Planning and creating the best cath lab for your facility and market requires a wide range of considerations, from current and future business patterns to space design to workflow and communication concerns. A good plan that includes input from all the relevant stakeholders goes a long way toward a successful long-term venture.
A successful cath lab or heart center requires a realistic view of current and future business. You don’t want to overestimate and spend a small fortune on space that is underused and offers little return on the investment. You also don’t want to underestimate and not have enough space to accommodate current and growing volume. Unfortunately, hindsight is 20/20 vision, which is particularly applicable to the planning and design of cath labs.
Among the first considerations is whether to build new or renovate existing space. Depending on the status of the existing space, it can be cheaper to build new, says Georgann Bruski, director of contracting CVI at Beth Israel Deaconess Medical Center in Boston and principal consultant for radiology and cardiology services of ADVANCE Healthcare Consulting. If the ceiling height has to change to accommodate equipment, or the existing conduit is not compatible and floor drilling has to occur, costs can quickly add up.
More recently, Bruski says facilities are overestimating their cath lab business and building more than they can use. “They believe that ‘if they build it, patients will come.’ That might have been true five years ago, but it’s not true now.”
She cites a facility that built two cath labs but now performs only five procedures a day. The organization should have partnered with physicians and created a business plan to determine where their patients will come from, she says. “You have to design an RFP [request for proposal] for your needs. Set a goal of expected revenue.” A cath lab is a very expensive undertaking. Besides the initial set-up costs, people often don’t consider the annual operational fees—which can run more than $100,000 a year in equipment maintenance.
Facilities and practices need to thoroughly evaluate the marketplace to determine if it will generate enough volume to pay for a cath lab, says Susan N. Heck, vice president of Corazon, a cardiology consulting firm in Pittsburgh, Pa. “It’s a complex question. It’s not all about bricks and sticks,” she says. Aside from ensuring that there are enough patients, a good program requires reliable cardiologists. Since you can’t run a cath lab without physicians, you need doctors willing to commit to the facility.
“Our experience is that, if you work at it, you’ll find doctors who will partner with the hospital and commit to provide that service.”
South Shore Hospital in Weymouth, Mass., transformed its cardiovascular services in 2006. Accurate volume projections were essential, says Bill Burke, director of cardiology, since the hospital was considering a $13.5 million expenditure—its largest expenditure ever. The whole project took 18 months from first drawings to the open house. Corazon oversaw task forces for clinical workflow, patient and family experience, and facilities, which included IT infrastructure, equipment and staffing. Corazon’s work allowed the facility’s team to “focus purely on building and designing rather than worrying about the operational piece,” Burke says.
Data indicated that the area had a slightly higher than state average prevalence of cardiovascular disease, Burke says. To capture the market right away, the facility went live with a 24/7 emergency angioplasty program, which quadrupled volume in short order. Soon after, the hospital began offering elective angioplasty. South Shore is participating in the Mass Comm Trial, a randomized trial comparing the safety and long term outcomes for percutaneous coronary intervention between Massachusetts hospitals with cardiac surgery onsite and community hospitals without cardiac surgery backup. At this point, the first batch of data is being reviewed and Burke hopes the results will provide a “stamp of approval” on the process.
For now, the hospital has realized the fruits of its labor in terms of door-to-balloon (D2B) outcomes, Burke says. Last year, 88 percent of patients had D2B times of 90 minutes or less. This year, the number improved to 95 percent. The facility also is about four standard deviations below the mortality rate for acute myocardial infarction of angioplasty patients for its area. “That crystallized it