Cath Lab ‘Best Practices’ Handbook Gets an Update, Including Tips for Relations With Industry Reps
Cardiac cath lab directors now have an updated go-to document for answers about everything from what should go in postprocedural reports to how to manage industry relationships.
The Society for Cardiovascular Angiography and Interventions (SCAI) released this week their second expert consensus statement on best practices in the cath lab. The newer version adds several components not seen in the first edition published in 2012.
“All cath labs in the country are all trying to do the same thing, which is to deliver high-quality care and a process that prioritizes patient and physician satisfaction while being fiscally responsible,” writing committee chair Srihari Naidu, MD (Winthrop University Hospital, Mineola, NY), told TCTMD. “We’d like cath labs to standardize their practices, so that as a community we support each other in terms of what expert opinion is on how to run a cardiac cath lab.”
The new document beefs up the preprocedural checklist offered in the first version, adds sections on radiation exposure and “time out” procedures, and tackles the topic of cath lab governance especially related to industry presence and cost control. Specifically, the writing committee wanted to address new data that have been published in the last 4 years related to medications like ADP antagonists, Naidu said.
The governance section was a “very clear glaring omission” of the 2012 consensus statement, he noted. “This document recognizes that industry relations with the cath lab are a vital part of the flow and quality and care . . . as long as they live by a set of rules that makes sure that relationships are not about business but rather about quality care.” Specifically, the consensus statement does not dictate exactly how often industry reps can visit the cath lab, but rather suggests that institutions should set consistent guidelines based on their own needs.
His overall hope is that regulatory bodies can use this document to evaluate institutions in a consistent manner “rather than putting their own regulations in place for individual areas of the country,” Naidu said. They plan on publishing another update by 2020.
A Needed Update
Commenting on the statement, Morton Kern, MD (University of California, Irvine), told TCTMD that cath lab leaders need to be cognizant of industry’s proper role in the cath lab. “Industry now can’t just come rolling in the door randomly and camp out,” he said, adding that many hospitals have instituted stricter policies in the last 4 to 5 years regarding reps in the cath lab. “My own preference is that there should be some balance between industry-sponsored education activities . . . without too much influence in terms of gifts, goodies, and giveaways, [because] education is something we need and can’t get through most other means.”
So while cath lab leaders have been aware of potential conflicts with industry for some time, Kern notes, blanket rules have never been expressly spelled out and the issue has not been “as widely appreciated as it will be after this report.”
As author of The Cardiac Catheterization Handbook, he is well aware of the logistical issues that cath lab physicians and administrators face. While the updated SCAI consensus statement is a concise distillation of content already existing in textbook form, Kern thinks it will be a “widely read and used document.” Its updated tables and checklists were needed by the community, he continued, adding that he will likely include many of them and a section on cath lab governance in the next iteration of the Handbook.
Naidu SS, Aronow H, 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;Epub ahead of print.
- Naidu and Kern report no relevant conflicts of interest.