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Commentary: An Evaluation of Cath Lab Turnaround Time
• We opened a 5-bed staging area where all sheaths are pulled. Interventional patients are monitored there for 4 hours after hemostasis (in an attempt to decrease groin complication rates). The staff in the staging area pick up and return patients to their rooms, thus freeing up cath lab staff. Cath lab staff also do not have to pull sheaths and hold pressure. The staging area direct admits patients to the cath lab when there is a bed issue. All of our outpatient cardioversions, transesophageal echos (TEEs), tilt table and outpatient cardiac biopsies done by echo go through this area also. We also recover interventional radiology patients when there is a staffing issue in radiology.
• The cath lab staff used to clean the rooms after procedures, i.e., mopping the floor, etc., but an environmental staff person was assigned to the lab and holding area. This helped to decrease times spent cleaning the rooms.
• We have an inventory person who checks and orders all the supplies for the lab. She checks supplies in each cath lab daily.
• We have one cath lab staff assigned each day as a lead, a position that rotates through all staff on a daily basis. This person makes staff assignments and takes care of sending for patients, pre-medicating patients and arranging for beds after procedures. The lead is also responsible for adjusting staffing when emergencies come in.
• The lead also is in constant touch with the nursing supervisor and leads on the nursing units to keep the flow of patients moving.
• Each staff person is assigned a room by the lead on a daily basis. The tasks of crash cart check, narcotics check, quality analysis on O2 sat machines and ACT machines, and temperature logs for contrast and refrigerated meds are usually done by the nurse assigned to the room. Stocking supplies is done by all the staff in the room and our inventory person. We have found this helps to keep rooms always stocked and ready.
• Interestingly, we initially thought that the physicians held up cases by frequently being late. After some study, we found physicians were not really the main source of long turnaround times. Of course, some physicians were indeed late, but the impact was not as large as we first estimated.
As a result of the way we have organized our lab, we can come up with a crew quickly for emergencies and when cases run late and a fourth room needs to be opened. We also have cross-trained staff to make each staff person more flexible in terms of what they can be assigned to do in each room. It has worked well and the flow is much improved. We encourage other cath labs who are trying to improve their turnaround times to first look closely at their current practices and do a time study to determine where their problems are. Once the problems are identified, you can develop a plan to correct them. Get input from your staff on what the problems are and solutions that may help to remedy them. Do another time study once you have instituted these changes and see if the turnaround times improve.
