Inside the State-of-the-Art Cath Lab

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Image courtesy of Witt Biomedical

The state-of-the-art cath lab is the model of healthcare efficiency and optimized patient care. Take for example The Richard M. Ross Heart Hospital at The Ohio State University Medical Center in Columbus. The new facility is a fully functional cardiovascular hospital that provides all aspects of cardiovascular care under one roof. It includes eight cardiac cath, vascular and electrophysiology (EP) labs.

“The benefits of this approach are reduced costs, enhanced quality and flexibility and increased speed in the delivery of healthcare tailored to our patients,” explains Duane Hart, imaging engineering service manager. The cath lab has been profitable since month one, length of stay data indicate positive performance and outcomes and patient and staff satisfaction scores are up by 25 percent.

Kathleen Rizer, RN, director of The Heart Lab at St. Elizabeth’s located on the campus of St. Elizabeth Health Center in Youngstown, Ohio, adds to the list of benefits. “Image clarity for diagnosis is outstanding. Digital imaging is crystal clear for interventional procedures.” Superior imaging technology allows physicians to handle more complex cases with a high degree of confidence, says Stanley Katz, MD, chief, division of cardiology and director of the cardiac cath lab at North Shore University Hospital in Manhasset, N.Y.

Precise imaging is essential as the cath lab evolves from the old-school model based on cardiac surgery as the ultimate treatment to a new model characterized by an increasing number of interventions and fewer invasive procedures in the cath lab.

Another element of the state-of-the-art approach — integration among modality, information technology and storage solutions — reduces the need for image storage and enables anytime/anywhere availability of current and historical images, Rizer says.

The state-of-the-art cath lab achieves these benefits by balancing multiple imaging and image and data management solutions. The recipe for success includes:


  • Direct digital imaging equipment
  • A dedicated cardiac archive
  • Multiple lead hemodynamic monitoring systems with a network-based archive interfaced to the hospital information system(s)
  • Online access to images for referring clinicians and specialists
  • Ability to transfer images to PACS for diagnostic quality review throughout the health system
  • Ability to create DICOM CDs and the integrated cardiac record

The proactive approach



The common theme among state-of-the-art cath labs may be their fidelity to the future. The average cath lab lifespan is six or seven years, so it’s important to invest in flexible, upgradeable solutions “We looked for the most advanced equipment that could take us into the future,” says Rizer. On the imaging side, that meant Siemens Medical Solutions AXIOM Artis digital flat-panel system. The cath lab selected Witt Biomedical Corporation’s CALYSTO for cardiology enterprise solution, which includes the Series IV Physiomonitoring and Information System, Image IV Cardiology Image & Information Management System and WEBDV for secure access to imaging, data and reports via the internet.

The cardiovascular information system (CVIS) “complies with HIPAA [privacy] and other government regulations, handles data collection, statistics and querying and integrates with the most current and advanced equipment, and it can be expanded to take us into the future.”

That future flexibility is key for the for-profit cath lab. “Cardiac cath scanning and MRI is the big buzz right now. As these technologies develop, we anticipate the need to evaluate our capabilities [and] position ourselves for operational growth,” explains Rizer. The Heart Lab includes a shell to expand to an additional lab, which will provide the necessary space for future operational needs.

In the interim, the CVIS and digital cath lab serve the lab’s financial and patient care needs very well. CALYSTO can hold up to 100,000 physiological/hemodynamic cases. Images can be stored indefinitely on the CVIS, which represents a cost-savings as the lab no longer burns images onto CDs for storage. Historical images are easily accessed; the system allows users to actively view images from multiple admissions on one screen.

Similarly, The Richard M. Ross Heart Hospital was built with an eye on the future. The lab relies on GE Healthcare’s Innova digital detectors and Centricity PACS. EP suites are equipped with InfiMed’s Inc.’s Platinum One cardiac system. The cath lab area also is designed to accommodate three 3T MRIs in the future. “We don’t need them today, but we know we’ll need them tomorrow,” Hart says. The hospital also features a gigabit network backbone and full wireless capability throughout the building.

Hart credits the hospital’s success to an inclusive approach that sought input from multiple stakeholders including medical, technical, ancillary support, nursing and administrative staff. A dedicated leadership team further ensured the success of the project.


Vendor partnership pays off


North Shore University Hospital is unusual among cath labs because GE is the sole vendor for its nine labs, says Katz. The solutions include an Advantx LC+ x-ray unit for EP, three Innova 2000 digital flat-panel systems, one Innova 4100 digital flat-panel system, two Innova 2100 IQ digital flat-panel systems, two Innova 3100 digital flat-panel systems, Centricity Cardiology PACS and Centricity Data Management System.

“We try to remain at the cutting edge of technology. GE always comes to us with new technology, and our physicians work with their engineers to optimize their products,” Katz says. For example, when the hospital outfits a new lab, GE engineers spend a few weeks working with physicians to tweak the imaging and attain the absolutely highest possible resolution. This commitment to excellence translates into a consistent top outcomes rating for North Shore among New York state facilities.

“This approach requires a lot of patience,” cautions Katz. “When a lab opts for cutting-edge technology or first-to-market solutions, there will be issues that need to be resolved.” Translation? Plan for downtime. North Shore’s nine labs provide flexibility; when engineers tweak one lab the remainder takes up the slack, allowing the department to function efficiently.

One of North Shore’s current pilot projects with GE centers on Centricity Data Management, the company’s new report-generating database. The database allows physicians to access reports and images anytime/anywhere via the internet. “Access to diagnostic quality images from home is very useful for patients and physicians,” notes Katz. North Shore physicians can easily review images of patients from outside the local area, and offsite doctors can review angiograms with their patients.

Wisconsin Heart Hospital in Wauwautosa adopted a similar single-vendor approach when it opened the doors to a new state-of-the-art heart hospital early in 2004. “The hospital grew out of a physician vision to provide better cardiac care with greater efficiency and hopefully at a lower cost,” explains Cath Lab Director David Kasun.

That vision drove everything from architecture to policies, procedures and processes. It also led to the selection of Philips Medical Systems as the primary provider of the hospital’s solutions. The cath lab is equipped with four Philips FD10 flat panels, an Allura 15 vascular lab and XCLM Cath Lab Management system. On the image management side, the hospital relies on Philips Radiology PACS (EasyAccess and EasyWeb) and Xcelera Cardiology PACS.

Kasun says one advantage of the strategic alliance is a high degree of integration among systems. The hospital integrated its Philips Tracemaster monitoring system with the 12-lead EKG and EKG archive. The close relationship also means the hospital can turn to the vendor for problem-solving. For example, the hospital teamed with Philips to develop a comprehensive, aggressive training program for all staff.

The end product at Wisconsin Heart Hospital is a state-of-the-art, patient-centered cath lab. “Our intent is to be as comprehensive as possible. The hospital’s five cath labs perform diagnostic procedure, percutaneous interventions including drug-eluting stents and balloons, cool-tip ablation and patent foramen ovale (PFO) and ventricular sepal defect (VSD) closures. In the EP suite, the hospital has linked state-of-the-art cardiac arrhythmia mapping tools with CT imaging.”

Wisconsin Heart Hospital effectively blends high tech and high touch. For example, Xcelera PACS displays images wirelessly and via the web, so physicians can use tablet PCs to share images with patients anywhere on the campus. “This helps educate patients, and it’s a tremendous physician satisfier as they no longer need to draw pictures. Plus, they can access and review images from home before coming to the hospital to see patients admitted to the ER,” notes Kasun.


Efficiency matters


Excellent imaging certainly affords the ability to provide top-notch patient care. But another critical ingredient in the state-of-the-art cath lab is efficiency; an efficient operation enables healthcare providers to focus on patients rather than minutia.

The cardiac cath lab at St. Anthony Medical Center in St. Louis, Mo., relies on Camtronics PhysioLog hemodynamic monitoring and data management system and Vericis image and information management system. The benefits include increased accuracy, streamlined inventory and more comprehensive and accurate billing. “When a case is finished in PhysioLog, data are exported to Vericis. Physicians use the clinical reporting feature to create a structured report, which improves workflow,” sums Cardiology PACS Manager Cathy Gorman. Vericis also helps populate data for American College of Cardiology (ACC) reporting. “These processes used to be manual, so the new systems help us save time,” says Gorman.

Another timesaver/workflow booster is real-time inventory management. As stents and other inventory are used, nurses scan the product into Physiolog, which immediately removes it from inventory. In addition to providing a real-time view of inventory, the system has dropped the time required for year-end inventory reporting from two to three weeks to less than 24 hours.


Imaging impacts


“We are on the threshold of a revolution in imaging in the cath lab,” asserts Hart of The Richard M. Ross Heart Hospital. As direct digital detectors become mainstream, the next step is rotational angiography, providing the ability to develop 3D datasets from the cardiac cath lab. 3D and 4D ultrasound will become faster and more accessible to clinicians and 3T or 1.5 T MRI will allow MR-validated interventions, myocardial perfusion information and reduction of ionizing radiation to the patient.

Sixty-four slice CT will have a dramatic impact on the diagnosis of patients’ cardiovascular status. Interventional cardiologists at North Shore University Hospital use a 64-slice scanner, but Katz has seen little impact on cath lab volume. “Sixty-four slice CT will help us pick up patients earlier in the disease cycle and exclude more normal patients. Our lab has a 9 percent normal rate, which should decrease with 64-slice CT,” explains Katz. At the same time, Katz predicts that cath lab volume will increase because of demographic factors: diabetes, aging and obesity.


Advice from the cath lab trenches


As demographic factors and aging equipment collide, more healthcare facilities are finding themselves in the cath lab replacement market. Although every site is different, cath labs can gain from others’ experiences. Insiders offer a few tips:

  • Plan, plan and plan. A successful project requires stakeholders from multiple disciplines and leadership at all levels, says Hart.
  • Adopt a future-oriented vision. Look for upgradeable, expandable solutions that won’t be obsolete in one year, says Rizer.
  • Know your vendors, and use as few vendors as possible, says Kasun. Look for partners that provide the widest array of capital items. The new lab will benefit on the integration and financial fronts.

Making a commitment to a state-of-the-art project is a major undertaking, but it carries benefits on all fronts. Hospitals that have implemented state-of-the-art cath labs have realized improvements in patient care and efficiency via anytime/anywhere access to images and data. Costs may drop with improved efficiency and inventory controls and shorter patient stays. Staff and patient satisfaction is high with access to the latest procedures and solutions.

 

Where Cardiac Cath Lab Meets the OR

Perhaps no healthcare facility better illustrates the evolving nature of the cardiac cath lab than the hybrid cardiac cath lab suites at The Heart Center of Columbus Children’s Hospital in Ohio. The new suites are a direct reflection of the advances that have blurred the lines between cardiothoracic surgery and transcatheterization therapy for the treatment of congenital heart defects, says John P. Cheatham, MD, director of cardiac catheterization and interventional therapy.

The goal for the new rooms was simple: to improve patient outcomes by reducing the risks of treatment and combining the advantages of catheterization and surgery in one setting.

The lofty goal is unattainable in a conventional setting as a cardiac OR is geared to open heart surgery and lacks the imaging capabilities of a cath lab. When a cardiologist is called to the OR, he travels with mobile imaging systems and is forced to image through the table and often cannot image from complex angles. Similarly, the surgeon called to the cath lab for a surgical intervention is handicapped by setting designed to catheterization rather than surgery. “It was clear that we needed to design a venue to meet both needs,” sums Cheatham.

The new suites required imaging and ancillary equipment for cardiac anesthesiologists, an induction room, perfusion machine and surgical lights. Cameras had to be located to be unobtrusive to all participants yet provide complete access to the patient.

The planning and engineering processes took nearly seven years, but the hospital achieved its goal. Six Stryker-mounted monitors are placed in strategic locations around the suites to display all type of cardiac images and data including echocardiograms, angiograms, fluoroscopic and CT images and hemodynamic data. The two hybrid cardiac suites are linked to a cardiac teleconference center that provides access to real-time images and data from the suites to physicians throughout the hospital and around the world. Images can be transferred to a traditional cardiac OR, enabling interactive clinical conferencing among physicians. Data are transferred from multiple systems including GE Healthcare’s Centricity PACS; Camtronic’s Vericis echo archive and Agfa HealthCare’s Heartlab Encompass angiography archive.

Integration is critical, says Cheatham. “We needed to ensure that all vendors were compatible and capable of cross-talk.” The other major IT hurdle was the massive amount of data generated by Toshiba America Medical Systems Infinix CF-i/BP, which features a five-axis positioner and bi-plane flat-panel detectors. A single case can produce up to 1.5 gigabytes of data. Transmitting the angiographic images would crash the hospital network, so the hospital ran a separate fiber-optic video and audio network for the hybrid suites.

Building the world’s first hybrid cardiac cath lab suites required high-level, long-term planning and tremendous administrative support, says Cheatham. Hospitals must determine the purpose of the venue, which drives equipment decisions. Open lines of communication among all parties are critical as well. Clinical staff must communicate their goals and intended clinical applications to engineers to help them develop optimal solutions. Although the legwork is tremendous, the end result rewards the efforts.

The new suites demonstrate that the sum can be greater than its parts. The $8 million rooms improve patient care by providing an environment truly designed for a multidisciplinary team and enabling real-time information flow throughout and beyond the enterprise.