Waukesha Memorial Hospital

The hospital is the flagship provider for ProHealth Care, Inc., a community-based, non-profit system which also includes: Oconomowoc Memorial Hospital; 14 primary care clinics; Four nursing homes; Three senior living communities; A health and fitness center; Home health care, and more. We are currently a full-service hospital with 263 beds. Waukesha Memorial Hospital is also in the process of building an addition. Once it is complete, we will have 330 available beds, 54 of which will be dedicated to a heart care unit. The hospital addition will also house a new 24-bed intensive care unit. What is the size of your cath lab and number of staff? We have three cath labs with a fourth that doubles as a cath/EP lab. All 4 labs are Philips Integris systems. Currently, we are staffed with 17 employees. There is a mixture of registered nurses (RN), cardiovascular technologists (CVT) and radiologic technologists (RT[R]). One of the radiologic technologists is registered in cardiovascular-interventional technology (RT)(CV). We also have two employees who are registered cardiovascular invasive specialists (RCIS). One of our staff is the cath lab educator and another is the cath lab coordinator. The cath lab coordinator is responsible for the daily flow of the lab. Our manager, Lars Anderson, is a RCIS and fairly new to our lab. He has been a great asset to us and is able to work in all areas of the lab when needed. Rounding out the staff is our secretary, Gail Damask. She is very valuable and helps the cath lab run smoothly. What types of procedures are performed at your facility? In 2001, our cath lab performed approximately 4500 procedures. We are a full-service lab and offer the latest in technology. We do cardiac catheterizations, coronary interventions, peripheral interventions, non-invasive tilts, electrophysiology, ablations, pacemaker implants and ICDs (usually performed in the operating room), dobutamine stress echos, TEEs and ICD checks. We also perform ICD and pacemaker interrogations. The lab is supported by a cardiac surgical service that performs approximately 450 revascularizations, 80 percent of which are performed off-pump. We are in a unique situation in that we have opened a fifth cath lab at nearby Oconomowoc Memorial Hospital (OMH). This lab is a new GE Innova system. OMH’s new cath lab is staffed by our department, which provides 24-hour coverage, and is located approximately 17 miles west of Waukesha Memorial. In the past, OMH patients were transferred to us via ambulance or air. Does your cath lab perform primary angioplasty in acute MI? Yes, our cardiac program believes in rapid transit to the cath lab for direct reprofusion of the myocardium. Do you have cross-training in the cath lab? Since the lab opened in 1989, we have held the philosophy that all staff should be cross-trained in all positions. All RNs and CVTs circulate, monitor, scrub and pan. CVTs are allowed to provide medications under the direct order of the cardiologist, including I.V. drips, conscious sedation, and resuscitative and prn medications, once they have proved competency. This is done using a skills check list with return demonstration. However, not all staff have been cross-trained to the EP lab. At the present time, six of the staff are proficient in EP, and it is our goal to eventually have all staff cross-trained. Staff cross-training is accomplished by mentoring. Once the staff member has been evaluated and can show competency, he or she may work independently. Our staff is very receptive to cross-training as it makes for better working relationships and teamwork. It also helps the lab run smoothly, helping with staffing issues and room availability when we are short-staffed due to vacations and sick calls. What are some of the new equipment, devices and products used by your lab? New equipment we currently offer in the lab includes: PercuSurge® (Medtronic, Minneapolis, MN) RADI PressureWire (Reading, MA); Cutting Balloon (Boston Scientific, Maple Grove, MN); Bi-ventricular pacer and ICD implants; Brachytherapy has been started this year. We use Novoste’s Beta-Cath System (Norcross, GA); Angio-Seal (St. Jude Medical, Minnetonka, MN) was recently introduced, and we are very happy with the outcomes. Is your lab filmless? We have been filmless in the cath lab since 1997. Cardiac cath procedures had been archived on magnetic optical disks using the Philips Inturis 60 platter Sony jukebox (Bothell, WA). Last year, we installed digital echo, our next step on the path to a complete cardiology information system (CIS) using the Camtronics VERICIS System (Hartland, WI). We migrated the old MOD archive to the newer Camtronics AIT-2 (digital tape) and image server. Both cath and echo studies can be reviewed at any of our 12 review stations located in the cath lab, physician reading room and cardiovascular department. A web browser links our CIS server to the hospital intranet to allow physicians to review studies with other physicians, staff, patients and families in patient care areas such as the intensive care unit and cardiac care unit. The fifth cath lab at Oconomowoc Memorial Hospital is filmless as well. Since all the physician groups and patient populations are shared under ProHealth Care, Inc., we will be using the same CIS server, located at WMH. Physicians and staff can access, review and report on any study done from either location. This year, we integrated our CIS with the hospital information system. Our physicians are now using the structured reporting for echo, and will do the same for cath procedures once the interface for our hemodynamic system is completed. Physician dictation is replaced by point and click customized reporting, allowing for immediate signed reports and a paperless cath lab. We will have a complete electronic patient file with the ability to access multi-modalities and reports at one review station. How does your lab handle hemostasis? Diagnostic sheaths are pulled in the lab using manual pressure or a closure device. The closure device is either deployed by the cardiologist or staff who have been trained to perform this function. The patient is then taken back to our recovery room for bed rest and discharged the same day. Angioplasty patients may have their sheath removed in the lab using a closure device. If a closure device is not used, the sheath is sutured in place and the patient is taken to the Heart Care Unit or the ICU. The sheath will be pulled using manual pressure by the patient’s nurse when the ACT reaches 180 or less. Peripheral angioplasties are an exception to this rule. Our cardiologists prefer that these sheaths be pulled by the cath lab staff using manual pressure. The nurse will alert our cath lab coordinator when the ACT reaches 180 and she will assign a staff member to pull the sheath. Radial access is closed using the HemoBand device (HemoBand Corporation, Portland, OR). Manual pressure is used when necessary. Has your cath lab recently expanded in size and patient volume? Waukesha Memorial Hospital has seen a very steady growth of patient volume. Due to this increase, the hospital is in the process of adding on a six-story, 217,000 square-foot addition. The addition will house a new inpatient cardiology unit and as a result, we will have increased space for our prep and recovery room, which we desperately need. Our congestive heart failure clinic also continues to grow this year, with patient volume increasing 50 percent. New staff is being hired in for the clinic due to volume increases attributable to our aging population. The cath lab is also in the process of hiring new staff to lessen the effect of the increased patient volume. We are facing the same challenges as everyone else in dealing with staff shortages. We are currently conducting market surveys to make sure we offer competitive wages that will attract staff to our program. Overtime continues to be a problem, as it is in all labs. We do stagger shifts to help lessen the overtime for non-call staff. What measures has your cath lab implemented in order to cut costs? We are constantly looking for ways to cut costs while still maintaining the highest level of health care for our patients. All of our interventional supplies are consigned. We limit our cath lab to only two vendors, a primary and a secondary. This usually results in bidding that in turn gives us better pricing. The hospital is part of a buying group that gives us a break on pricing. Our contrast bottles are used with multi-dose devices. Sheath and catheters are opened only after speaking with the cardiologist. What type of quality control assurance measures are practiced in your lab? We use the American College of Cardiology/STS database to measure outcomes and benchmark our institution with national trends. We participate in multi-departmental utilization of medicating (IIb/IIIa utilization, cost, adverse outcomes), conscious sedation monitoring, and variances with use of reversal agents. We track outcomes of closure devices for staff and physician deployment of Perclose and Angio-Seal. We continue to reduce on-shelf inventory and rotation of stock with our computerized inventory system. How is inventory managed at your lab? Our inventory is closely monitored. We currently have the Witt Series 4 Hemodynamic monitoring and recording system and use the inventory screens to track equipment. All supplies are placed into these inventory screens and par levels are set. As supplies are used, they automatically are deducted from the par level. At the end of the day, a below-par inventory list is printed. We will order the supplies that are under par. We order every weekday to help keep our cost down and limit the amount on our shelves. There are three staff members responsible for ordering equipment and supplies in the lab. Complete hand counting is usually done at least once a month to make sure we are on track with our par levels. How are new employees trained at your facility? All new employees must attend a two-day general hospital orientation. Our staff is oriented to the cath lab with a preceptor. We then have a three-month probationary period. Staff coming to us with previous experience are assessed on their skill level and competence. Orientation is adjusted to the individual as needed. We assign call hours to new staff, at first designating them as a fourth call team member. This way they see how the call team works together in emergency cases and they are eased into the call position. When we feel that the orientee is ready to function alone, he or she will then be placed on a call team as the third member. We usually start new staff with no prior experience in the circulator role. This way, they begin to understand the flow of the lab and learn supplies and equipment. We then start adding the monitor role and last but not least, the scrub role. What types of continuing education opportunities are provided to staff members? Each staff member is responsible for maintaining his or her own continuing education credits in accordance with state and national license requirements. Our goal is to have all the staff credentialed or certified in their area of expertise. When available, staff is given opportunities to attend outside conferences in the area. National conferences may be attended, and opportunities rotate yearly by seniority. Educational inservices are mandatory for any new product brought into the lab. We also have educational inservices from company vendors. We try to keep Wednesday mornings from 06:30“08:00 for inservices and education. Our cardiologists have this time for cardiology case review and section meetings, so it works out great for us. We most recently were inserviced on: AngioJet® (Possis Medical, Inc., Minneapolis, MN); JOMED stents (Helsingborg, Sweden); RADI PressureWire; Guidant’s new ZETA stent. We have an upcoming inservice set for the coated stents. How is staff competency evaluated? New staff is evaluated during and at the end of completion of orientation by their preceptor and the manager. All staff are evaluated annually and must complete the hospital competencies such as fire and electrical safety, blood borne pathogens, radiation safety, and so on. All of our staff is required to be CPR and ACLS certified. How does your lab handle call time for staff? Our cath lab is staffed from 06:30 to 17:00 each weekday with call starting at 17:00. Weekend call starts at 17:00 on Friday and runs until 06:30 Monday. Call is on a rotating basis for all employees. Our call team consists of three staff members, with at least one member proficient in EP. Does your cath lab utilize brachytherapy? We are very excited to be able to offer this option to our patients. We utilize the Beta-Cath System (Novoste, Norcross, GA). In the past, brachytherapy procedures were only scheduled on Wednesdays and Fridays, due to the requirement of having both a physicist and radiation oncologist present. Now, however, we are very fortunate to have a radiation oncology department that is willing to do these procedures whenever we need to. We have a great working relationship with this department. How does your cath lab compete for patients? We rely on word of mouth as well as a strong presence in the community. We feel that the patient is the best advertisement for Waukesha Memorial Hospital. Each patient is treated with dignity and respect. We believe in treating patients and their families as we would want to be treated ourselves. Therefore, we only provide personalized, friendly and compassionate care, along with the latest in technology. As part of the cardiology product line for ProHealth Care, Inc., the cath lab benefits from extensive advertising and public relations efforts, including television, billboard, radio and print advertising, newsletters and direct mail. Please tell the readers what you consider unique or innovative about your lab and staff. Our heart program has existed for approximately 12 years. We are very fortunate to have staff with many years of experience, some with more than 15 years in the cath lab. When possible, the hospital recruits experienced individuals to ensure our heart program has a qualified staff to provide excellent care to the patient, family and the cardiologist. Staff with little or no experience will benefit from the knowledge and expertise that surrounds them in our lab.

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