By: Faisal Latif, MD, FSCAI

As interventional cardiologists, we spend a considerable amount of time in the cardiac catheterization laboratory (CCL). Over many decades, best practices in the CCL have evolved, as has the complexity of the cases performed.

Various regulatory bodies consider the CCL as just another operating room (OR) and try to implement OR practices in the CCL. As the official representative body for interventional cardiology, SCAI published an expert consensus document in 2012 for best practices in the CCL. Recently, an update to the consensus document has been published¹ to efficiently manage the workflow in the CCL while ensuring high standards for safety and quality.

Structured fellowship training, careful case selection, and refinement of equipment have reduced the incidence of major complications in the CCL. The rarity of complications could make physicians and CCL staff “rusty” in the management of complications. Emergency drills are a useful way to keep ourselves prepared for such an eventuality. There is a table in the document with suggestions for this periodic exercise. Additionally, these drills are discussed in the September Tip of the Month.

Some of the highlights are:

A. Checklists are the hallmark of this consensus document! Here is a list of useful checklists the physicians and CCL staff can leverage to improve workflow:

1. Pre-procedure checklist
2. Minimum components of a “Time-Out”
3. Components of a well-written “Cardiac Catheterization Report”
4. Responsibilities of a CCL Director
5. Topics for emergency CCL drills
6. How to enhance patient satisfaction

B. Other interesting topics addressed in the document are listed below:

1. Credentialing Interventional Cardiologists
2. Hand-washing before each case is NOT mandatory!
3. Management of industry presence during cases
4. QA and M&M Conferences
5. Optimization of discharge instructions
6. Random case reviews
7. Hand-offs to referring physicians

This highly utilitarian document represents the efforts of a group of experts in the arena of cath lab quality improvement, is concisely worded yet broadly inclusive topically, and uses guideline recommendations or expert opinions where available. It will be a highly valuable resource to all SCAI-QIT champions going forward.

Reference

1. Naidu SS, Aronow HD, Box LC, et al. SCAI expert consensus statement: 2016 best practices in the cardiac catheterization laboratory: (Endorsed by the cardiological society of India, and sociedad Latino Americana de Cardiologia intervencionista; Affirmation of value by the Canadian Association of interventional cardiology-Association canadienne de cardiologie d'intervention).Catheter Cardiovasc Interv. 2016 Sep;88(3):407-23.