Technology Refresh: Integrating Cath Lab to CVIT

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DSC_3859.jpg - Gary Idelchik, Saratoaga Hospital
Image quality and low radiation dose were at the top of Interventional Cardiologist Gary M. Idelchik’s list in choosing a new interventional lab, the Innova IGS 530 from GE Healthcare, to launch the new PCI program at Saratoga (N.Y.) Hospital in January. The team at Saratoga chose a fully integrated, single vendor solution for the lab, hemodynamic monitoring and cardiovascular image and information management.

The semiconductor industry has been booming for a decade in Saratoga County, N.Y., driving a population surge that may be the fastest on the East Coast. In Saratoga Springs, just 35 miles north of the state capital of Albany and up to now best known for horse racing and mineral springs, the 190-bed Saratoga Hospital has grown from a community hospital to a regional, integrated, 130-provider delivery network. Growth seeded the need for a dedicated PCI program that went live in January along with a complete technology overhaul: cath lab, hemodynamic monitoring, echocardiography and a fully integrated cardiovascular information system. The PCI program, close to 100 interventions later, is now considered a jewel of the county and a model for other facilities considering a technology refresh.

‘I can see with excellent precision’

Looking back at how far they’ve come, and how fast, Saratoga’s PCI project leaders recall that once the decision was made to transition from transferring cardiac patients to treating them, recruiting the best and the brightest clinicians shot straight to job one.

“In developing a cardiac program, we recognized that there were multiple ways in which we had to invest,” says Mary Jo LaPosta, PhD, RN, chief nursing officer and senior vice president for patient care and organizational excellence. “First and foremost is investing in medical staff who are very, very good at what they do.”

The top recruit brought in to help launch the PCI program, Interventional Cardiologist Gary Idelchik, MD, describes job two: picking technology. Image quality and low radiation dose were his top priorities coupled with fully integrated imaging and reporting, says Idelchik who recently moved back to his roots, bringing along the skills of many successful years as a leading edge interventionalist in Houston.

He also advocated a single-vendor approach to help increase functionality and streamline product interfacing. “There are significant positives and advantages to going with a single-vendor solution,” says Idelchik, with the clear nod of LaPosta.

The fully integrated solution needed to give Saratoga’s clinical, operational and administrative teams the ability to extract quality data in real time, analyze that data and then make them readily available to external stakeholders, says Diane Bartos, director of intensive care services. The project team knew they needed to have “good collection of data [to spur] process improvements for physicians, nurses and technologists,” she says. “Everyone here works together to make improvements.”

All three recall that a consensus quickly formed, GE Healthcare was the right vendor to support their growth ambitions. The expansion was an evolution of productive relationships and solid services they already had in place. “It was a maturation of those processes,” LaPosta says.

They selected one of GE Healthcare’s Connected Cardiology Solutions—Innova IGS 530 for image-guided PCI with Mac-Lab IT for hemodynamic recording and Centricity Cardio Enterprise1 image and information management solution—which has allowed the institution to “put in the hands of our clinicians the appropriate technology,” says LaPosta. Seeing is believing for Idelchik. “I can see with excellent precision,” he says.

An integrated solution

While Idelchik’s relocation from Texas initially had much to do with his family ties in the area, after exploring several openings, he saw in Saratoga an opportunity to effect clinical improvements on a population scale. Most residents lived outside the American College of Cardiology’s recommended 30-minute range of access to PCI. Albany may be about a 45-minute drive, but traffic often gets in the way.

“From a true myocardial salvage scenario, when you have a heart attack, time is muscle,” says Idelchik. “One of the nice things about having PCI now in the backyard of this large community is that, instead of jumping into an ambulance for even elective PCI procedures, patients can now have it at the time of their initial diagnostic catheterization and go home the same day.”

Centricity Universal Viewer provides FDA-cleared remote access to diagnose and measure echocardiographic studies. There are “a lot of positives,” Idelchik says, in providing appropriate care both onsite and offsite for cardiac patients.

“With Centricity Cardio Enterprise and its integration with Mac-Lab, at the end of the case, I can already start my report,” he says. “The appropriate equipment and hemodynamics are already in the reporting system as well as what I did if there was an intervention.” This increases ease of use and efficiency, as documentation is often completed before the patient leaves the room.

During the procedure, interventions are documented including details on use of balloons, stents, guidewires and other devices. Mac-Lab procedural data automatically flows into Centricity Cardio Workflow so it can be utilized for the report and billing—another advantage of single-vendor integration. “We are more than just people who fix arteries and other cardiac structures,” Idelchik notes. “We need to be conscientious of supplies that were utilized, their cost, understand how much we are using of what. And having an integrated system allows me to have both that global view and a direct and specific view of getting the procedure done and reported.”

All this and a better bottom line, too

Growth of the PCI program has been palpable—“exponential,” Bartos says. “We are probably a good 50 percent up from where we were a year and a half ago.” To further propel that growth, the hospital looks to add a second interventional lab over the next 18 months to be shared by cardiology and radiology.

From the perspective of the bottom line, decreasing length of stay has probably brought the single biggest boost to economics, she notes. But it’s also true that, because the procedures are more efficient, per-day volume stands to increase—and billing can be done right away, on the heels of the instant and more complete reporting. 

“As we grow from a community hospital to a more integrated delivery system, the technologies from GE Healthcare have helped us keep patients in the community,” LaPosta says. The upgrade also has “offered the opportunity for our primary care physicians to readily refer patients to our cardiologists because we have improved capabilities in the lab. We are becoming more and more accountable to take care of the members of our community throughout the trajectory of their illness.”

The patient experience has been very positive, she says. “The community wanted us to have PCI. Even though a major tertiary care center is not that far away, when you have to go back and forth on a daily basis, for the families and for the patients, it is a lot. We are lucky that we just happen to be in the right spot, with all the growth in the population, to be able to support the program.”

For his part, Idelchik sees momentum turning this new PCI program into an established model that others can follow. “Our vision is to grow this program into not just one of the leading centers in the area,” he says, “but also a destination center for care in cardiology.” Stay tuned.