A Consensus on Cath Lab Patient Flow | Feature

Several vital components should be reviewed and documented prior to performing cardiac catheterization. The Society for Cardiovascular Angiography and Interventions recently published a clinical expert consensus statement on best practices in the cardiac cath lab.

The atmosphere of a catheterization laboratory poses challenges to maintaining and prioritizing high-quality care and patient safety. Despite these challenges, healthcare providers performing procedures in the cath lab are expected to maintain appropriate communication, clinical management, documentation, and universal protocol.

A Uniform Standard for Cath Labs

My colleagues and I, on behalf of the Society for Cardiovascular Angiography and Interventions (SCAI), published a clinical expert consensus statement on best practices in the cardiac cath lab in the March 20, 2012 online issue of Catheterization and Cardiovascular Interventions. Previous standards from the American College of Cardiology and SCAI have focused on how to set up a cath lab and run it as an administrator, but the new consensus statement focuses on the processes of patient flow.

Following cardiac catheterization, careful patient monitoring is crucial during the hospital stay.

Several vital components should be reviewed and documented prior to performing cardiac catheterization. Because percutaneous procedures are often complex, patients should be well informed about the procedure and their possible outcomes. When patients arrive at the cath lab, it’s recommended that a checklist be filled out documenting informed consent, history and physical exam information, medications, and allergies. It’s also important to document each patient’s candidacy for drug-eluting stents as well as sedation and anesthesia, their healthcare proxy status, and results of laboratory evaluations that are needed prior to the procedure. It’s highly recommended that use of any checklists cover all the nuances that can be easily missed if they’re not properly recorded.

The SCAI recommends that best practices during cardiac catheterization include a thorough review of patient medical records, access site concerns, allergies, blood test results, recent medication, advance directives, informed consent, and living wills. The “time out” protocol process should also be streamlined to only include aspects relevant to the cath lab, including verification of patient identification, procedure route and equipment needed, patient allergies, and special medical conditions.

Following cardiac catheterization, careful patient monitoring is crucial during the hospital stay. Communication with patients and their family, nurses, other hospital staff, and the referring physician is also important. Communication on results of the procedure and adherence to prescribed medications should be discussed verbally and documented. Post-procedure practices should include the scheduling of a follow-up appointment in 2 to 4 weeks (1 week for those with abnormal blood work or other potential complications) to confirm that the access site is healing, determine if there are any medication complications or problems, evaluate if there are any lifestyle limitations, and enroll patients into cardiac rehabilitation.

Looking Ahead with the SCAI Consensus Statement

Quality metrics in the cath lab are becoming increasingly important throughout the United States. Interest has grown in the timing of hospital discharge following PCI and ensuring that patients are undergoing necessary and appropriate procedures. Future iterations of the SCAI consensus statement will likely include sections that address these areas from a patient care standpoint. The next revision to the consensus paper is expected within 3 to 4 years as more data emerge. In the meantime, healthcare providers practicing in the cath lab can use the current document to help maximize care quality, enhance patient safety and efficiency within the cath lab, and increase physician and patient satisfaction alike.

Additional Resources:

Naidu S, Rao S, Blankenship J, et al. Clinical expert consensus statement on best practices in the cardiac catheterization laboratory: Society for cardiovascular angiography and interventions. Catheter Cardiovasc Interv. 2012, March 20 [Epub ahead of print]. Available at http://onlinelibrary.wiley.com/doi/10.1002/ccd.24311/abstract.

Singh M, Holmes D, Lennon R, Rihal C. Development and validation of risk adjustment models for long-term mortality and myocardial infarction following percutaneous coronary interventions. Circ Cardiovasc Interv. 2010;3:423-430.

Peterson E, Dai D, DeLong E, et al. Contemporary mortality risk prediction for percutaneous coronary intervention: results from 588,398 procedures in the national cardiovascular data registry. J Am Coll Cardiol. 2010;55:1923-1932.

Krumholz H. Informed consent to promote patient-centered care. JAMA. 2010;303:1190-1191.

Jamula E, Lloyd N, Schwalm J, et al. Safety of uninterrupted anticoagulation in patients requiring elective coronary angiography with or without percutaneous coronary intervention. A systematic review and meta-analysis. Chest. 2010;138:840-847.

Berwanger O. Acetylcysteine for prevention of renal outcomes in patients undergoing coronary and peripheral vascular angiography: main results from the randomized acetylcysteine for contrast-induced nephropathy trial. Circulation. 2011;124:1250-1259.

Chambers C, Fatterly K, Holzer R. Radiation safety program for the cardiac catheterization laboratory. Catheter Cardiovasc Interv. 2011;77:546-556.

Best P, Skelding K, Mehran R. SCAI consensus document on occupational radiation exposure to the pregnant cardiologist and technical personnel. Catheter Cardiovasc Interv. 2011;77:232-241.

 

 

 

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