Who`s Working in Your Lab?

We no longer have just a cardiac catheterization lab for cardiac catheterization procedures, surgical labs for vascular surgery procedures or interventional radiology labs for angiograms. Peripheral stents are not just performed by the interventional radiologist, but by cardiologists and vascular surgeons. The new combination labs are a direct result of aggressive physicians’ desire to manage their patients completely rather then referring them to different disciplines for interventional work. This results in a breakdown of the barriers between physician groups (cardiologist, surgeon, interventional radiologist and neuro-radiologist). Credentialing battles must go away as we embrace a model of collaborative medicine in order to integrate care processes around the unique needs of heart and vascular patients. Professional societies are spending a great deal of time collaborating in order to develop physician credentialing for catheter-based vascular procedures, carotid stenting, and cardiac CT and cardiac MRI procedures that will be acceptable to all the disciplines, demonstrating that collaborative medicine is here to stay. In July 2004, the American College of Cardiology (ACC), the American College of Physicians (ACP), the Society for Cardiovascular Angiography and Interventions (SCAI), the Society of Vascular Medicine and Biology (SVMB) and the Society for Vascular Surgeons (SVS) developed new guidelines for clinical competency for physicians who wish to practice vascular medicine and catheter-based vascular interventions.₁ The purpose of the document is to ensure that practitioners have the appropriate knowledge base and training to provide excellent quality care to the patient. Our hospitals must be in-line with credentials established by these professional societies, since the Joint Commission on Accreditation of Health care Organizations (JCAHO) requires that the granting of continuing medical staff privileges be based upon assessment of applicants against professional criteria specified in the medical staff bylaws. It is the physician’s responsibility to identify the criteria and develop the criteria to test the competence level of their peers. The clinical competence statement, published in the Journal of the American College of Cardiology, provides specific guidelines for not only vascular medicine expertise but also catheter-based peripheral intervention criteria for cardiologists, vascular surgeons and interventional radiologists. A multi-disciplinary focus has also been developed for physicians interested in performing carotid stenting. The physician criteria require that physicians meet the catheter-based peripheral intervention criteria before venturing into the carotid stenting arena. The SCAI/SVMB/SVS Clinical Competence Statement on Carotid Stenting paper describes the cognitive, technical and clinical skills necessary to perform carotid stenting. Interventionalists training in carotid stenting must perform a minimum of twenty-five patient procedures in a supervised setting, half as the primary operator.₂ In addition, to the physician credentialing it is critical that carotid interventions be performed with highly-trained support staff. Extremely skilled allied health professionals (certified cardiovascular/ interventional radiological technologists [RT(R)s], Registered Cardiovascular Invasive Technologists [RCISs], and Registered Nurses [RNs]) are also necessary to evaluate the patient before and after catheter-based interventions. Specific training and skills competency in the recognition and management of acute neurological symptoms is required. Staff must also be available to provide immediate rapid response to hemodynamic and rhythm instability; therefore, ACLS certification should be mandatory for staff in this area. Staff must, in real-time, chronologically document the events of the procedure, as well as interpret physiological, hemodynamic and cardiac findings throughout the procedure. Not all physicians and staff will agree with the credentialing recommendations established by these societies, but many hospitals have already adopted these recommendations. Hospitals allowing for physician collaboration in the various heart and vascular procedures must assure that there is a uniform mechanism for credentialing and maintaining credentialing. These guidelines/recommendations are paramount to revolutionizing patient care through physician collaboration. Who will be working in your lab? Victoria Hollingsworth Schuler can be contacted at vhollingsworth@ beaumonthospitals.com

1. ACC/ACP/SCAI/SVNB/SVS Clinical Competence Statement. JACC August 18, 2004;44(4):941-957.

2. Clinical Competence Statement on Carotid Stenting: Training and credentialing for Carotid Stenting- Multispecialty Consensus Recommendations. Catheterization and Cardiovascular Interventions 2005;64:-11.