How the Cleveland Clinic streamlined operations in the cath lab

A team of healthcare professionals from the Cleveland Clinic detailed in JACC: Cardiovascular Interventions how they improved efficiency in their cardiac catheterization lab, providing a potential blueprint for other practices.

By switching their nursing scheduling structure, increasing the use of an electronic scheduling system and streamlining processes in the preparation and recovery areas, the lab improved start times by 17 minutes on average and reduced turnaround times by 4.1 minutes, leading to a gain of approximately 5.1 to 5.6 hours per day of cath lab time across eight rooms.

In addition, no significant changes were made in staff overtime, weekend or night cases, and employee satisfaction increased significantly after the implementation of the program.

“The changes with the most impact on efficiency seemed to be switching from a block to a pyramidal nurse staffing system to address scheduling inefficiencies, instituting an electronic whiteboard to decentralize communication between caregivers, and reducing barriers to patient transfer through increased utilization of a preparation and recovery ‘holding’ area,” reported lead author Grant W. Reed, MD, MSc, and colleagues. “In our experience, human resource management by promoting a culture of continual improvement and teamwork where each caregiver is appreciated and constructive feedback embraced was essential to realizing our goals and fostering employee ‘buy-in’ to the changes implemented.”

The researchers analyzed all procedures for one year before and two years after the program’s June 2014 start date. To design the program, a multidisciplinary team studied the workflow in a typical intervention to identify the time each step took, redundancies and where potential bottlenecks could occur.

They changed the schedule to allow more rooms to be open from 7:30 a.m. to 3:30 p.m. and adjusted the nursing schedule accordingly. Under the old system, four to five rooms were open from 7:30 a.m. to 7 p.m. With the new system, seven to eight were available from 7:30 a.m. to 3:30 p.m., and then one or two rooms were open until 7:30 p.m.

“With this change, approximately 80 percent of cases could be completed by 3:30 p.m., allowing a greater number of urgent and add-on cases to be completed earlier in the day,” Reed et al. wrote.

The authors encouraged other institutions to share their own efficiency improvement initiatives, which could educate other practices and “allow for comparison and standardization of delivery metrics in lab operations.”

While their study didn’t analyze patient outcomes, Reed and colleagues said streamlined workflow lends itself to better operational performance and improved patient care because staff members are more focused on the patient. In addition, efficiency is crucial as healthcare shifts away from fee-for-service payment models.

“In a bundled payments environment, the onus will be on the hospital and provider to use a fixed amount of resources to complete a given case, and thus reducing costs and utilizing resources as effectively and efficiently as possible will be paramount,” they wrote. “It is with this realization that quality improvement projects such as this one are essential to maintaining the financial health of providers and institutions.”

In a related editorial, R. David Anderson, MD, and Michael R. Massoomi, MD—both with UF Health at the University of Florida—pointed out some of the scheduling changes implemented at the Cleveland Clinic would be difficult to implement at smaller institutions with less staff flexibility. They said initiatives like this must be tailored to individual practices, but there are still lessons from the study that can be more broadly applied.

“One of the most significant achievements of this work is the assembly of stakeholders across the spectrum of care for patients who interact with the catheterization laboratory,” Anderson and Massoomi wrote. “The importance of this type of teamwork should not be underestimated, perhaps now more than ever. This in fact may be the part of their work most easily translated to other institutions.”