Several years ago, the Society for Cardiovascular Angiography and Interventions (SCAI) published an expert consensus statement on best practices in the cardiac catheterization laboratory (CCL) to provide clinicians with standards for pre-, intra-, and post-procedural evaluations and patient management. The document, released in 2012, offered important recommendations for taking a patient-centered approach to safety and quality in the CCL, a setting in which high throughput and increasing patient complexity demand optimal peri-procedural communication, clinical management, documentation, and protocols.
“In 2016, SCAI updated this consensus statement to better address process standardization in CCLs,” explains Srihari S. Naidu, MD, FACC, FSCAI, FAHA, who was lead author of the 2016 update as well as the 2012 paper. “Many CCLs had been working under only local regulation and policies. Over the past several years, there has been increasing interest among interventional cardiologists for a comprehensive document that outlines the details on how CCLs should operate.” He adds that it is important to tailor directives to the percutaneous setting in order to assure quality, optimize patient safety, and maintain efficiency.
A Helpful Update
The 2016 update from SCAI, published in Catheterization and Cardiovascular Interventions, outlines best practices in the CCL with a set of evidence-based, agreed-upon recommendations that were developed by expert interventional cardiologists. The update was designed to improve patient and physician satisfaction by offering pre-, intra-, and post-procedure recommendations to ensure the highest quality of care and improve patient outcomes.
An important component to the SCAI update is an updated pre-procedure checklist for cardiac catheterizations. The checklist provides nurses, technicians, physician extenders, and physicians with a set of questions to review with patients before they undergo these procedures. “The checklist notes that all members of the procedural team must be present for a ‘time out’ before the procedure takes place, immediately before vascular access is obtained,” says Dr. Naidu.
The physician taking ultimate responsibility for the procedure should lead the time out and ensure that each of the following items is announced:
- The patient’s name and medical record number.
- The precise procedure to be performed.
- Confirmation that the equipment needed is available or alternatives are available, including intended stent type for PCI or cath-possible patients.
- The patient’s allergies and pre-medication, if appropriate.
- Any special laboratory or medical conditions the patient may have.
- Confirmation that informed consent was signed, witnessed, and present.
“The SCAI update also provides clinicians with techniques on how CCLs can improve function through effective governance and management strategies,” Dr. Naidu says. In addition, the document outlines specific strategies that CCLs can employ to provide the highest value of care.
When SCAI released its previous recommendations in 2012, the document did not cover information regarding the recent support for using radial access procedures. “The SCAI update now includes best practices on when radial access is appropriate and factors that CCLs should take when considering using this treatment approach,” says Dr. Naidu. “The update also provides clinicians with new evidence on medications that have been brought to market since the last consensus document was published, including information on when to use certain drugs and the appropriate dosage amounts of these medications.”
Maintaining Industry Relationships
Recommendations on maintaining appropriate industry relationships are a new addition in the SCAI update. “This is a hot-button topic,” Dr. Naidu says. “SCAI recommends that industry’s role in individual CCLs should be consistent with policies set by the hospital and/or director.” Industry should not have “hands-on” equipment in the CCL, except for defined educational purposes or device preparation. In addition, it is recommended that industry always provide information and advice that is in the best interest of patients, regardless of other considerations.
The SCAI update to the expert consensus statement also cross-references other SCAI reports and documents, reflecting the direction in which the profession of interventional cardiology is heading. “These recommendations are patient-centric and strive to enhance patient satisfaction,” says Dr. Naidu (Table below). “The document also specifically addresses cost containment strategies that should be implemented when managing all patients in the CCL.”
The measures outlined in the SCAI document are critical to patient safety, laboratory efficiency, and patient and referring physician satisfaction. Healthcare systems should provide resources through adequate staffing, equipment, and information technology—including physician extenders where appropriate—to ensure that the performance of these practices are effective and that they be reviewed from time to time.