediatric center in the state of Georgia to offer transcatheter pulmonary valve replacement. 

What is your rate of normal diagnostic caths?   

It is exceedingly rare that we have a completely normal diagnostic cath. If a pediatric patient is referred for cardiac cath, it is because there is concern that something is abnormal. Normal healthy kids usually don’t see a cardiologist and don’t get referred to cath. It has happened, very rarely, where we have the pleasure of telling a child and his or her family that nothing is wrong with his/her heart. 

Who manages your cath lab? 

Arlene Porter, MSN, RN-C, is the manager of our cath labs and pre/post cath recovery unit. She is responsible for administrative leadership, daily operations of the units, and manages the capital and operational budgets for the departments, working in partnership with Dr. Dennis Kim, medical director of the cath lab. Helen Diehl, RN, CNML and Mary Stevens, RN, BSN, CPN, are responsible for staffing and daily operations. Carolyn Winn, RN, BSN, CPN, is our educator. She provides the orientation for all new employees and is responsible for ongoing education, yearly competencies and Joint Commission readiness.  

Do you have cross-training? 

Our staff consists of RNs and RCISs, all of whom are cross-trained to other positions where they are licensed to practice. Generally, the RCISs will scrub, as well as circulate and monitor. The RNs will circulate and monitor, and act as team leaders. 

Are there licensure laws in your state for fluoroscopy? 

The state of Georgia is one of the few states that do not have laws governing use of fluoroscopy; however, we take patient exposure ALARA (as low as reasonably achievable) seriously. Our goal is to “image gently,” minimizing patient exposure as much as possible. The cardiologists, fellows, and scrub person operate the fluoro pedal, pan the table and position the image intensifier (II) during cases. All of our RNs and RCISs can perform basic operation of the x-ray equipment (positioning of II, stepping on the fluoro pedal and changing angles). One of our RCISs is adept at troubleshooting and more advanced operations. Our attending physicians are also responsible for operation of the x-ray equipment as listed above and have advanced knowledge of the systems. 

How does your cath lab handle radiation protection for the physicians and staff? 

Creating a safe environment by reducing radiation exposure to our patients, staff and physicians is a top priority. Staff and physicians attend an annual radiation safety lecture taught by our physist. A yearly radiation computer based training module is required for all staff. Staff is custom measured and fit for personal lead. This includes exact body measurements and identifying needs based on exposures in the cath lab. For instance, in the EP lab, most of the staff monitoring St. Jude, GE Prucka and ablators (Medtronic and Cryocatheter) has more posterior than anterior exposure. Due to this difference in exposure, the posterior portion (0.5mm Pb @ 100KVp) of the lead is slightly more leaded than the anterior (0.25 mm Pb@ 100KVp). In addition, fourth-year fellows and attending physicians are provided customized lead glasses, and other physicians and staff have lead glasses available for their use.

What are some of the new equipment, devices and products introduced at your lab lately? 

We have been utilizing the Melody Valve (Medtronic) for transcatheter pulmonary valve replacement and were the first pediatric center in the state to offer this transcatheter therapy. There are very few new technologies/devices that are specific for pediatrics and most of them trickle down from the adult side. For instance, neurovascular coils find additional uses in the care of children with heart disease. Some of this is related to size of our patients, as the size of catheters or other equipment does not make it suitable for use in some of our smaller pediatric patients and babies.

Can you discuss your department layout?

All three of our labs are approximately 900 sq. ft. We struggle with having adequate storage space. We are located in the center core surrounded by the cardiac ICU and cardiac step down unit. Being located in the center core has greatly impacted our ability to expand. 

The patient rooms in pre/post cardiac recovery unit are located around the perimeter of the nurses’ station, allowing quick access to the patient. The unit is adjacent to the cath lab, which allows for easy transport of our patients from one area to the other. 

How does your lab communicate information to staff and physicians to stay organized and on top of change? 

We utilize many methods to communicate to our staff and physicians. Among them are daily morning rounds with staff and physicians to discuss the day’s patients and ensure continuity of care; arranging for frequent in-services to educate about new products/equipment/practices; frequent emails keeping everyone abreast of changes to guidelines or products; white boards in visible areas that are updated to reflect changes in product or stock; quarterly staff meetings and cath committee meetings (which include our physicians) to discuss issues and concerns as well as provide updates; and a department page on our system website which is easily accessible for updates to policies and guidelines as well as other pertinent information. We also have four councils in which staff actively participates: Clinical Practice, Patient Safety and Quality, Professional Development, and Equipment and Technology. The councils are led by staff members, who hold chair and co-chair positions, with physician representation on each council. The councils set yearly goals based on system and department initiatives, and update staff on their progress during the year. 

How is coding and coding education handled in your lab?

Given the complexity of our cases and the ever-changing coding rules, two years ago we decided that it was time to transition coding responsibility from our leadership team and staff to a certified coder. Our cardiac cath lab charges are captured daily with the help of our cardiac service line coder, who holds the following credentials: MBA, Certified Professional Coder, Certified Professional Coder-Hospital Based, Certified Professional Coder-Instructor, and Certified Coder Specialist-Physician Based. It is very important that our physicians have a good understanding as to why a particular code is being deleted, revised, or even introduced as a new CPT code that will be used for the upcoming year. Within our service line, our main focus is to perform physician documentation review daily while ensuring that the correct facility codes are being selected at the most appropriate charging and reimbursement level. Our physicians and our coder have a very open dialogue to discuss any type of documentation and/or charging issues that could occur with a procedural case. It is very important that our service line stay educated with the continuous changing of CPT, ICD-9-CM and HCPCS codes, while also transitioning towards using ICD-10-CM and ICD-10-PCS. This is done with our coder attending several coding conferences throughout the year, while providing our physicians with the education that they need in order to make sure that the documentation supports the codes that has been selected for a particular case. We have a great team of physicians that also really take the time to educate our coder. The team also acts as a superior resource by providing experiential knowledge that cannot be found within a textbook. The goal within our department is to make sure that our physicians and also other cardiac cath lab staff members stay up to date with any new coding changes regarding CPT, ICD-9-CM, and HCPCS codes or any coding rules that could affect the revenue of the department or the physician billing cycle.

Who pulls the sheaths post procedure, both post intervention and diagnostic? 

The staff pulls a majority of the sheaths and holds pressure post procedure, unless there are concerns regarding the size of the sheath or recent anticoagulation. In these situations, the attending or fourth-year fellow may pull them. Since ours is a pediatric cath lab, a majority of the sheaths are in the femoral vein and/or artery. Training is overseen by staff preceptors during orientation and is part of initial competency assessment. 

Where are patients prepped and recovered (post sheath removal)? 

Our patients are admitted to and recovered post procedure in our pre/post cath recovery unit, an 8-bed unit specifically dedicated for this purpose, adjacent to the cath lab. The prep for the procedure occurs in the cath lab, as does sheath removal and obtaining hemostasis. Each member of our cath lab staff is responsible for obtaining manual hemostasis and dressing the site, even if a vascular closure device is used, for the cases they are assigned.

How is inventory managed at your cath lab? 

We have OptiFlex cabinets (Omnicell), an automated inventory management system. Our senior buyer is a member of our cath lab team and is responsible for inventory management. He works closely with our vendors, physicians, staff and purchasing department to make sure that we have the products needed for our cases. He is also responsible for purchasing supplies. 

Who handles the purchasing of equipment? 

Equipment purchases are part of our capital process and are handled by the cath lab manager. Each year, she works closely with the cath lab medical director and medical director of the EP service, physicians, and staff to identify equipment needs and applicable new technology for the coming year. 

Has your cath lab recently expanded in size and patient volume, or will it be in the near future? 

We are the only lab providing comprehensive EP care to pediatric patients in the state of Georgia, and we continue to see our patient population grow. We have seen a 25% increase in our interventional case volume and an 11% increase in our heart transplant population. As device therapy and technology improve, and can be adapted to meet the needs of the pediatric patient, we expect these trends to continue. 

Is your lab involved in clinical research? 

We are actively involved in clinical research. Some of our research initiatives are: 

• Comparison between Surgical versus Balloon Angioplasty versus Intravascular Stent Placement for Recurrent or Native Coarctation of the Aorta  
• Covered Cheatham-Platinum Stent for Prevention or Treatment of Aortic Wall Injuries Associated with Aortic Coarctation: Continued Access (COAST II/CA)
• Coarctation of the Aorta Stent Trial (COAST)
• Pulmonary Artery Repair with Covered Stents (PARCS)
• AMPLATZER Duct Occluder II (ADO II) Clinical Study
• Closure of Atrial Septal Defects with the AMPLATZER Septal Occluder; Post Approval Study (ASD PMS II)
• GORE HELEX Septal Occluder Post-Approval Study, HLX 06-04
• GORE Septal Occluder Clinical Study: A Study to evaluate safety and efficacy in the treatment of transcatheter closure of ostium secundum atrial septal defects (ASDs)
• Congenital Multicenter trial of Pulmonic Valve regurgitation Studying the Sapien Interventional THV

What measures has your cath lab implemented in order to cut or contain costs? 

With the rising cost of healthcare and reimbursements shrinking, in order to stay viable, we have to control our cost. Our staff and physicians are extremely cost conscious and have made this a priority over the past several years. We do not carry individualized stock for each of our physicians. Instead, a conscious effort is made to maintain consistency among them. Our physicians review new products together and agree whether a new item should be stocked. Physicians must get approval from the cath lab medical director and the cath lab buyer before ordering any new products. Most new products are trialed prior to purchasing to ensure that all physicians agree upon the need and efficacy of the new product prior to purchasing. The buyer keeps close track of inventory so that par levels are kept to a minimum and products that are not being utilized are not allowed to expire. Staff works with the cardiology fellows to ensure they are aware of the costs of products and the need for careful attention during procedures to ensure that products are not wasted or allowed to become contaminated. In addition, the staff does not open products until they are sure they will be used. We also have a communication board that lists soon-to-expire products. As a result of tight cost control, just-in-time delivery, low par levels and staff that is acutely aware of waste, we have manage to keep our expired products to less than $12,000 per year. Given the size of our inventory, this is an incredible accomplishment and speaks to the commitment of our team of being good stewards of our dollars.

One of our recent initiatives was around cost/outcomes and quality. We conducted a value analysis of radiofrequency ablation versus cryoablation for atrioventricular nodal tachycardia in children to the impact on procedure approach and outcomes. The purpose of the study was to develop a model comparing the demonstrated value of radiofrequency ablation versus cryoablation by identifying each treatment’s cost and long-term success.

What quality assurance (QA)/quality control (QC) measures are practiced in your cath lab? 

Our QA and QC measures include tracking and monitoring radiation dosages/usage; monitoring hand hygiene compliance among all patient providers; monitoring the use of chlorhexidine (CHG) to “scrub the hub” prior to accessing patient lines; measuring liquid controls on a weekly basis to ensure Avoximeter accuracy; and daily refrigerator temperature checks to ensure the accuracy of point-of-care cartridges. We have a very aggressive radiation safety monitoring and QA program that tracks and reports radiation exposure monthly, and investigates all cases that fall out of our standards. We review all cath lab complications monthly and discuss the findings quarterly with the Cath Lab Committee, which includes all staff, interventional cardiologists, and electrophysiologists. We also utilize a system-wide error reporting tool that reports not only errors that reach the patient, but also near misses (errors that were caught before they reached the patient). The cardiac service line is participating in a patient safety training program designed to improve patient safety by establishing error prevention behaviors among everyone through clear and complete communication. 

Are you recording fluoroscopy times/dosages? 

On every case utilizing fluoro, the fluoro time, mGy and cGycm² is recorded on the cath report and is reported monthly to the physicians and manager. All patients undergoing procedures have their groin and thyroid shielded. Each case is broken down by weight into < 50 kg or > 50 kg. The upper limit for dosage for < 50 kg is 1000 mGy and > 50 kg is 2000 mGy. When a patient reaches 50% of the upper limit, the attending physician at the table is notified. All cases that go beyond this limit for mGy are reviewed and reported to the cath lab physicians and cath lab manager. Quarterly, these numbers are then reported to the hospital-wide Radiation Committee and the radiation safety officer. 

In March 2012, we purchased a St. Jude Velocity 3D Mapping system for our EP lab.  This system has drastically reduced radiation to these patients. Pre St. Jude, the average was 355 mGy and 17.3 minutes of fluoro time over an annum. Post St. Jude, the average is now 95 mGy and 7 minutes of fluoro time over an annum. In April 2013, staff presented 5 months’ worth of preliminary data from 2012 for a campus-wide patient, safety, and quality fair. This year, with an annum’s worth of data, we had a poster presentation titled “Radiation Vacation with Velocity” at the Children’s Hospital of Philadelphia (CHOP) Cardiology conference in Orlando, Florida, in February 2014.

Who documents medication administration during the case?  

The staff person in the monitoring role documents medications given by the cathing physician in our cath report. If anesthesia is involved in the procedure, they document the medications given in their anesthesia report.

Do you use the American College of Cardiology National Cardiovascular Data Registry (ACC-NCDR) or any other outside data collection registry? 

We participate in the following registries: Improving Pediatric and Adult Congenital Treatment (IMPACT), Congenital Cardiac Cath Project on Outcomes-Quality Improvement (C3PO-QI), and the ICD Registry. Over the course of the past three years of data submission to the IMPACT Registry, we contributed over twice the data as the average institution involved in these registries. We also pride ourselves that the data we contribute is as clean and accurate as possible. The quarterly outcomes reports from IMPACT are reviewed and the date relevant to our population is compared to like institutions. The resulting data helps drive our quality initiatives. 

We have been part of the IMPACT registry since its inception. We are very fortunate to have Dr. Robert Vincent, Vice Chairman (and incoming Chairman) of the IMPACT Registry Steering Committee of the ACC-NCDR, as one of our cathing cardiologists. He encouraged our participation and stresses the importance of this database. 

The initial goal of the new C3PO-QI collaboration is to reduce radiation exposure in the pediatric catheterization interventions. We are very excited about the registries and their commitment to not only collecting data, but also analyzing and sharing the data in order to help drive improvements in the quality of care that we provide to our patients.

How does your cath lab compete for patients? Has your institution formed an alliance with others in the area? 

Our lab competes for visits by maintaining an “open lab” policy. That is, any child who needs a procedure will be able to have it done at Children’s Healthcare of Atlanta. As a result, we attract patients from other states. We consistently track our customer service scores and are proud to have had ratings ranging from 97 – 100% over the past several years. We also maintain a collaborative approach with Emory University and the Adult Congenital Heart Center. We pride ourselves on having a close relationship with Emory University. There have been circumstances where adult patients required our expertise and have had their procedures done at Children’s Healthcare of Atlanta. Additionally, we have collaborated with the adult interventional cardiologists who have particular expertise in coronary interventions. Our pediatric cardiologists partner with the adult cardiologists at Emory for catheter-based interventions in adults with congenital heart disease. Our institution also has formed collaborative alliances with Georgia Institute of Technology and Emory University in device and nanotechnology development.

How do you handle vendor visits to your lab? 

We have a very strict vendor policy and vendor agreement that anyone wishing to do business with our hospital must follow. Vendors must have set appointments and be registered through our security portal. Upon arrival at the hospital, they register with security and are issued a photo identification that is good for one day. Vendors are not seen without a prior appointment. Vendors who provide clinical expertise and assistance with new products are allowed in the cath lab. They are required to wear hospital-issued scrubs, adhere to our strict hand hygiene program, and are issued a red surgical cap that identifies them as a vendor. 

How are new employees oriented and trained at your facility? 

New employees attend new employee orientation classes based on their job descriptions, overseen by our system’s learning services department. This includes orientation to the system’s electronic medical record, and policies and procedures. Once their system-wide orientation is complete, they begin our department orientation process and are assigned a preceptor to oversee their training. They are given numerous resources for self study as well as one-on-one instruction. A department-based initial competency assessment is provided as a basis for their orientation, which lists all of the required information to be covered.

What continuing education opportunities are provided to staff members? 

Our staff members are allowed to attend outside conferences on a rotating basis every three years, paid for by the system. Also, an hour is allotted on most Tuesday mornings for continuing education for department staff. This includes in-services on topics of interest related to the cath lab by one of our cathing cardiologists, other in-services of interest based on the results of a survey sent to staff, journal club, and updates on new equipment/products by vendors. Other opportunities for continuing education within the system are distributed to staff via email and flyers. A bulletin board of potential learning opportunities is located in our staff break room as well as on a white board calendar outside of the cath lab. Our hospital has a very generous tuition reimbursement program that supports staff advancing their educational degrees.

How is staff competency evaluated? 

During department orientation, new employees must successfully complete their initial and advanced competency assessment in a required period of time. Once they have been on the job for a year, cath lab staff attends a department-based annual competency assessment, set up in interactive stations. The assessment is initiated by the department educator, with assistance from the professional development council. The competencies themselves are based on system mandates as well as the needs of the department, and have included such themes as patient safety seek and find, in which a scenario is set up with numerous violations that staff must identify, a sterile technique Jeopardy game, and for radiation safety, a “what’s wrong with this picture?”

Does your lab have a clinical ladder?  

Our nurses participate in a system-wide initiative, Career Advancement for Nursing (CAN), which is the process Children’s Healthcare of Atlanta has adopted to promote and support professional excellence in clinical nursing practice. Every nurse at Children’s, without exception, is expected to uphold these standards. To advance on the career ladder beyond the first year of employment, a Children’s nurse must exhibit competency in four areas: technical skills, interpersonal skills, critical thinking, and leadership. This matrix approach fosters the development of a well-balanced nurse. Staff that advances will receive an increase in pay. 

How does your lab handle call time for staff members? Is there a particular mix of credentials needed for each call team?

Weekday call time begins at 1730-0700 and 0700-0700 on weekends. Staff is on a six-week track schedule and call is based on full-time equivalent (FTE). We have a staff committee that establishes guidelines for on-call and daily staffing guidelines. The committee works very closely with the staff and leadership team to make sure the labs are covered appropriately, while making every effort to accommodate the needs of the staff. We require 3 staff members to be on call. The team can consist of two RNs and one RCIS, or three RNs. 

Within what time period are call team members expected to arrive to the lab after being paged? 

The expectation is that call team members are required to be at the hospital and ready to receive the patient within 30-45 minutes after being paged. 

Do you have flextime or multiple shifts? 

Our staffing is based on a six-week track schedule that incorporates staff requests and seniority, and maintains a minimum level of coverage to ensure that our labs are fully staffed Monday-Friday from 0700-1730. The pre/post cardiac recovery unit is staffed Monday-Friday from 0600-1830. Flexibility is encouraged and as a result, we have staff that works full-time and those that work at varying part-time levels. Three staff members work 8-hour shifts and the remainder of the full-time staff work 10-hour shifts. The call team is responsible for coverage after hours and on the weekends. 

Has your lab recently undergone a national accrediting agency inspection? 

The Joint Commission inspected our system during 2013 and it was a very positive experience, as we were well prepared. One area we focused on was our “OR readiness.” Since we perform numerous interventional procedures where devices are placed, cath labs are increasingly being held to operating room standards. As a result, we modified our guidelines to conform to OR standards with respect to dress (standard hospital-issued scrubs and hair covers in the labs, masks when trays are open), traffic patterns, cleaning procedures, and room air flow pressures. 

Where is your cath lab located in relation to the operating room (OR) and emergency department (ED)?

 The cardiac OR is located one floor above the cath lab. The ED is located one floor below the cath lab. The cath lab is located on the same floor with the cardiac ICU and cardiac step down unit. 

What trends have you seen in your procedures and/or patient population?  

Patients are becoming more complex, and we are intervening in younger and smaller patients. We are performing fewer diagnostic procedures and more catheter-based interventional procedures. Referrals for percutaneous pulmonary valve replacement are increasing and surgical pulmonary valve replacement is performed with the plan for future percutaneous intervention. There is an increasing trend for combined surgical and catheter-based interventions. Due to the increasing success of surgical and catheter-based procedures, there are more adults living with congenital heart disease than children. As such, catheter-based interventions are continuing to increase in this group of patients.

What is unique or innovative about your cath lab and staff? 

What makes us unique is the team approach we take, keeping the patients’ and their families’ best interests at the forefront of our decision-making processes. Each team member is valued for the experience and expertise they bring and is encouraged to build on these values. In addition, we provide invaluable support for one another on a multitude of levels. Our cath lab staff members bring their experience from a variety of backgrounds. Most have had significant experience as bedside nurses in the pediatric cardiothoracic ICU. Others have experience working in adult cath labs. While not currently practicing, one staff member was actually a pediatric cardiologist in another country.

Is there a problem or challenge your lab has faced? 

One challenge that we faced two years ago was our conversion from conscious sedation to the use of general anesthesia for the majority of our patients. This was initiated due to concerns regarding safety, since the cath lab physician was overseeing what had become “deep sedation” in addition to his role as cathing cardiologist. It was a huge practice change for the staff and there were multiple concerns regarding this transition. This challenge was addressed primarily by forming a committee composed of cath lab staff and an anesthesiologist who listened to the concerns of all sides. The anesthesiologist made recommendations for resolution and the encouragement of open communication between all parties. There continue to be minor challenges regarding this transition, but staff has come to realize that the presence of anesthesia in the cath lab is in the best interests of our patients. The anesthesia staff has become an integral part of our team. 

The other challenge is that of physical space. We moved into our new facility in 2007 and are already outgrowing the area. The cath lab is located in the center of cardiac services, surrounded by a 27-bed cardiac intensive care unit and a 27-bed cardiac step down unit. While this design is extremely effective in theory, it is also limiting, since there is no room for the cath lab to expand without affecting the neighboring units.    

What’s special about your city or general regional area in comparison to the rest of the U.S.? 

Atlanta is the capital of Georgia and is a truly cosmopolitan city. It attracts people from around the country and world. With staff and physicians from Africa, China, India, and Canada, this diversity is certainly evident in our staff and their families. Our cath lab culture reflects the world culture that exists in Atlanta. Atlanta is home to the country’s busiest airports, making Atlanta easily accessible from anywhere in the world. Our staff enjoys a large variety of quality social, cultural, educational and recreational pursuits in Atlanta.

Two questions from 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)? Does staff receive an incentive bonus or raise upon passing the exam?

Only staff trained as cardiovascular technologists is required to take the RCIS registry exam, as it is an expectation of their job description. The RN staff is encouraged to obtain advanced certifications. The majority of the staff has achieved RCIS, CCRN, certified nurse manager and leader (CNML), neonatal, and/or pediatric certification.

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, staff belongs to a number of organizations, including:

• The Society of Invasive Cardiovascular Professionals
• The Heart Rhythm Society 
• American College of Cardiology
• American Heart Association
• Southeastern Pediatric Cardiology Society
• Georgia Nurses Association
• American Nurse Association 

The authors can be contacted via Carolyn Winn, RN, BSN, CPN – Clinical Educator, at carolyn.winn@choa.org, or Arlene Porter, MSN, RN-C – Manger Cardiac Cath Labs and Pre/Post Recovery Unit, at arlene.porter@choa.org