WHAT DO YOU THINK?

On Call Definition: Is there a concrete definition of on call? Isn’t it for emergencies after hours? Our lab expects the staff to stay late to finish any elective cases without question. This sounds more like mandatory OT to me. Especially since the cases are electives and may have been added to the day’s schedule after 12 noon to accommodate a physician’s schedule vs. managing an acute patient. What about an overbooked day? What are people being paid to carry the on call beeper? At a recent Cath Lab Digest regional meeting this issue was raised. Some staff were paid $2.50-3.00/hr and others were paid minimum wage ($5.15/hr) and others were paid up to 20% of their base salary. What’s going on in other institutions? We should be able to define on call. Perhaps a loose definition and the abuse of staff’s personal time off is a major contributor to the high turnover in cath labs? jmr@beld.net Rachael: We have an on-call system for cardiac emergencies. Two staff members are on call during the hours when the lab is closed (we run M-F from 7am-6pm). They stay late to finish cases when the day runs over (the mandatory overtime you referred to in your question) and get called back in for any emergencies. We are compensated with $2.00/hr for beeper time and then you are paid for the hours you work (no 4-hour minimum as I have heard some facilities employ). For those of use who aren’t full time, our call-in time is paid as straight time, you only hit OT once you have worked 40 hours in a week. I might add that our rate of on-call pay ($2/hr) has been the same for nearly 2 decades, with no increase! I firmly believe we are on the low end of the spectrum and would like to put together a proposal to have our system and compensation re-evaluated. Gwen: This is a sore subject at our institution also. Right now we are running one team short, but are in the process of training at least half of a team. We are on call 2 or 3 nights a week and every 3rd weekend. We also have a team, called the late team, that often stays until 5 or 6pm to help finish an overbooked day. We often do routine cases on Saturday and Sunday. There is no printable definition of on call. We do get burned out but are quite dedicated to our patients and we all work quite well together. This helps decrease tension and super burnout. Our physicians also know how hard we work and are very appreciative. We often get together outside of the lab with our significant others to just take a breather and have fun together. We do not get a day off during the week when we work the weekend. We often average 15+ hours of overtime and more when the pay period includes a weekend of call. As far as non-emergent weekend cases, it is in the patient’s and hospital’s best interest not to sit in the hospital from Friday until Monday to wait for a cath. For cost-effectiveness, patients need to be in and out in a timely manner. If the patient were one of our family members, we would want the procedure completed as soon as possible too. We treat all patients like VIPs or family members. That mindset helps us get through the crappiest of days. You will always have to accommodate physicians’ schedules, always these are cardiologists and the world tends to revolve around them. They are also your client and colleague you work together. They have to give and take just like you this helps with harmony. Meet with them and voice your expectations. Physicians have two ears, and they will listen. We get $2.25/hr for on call. We used to get 20%, but that changed about 7 or 8 years ago. We have been asking for this to increase and it is being researched. When we work overtime, we get time and a half plus premium, we also get pm and night differential. Hang in there. The cath lab is the best place to work. You can go to any city you want and get a job. Hospitals are dying for experienced personnel in the cath lab. Debbie, RN, Cardiology Supervisor: Your letter sounded exactly like what we do at our hospital. We are a single diagnostic cath lab with shared staffing for invasive and non-invasive cardiology. We too are expected to stay late for add-ons or over-booked days without any type of compensation. We take call for the weekends only and are paid $1.50/hr with a minimum of 1 hour time and a half if called in. Our facility is planning to expand out services to interventional/CABG in 2003, so I feel we need to be proactive for future employee satisfaction and retention. Paul: We have 2 cath labs at our hospital. We have a staff of 15 scrubs, RNs and CVTs. We too have the problem of scheduled acutes on Saturdays and Sundays, and the call team staying till all hours of the night to finish the day’s work. Our staff all come in at 7am. We tried to have the call team come in at 8:30 to finish the late cases in their 10hr shift, but they usually left at 3 to 5 pm with the early team, losing hours. We get $2.00 per hour to carry the pager and take an average of 9-10 call shifts. Saturday, Sunday and holidays count as two call shifts (1 for every 12 hr period). After our 9th call shift, we receive a $$ bonus for being called in. For example, my 10th call shift I get called in at 10pm, I get my time and a half, plus call pay, plus my bonus. The bonus is for every shift, not every call-in. If a person chooses to take more than their required 9 days of call, they become eligible for these bonuses. OverEdge46: We have the same concerns regarding non-emergent cases being added on for the doctors’ convenience. Also, our call pay is not 3.00 per hour, which was cut last year down from 25% of base. This resulted in a loss of 8-10,000 dollars per year per person! Also, call pay is not consistent from one department to another, with radiology and surgery receiving 5.00 per hour. We will be interested in hearing results from other labs as well as how these issues have been addressed with management. Cath Lab Design: 1. Is a separate post-processing station necessary and is it worth the money/space? Does parallel fluoro completely solve this problem? 2. I’m trying to help design a new room with a shared control room. I’m debating whether to divide it with a glass partition and add head sets for better communication with in-room personnel or leave the area open? I welcome your comments! lorirous@yahoo.com Bob Young, BMET, CBET: I have been servicing the equipment in the cath lab for about 13 years now, so I have seen floor plans come and go. We have set up two of our labs just how you described in your plan. Over the years, we have found that because we are a teaching hospital, the lead glass windows in our control room supply a haven for visitors and students during cases. The noise in this area, since it does have access to the hall and each room, can become a problem. The counter space in this area allows for post processing of cases and it does get a little crowded sometimes with salesmen and technicians, which also distracts the doctors post processing. We have also found that the additional work load of dedicating 2 cath lab technicians to the control room is no longer realistic and that the technicians are running in and out of the rooms to operate the physiological monitor and recorders. In our next room, the director of the department put the physiological monitor in the corner of the room with easy access for the nursing staff. The front of the monitor area has 3 portable roll-around radiation shields that form a clear wall between the doctor and the physiological monitor operator. We have no intercom system or headphones to repair. We reduced the renovation cost substantially and we have a very simple shield for students and operators that is considerably cheaper than wall construction. We have naturally reduced the unnecessary visitors and noise. We have also been requested to remote the monitors out of the control room into the procedure rooms in rooms 1 and 2, and we have been requested to remove the control room, which would allow for better square foot utilization. This is difficult because we will now have to shut down two rooms. The overall consensus is that we wish we had not installed the control room at all. It is nice to have this area, and it is nice to have an observation area for visitors, but the square footage is too valuable and the additional manpower requirements are not realistic. Jacksoncvtply@aol.com: Radiation protection is of the utmost concern, so leaded glass is not omissible. You need a place to allow the third crew to be rested. Not to mention the cardiologists, nurses and other visiting persons. A third set of eyes can often be useful, especially if you have the talent available to you. Hemodynamic monitoring by the resting crew would be both cost-effective and good for overall morale. Competencies: Can anyone provide me with any cath lab competencies information? I am interested in annual competency checks and how they are coordinated. I have cardiac coordinators who assist with training and staffing it’s very difficult to break everyone out to a classroom due to patient demand. Suggestions are welcome! Email: Brmok@aol.com Paul M. Jellum, CVT: Our lab has a pretty good way of doing our yearly competencies. We do mini sessions throughout the day with staff when we have downtime. Many of our staff are trained by the hospital Education Department to train and pass off the competencies. Also, our hospital does clinics throughout the year at different times (morning, afternoon and evening). These sessions take about 15 minutes each and are on a come-as-you-can basis. If you would like more information, you can contact our lab director Tom Pachelli at Thomas.Pachelli@mountainstarhealth.com New Flat Panel Rooms: Is anyone using the new flat panel rooms? What comments can you share? We are thinking of purchasing one. Email: mloupitt@yahoo.com Wayne Taylor: Regarding your inquiry on flat plate technology I bought the first one available (the GE Innova). We have had it since December 15, 2000. Since install we have had approximately 8 hours down time in 13 months. The images are awesome and the backup support is incredible. Please feel free to contact me in New Orleans: Wayne Taylor, wayne.taylor@tenethealth.com

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