Q&A: Filling A Void with a Cath Lab Boot Camp

The Society for Cardiovascular Angiography and Interventions (SCAI) will launch a leadership boot camp for cath lab directors and managers at its scientific session May 28-31 in Las Vegas. Charles E. Chambers, MD, president-elect of SCAI, and Robert J. Applegate, MD, chair of SCAI’s education committee, discussed the new initiative with Cardiovascular Business.

Is this an inaugural event?

Chambers: Yes. This came out of a think tank that SCAI ran several years ago on quality. We often have physicians appointed or selected to this [cath lab] position but there is no good tutorial or support group. It became obvious that this needed to be expanded beyond the physician, not just [because] the physician and nonphysician organizations have to coexist for this to be successful, but there also is not a good tutorial for the nonphysician side.

What did you learn from your surveys and focus groups?

Applegate: There were two principal consensus opinions which were voiced. One was, no one told me what I was supposed to do when I became the medical director. I didn’t really know what I was getting into. It was clear responsibilities varied depending on the type of medical center.

Two, everybody realized they were being asked to perform functions that they didn’t have experience with. Some of it was business-related, some of it was personnel-related, contract-related, conflict resolution. With the importance of the hospital and difficulty in the healthcare environment making ends meet, it was clear that potentially the cath lab could be a huge cost center. Anything that you can do to better inform us and give us the information, skills and resources to do this would be very welcome.

Are the presentations based on consensus or determined by the presenters?

Applegate: This clearly is evolving as we think about it and put it together. Like anything else, when it is the first time you talk to a lot of experienced cath lab directors who work closely with administrators and you try to come up with the areas that are important. In terms of developing a consensus, we will see that as we go.

Chambers: It is important to look at this as the first part of a multipronged approach to the cath lab leadership boot camp. We will have this inaugural lecture. We hope to have online offerings. We hope to even create list serves where you can have communication.

One of the biggest enthusiasms from my perspective as seen at the focus groups was a smile on their faces; they now have someone to talk to. To a degree, you are out there and you are on your own. It is nice to say that now someone recognizes a need for this and is creating a group, a communication offering, a list of cath lab directors throughout the country. You would be surprised at how challenging that is to put together.

How did you do that?

Chambers: Still a work in progress. You would think it is easily extractable. By working with industry, our database, some of the other databases, we gradually are getting this list together. That has been a focus of Dr. Applegate’s from the beginning, is to emphasize the importance of this list: who we are talking to, why and to make sure their needs are being met. 

Applegate: There is a potential here for creating a group within interventional cardiology. [They] need a set of standards and a body that can represent them because of the importance of the role of the cath lab director in helping implement some of the quality initiatives essential to moving our field forward.  The cath lab director is the interface with the hospital administrator, the physicians in the group and may be the only physician within a cath lab who takes a look at all the cases being performed.

Do you expect attendees will have a variety of experience levels?

Applegate: Some have been in the position for a long time but frequently there is a lot of turnover as physicians move from one hospital system to another. As new people come in, some don’t like administrative responsibilities after a number of years. We are going to see a diverse group in terms of their experience. We must provide skills and resources for all of those levels.

How will you do that within one program?

Chambers: You have to have a multimodality approach. You start with an inaugural session. You get it as [widely] broadcasted as possible, to get the word out. Then you present what you think—and that is why we talked [to] the heads of the education, quality improvement, efficacy and executive committees—is a good start based on the focus groups and the surveys, of where to go. Then you respond, react and alter what needs to be done based on the initial outlay.

Applegate: If you look at the structure of the schedule, we intend this to be fairly interactive. There will be standard didactic presentations but several times throughout the program we will poll the audience to see if we are on target. There will be exit polling as well to help us better understand.

It may be that perhaps interaction with hospital administrators and contracting and things related to that will emerge as the dominant area of interest. We honestly don’t know. Maybe the experience level. We will try to sort through all of that.

How will you determine if this was a success?

Applegate: At the annual meeting we routinely send out questionnaires to attendees and ask what they thought of a particular presentation or session or track, since we divide the program into four tracks. We will do the same thing with this program.

Chambers: Also, the plus is that this is the kickoff part of the program. It is the first days of the program, arguably even before it officially starts, and that will give [us] the whole meeting as well as the Thursday afternoon session to constantly discuss, develop, get feedback in addition to follow-up surveys during that three-day period. 

Do you plan to continue this?

Chambers: Absolutely.

Applegate: One of the other vehicles that SCAI has used recently is regional programming. This could be floated at the SCAI annual meeting to see if this kind of regional cath lab boot camp can go on the road. My thought would be this could be incredibly productive and valuable.

Anything else?

Applegate: This is very timely as we see more and more cath labs and hospital systems [provide] programs and therapies like TAVR [transcatheter aortic valve replacement]. It has brought together a number of people who before would not have talked together in a meaningful way. It is not just paying lip service to have a heart team. It really is a very valuable, new direction.

What I would like and expect to come out of this is the same sort of integration. It is not just the nurses and techs and lab and the docs [going their own ways]. We literally are seeing an evolution as we go forward and this boot camp can help energize that. It may be the symbolic start of a cath lab concept where it really is the cath lab team.

Chambers is director of the cardiac catheterization laboratory at the Penn State Hershey Medical Center in Hershey. Applegate is an interventional cardiologist at Wake Forest Baptist Health in Winston-Salem, N.C.