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First-of-its-kind paper published on best practices in cath lab
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The Society for Cardiovascular Angiography and Interventions recently released a paper that describes several “best practices” to ensure constant high-quality care, patient safety, and patient and referring physician satisfaction in the cardiac cath lab.
“[Before this document], there was no uniformly recommended standard in terms of documentation, laboratory evaluation and even the acceptable time frame before the procedure for these to occur,” Srihari S. Naidu, MD, FSCAI, lead author of the paper and director of the cardiac cath lab at Winthrop University Hospital in Long Island, N.Y., told Cardiology Today. “This is just one example of the utility of this statement.”
The clinical expert consensus covers pre-, intra- and post-procedure best practices for interventional cardiologists and other medical staff in the cath lab setting.
Recommended best practices
The paper emphasizes the assembly of an optimal cardiac cath team. Best practice recommendations include ensuring that medical staff maintains proper credentialing, certifications and experience, and actively participate in peer review and other quality initiatives.
Pre-procedure practices should focus on optimal patient care and, to provide it, the writing group recommended that physicians utilize a pre-procedure checklist. The checklist focuses on whether the patient has had a recent history and physical examination; any medications and allergies; informed consent; sedation and analgesia; and the procedural indications, among others.
During the procedure, a dedicated “time out” protocol is warranted when all members of the team are present and before vascular access is obtained, according to the paper. During the “time out” period, patient identification is verified, as is procedure route, procedure equipment, patient allergies and special medical conditions. Naidu said, “This is very similar to what is done in the surgical suite for other operations, but tailored to the cath lab setting.”
Best practices for post-procedure communications and evaluation are also outlined. The experts list recommendations for careful monitoring following the procedure, as well as discussion of results of the procedure, any complications, unexpected findings and events with the patient and family. Post-procedure management plans should also be discussed, including the need for and duration of dual antiplatelet therapy in patients who received a stent. If the patient is sedated after the procedure, this conversation should wait until the patient is awake and alert. In the interim, if prior consent has been obtained from the patient, results of the procedure may be discussed with family members. Communication should not stop at the patient and his or her family. Naidu said physicians should also discuss the procedure and results with the rest of the care team in the hospital, and arrangements should be made for hand-off to primary physicians.
Follow-up appointments should be scheduled 2 to 4 weeks after discharge to confirm the access site is healing; ascertain that there are no medication complications or problems with adherence; arrange for laboratory evaluations, if necessary; evaluate the patient’s current lifestyle limitations; and enroll the patient in cardiac rehabilitation, if appropriate.
Elevating the standard of care
According to SCAI president Christopher J. White, MD, FSCAI, who is professor and system chairman of cardiovascular diseases at the John Ochsner Heart and Vascular Institute, New Orleans, La., “This paper will provide a benchmark for cath labs to base their current practices on and help set future goals elevating the standard of patient care across the practice.”
“My estimate is that most cath labs do 70% to 80% of these things. We are hoping that this document can help bring full compliance and a uniform standard,” Naidu said. – by Casey Murphy
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Disclosure: Dr. Naidu reports no relevant financial disclosures.