Teams of surgeons and interventionalists work in tandem in the hybrid OR at the Heart Hospital Baylor Plano in Texas.

Novel ways of approaching the cardiovascular disease process, such as in the hybrid OR/cath lab suite, are becoming increasingly common. A hybrid lab sets the stage for cutting edge cardiovascular interventions and facilitates collegiality among varied specialties. There are, however, several challenges to overcome when planning and initiating a hybrid OR/cath lab including turf, expenses and accounting.

Designed for whom?

The design of the hybrid suite will depend on the specialists who use it. A room used by interventional radiologists and interventional cardiologists will look vastly different from one used by interventional cardiologists and cardiothoracic surgeons. In reality, though, it’s not so much about equipment as it is about the culture of collegiality.

“We are very strong believers that this type of multidisciplinary approach is the way the world is going and unless you have this hybrid workplace, you will be left out of much cutting-edge cardiovascular treatment,” says Mike Mack, MD, medical director of cardiovascular surgery at Baylor Healthcare System in Dallas and co-director of cardiovascular research at Heart Hospital Baylor Plano.

Ten years ago, David Brown, MD, director of interventional cardiology and co-director of cardiovascular research at the Heart Hospital Baylor Plano, taught Mack how to do heart catheterization in the cath lab. But not every facility will have such willing collaborators among different specialties.
“[A lack] of collaboration and convergence is a major obstacle in many U.S. institutions that perform cardiovascular work,” says Brown. “But that has to change going forward in terms of patient quality and healthcare costs.”
 

Cost & consensus

Building a hybrid lab is not for the faint of heart. The cost can be upwards of $2.5 million. The Baylor system has two suites: one from Siemens Healthcare and one from Philips Healthcare. “It’s important when planning for a hybrid OR to engage the hospital CEO, highlighting patient care and marketing advantages to hybrid procedures, and use vascular volumes and revenue to build your case,” says Angela Riley, RT, executive director of the Cardiopulmonary Research Science and Technology Institute in Dallas. Riley also emphasizes the creation of an oversight committee, including multiple specialties such as physician users and key department directors from the cath lab, OR, interventional radiology and IT.

The staff should be a blend of cath lab and OR personnel, and hospital administrative support must be gained to minimize department conflicts surrounding charging, scheduling and productivity. During a two-day symposium on hybrid technologies at the annual meeting of the American Association for Thoracic Surgery in May, participants raised concerns about where to charge expenses. “Most accounting systems are not set up for this type of cross-fertilization,” Mack says.

Riley says hospital administration needs to decide whether costs will be borne by the cath lab or the OR.

To be successful with this approach, due diligence includes getting all stakeholders on board and answering key questions. Will it be used for peripheral interventions or electrophysiology procedures, as well as by interventional cardiologists, radiologists, vascular and cardiothoracic surgeons? Is there existing space? Does that space have to be remodeled? Who will staff the new room? Who will bear the charges?

In this new frontier with no templates and few published “how-to” articles the bottom line for success is cooperation and consensus among the various disciplines.