The Providence St. Vincent Medical Center Cath Lab Team
High TAVR volume, a diverse mix of cases, high-profile clinical trials, and live cases all keep this team on their toes.
The cath lab team from Providence St. Vincent Medical Center in Portland, OR, is the first group to be nominated for a profile on Cath Lab Forum. They were described by their nominator as “ an outstanding group with great outcomes and quality embedded in everything they do.”
The Providence St. Vincent Valve Team is one of the highest-volume TAVR sites in the nation and the highest-volume site in Oregon. Recently, the cath lab and OR teams received an interprofessional team award for demonstrating excellence in TAVR. Cath Lab Forum spoke with Valve Program Coordinator Marla Craft, RN, MS, and Cardiovascular Lab Manager Tracy Lee Cantrell, RDCS, RDMS, RVT, RT, about how they keep their teams efficient and cohesive.
What is the size of your cath lab, and what are your most common day-to-day procedures ?
Cantrell: Currently, we have seven rooms and one is our hybrid room we utilize with the CVOR. We usually run five rooms a day. Right now we are in the process of expanding our staffing model and adding three 12-hour teams. When that's completed we'll have about 42 staff including CVTs, RTs, and nurses. We do a mix of cardiac procedures—diagnostic coronary angiography, PCI, significant numbers of TAVR, as well as MitraClip (Abbott) and Impella (Abiomed) cases—on a regular basis. In addition to that, we also do a fair number of neurovascular, interventional radiology, and vascular procedures.
How do you stay efficient as a team?
Cantrell: That is something that we are really focused on, and it’s an ongoing process. We have worked hard to implement programs that will increase both our efficiency and the quality of care that we provide to our patients. For example, we have individual focus groups aimed at specific areas where we have identified issues. These groups meet regularly and discuss things such as barriers that are causing delays in cases. Everyone on the team participates in these discussions so that we all have a voice and a point of view to share.
Another thing that has been a little unique for us as a team is that another hospital in our area recently shut down their heart transplant program, so we have taken over to provide care for most of those patients. As a result, our volumes have increased pretty rapidly and we are working with other departments on ensuring that our patients continue to flow through safely and efficiently, avoiding delays in all areas from admitting, to recovery, and being routed home.
Craft: I work with the cath lab and OR teams on our structural heart workgroup, a multidisciplinary team devoted to quality and efficiency improvement. It took about a year of planning to create the workgroup, but it came out of a real desire to improve communications between individual team members and the team as a whole. Everyone is so focused daily on their own job, but it’s also important for all of them to really step back and look at how they are performing as a team, both in terms of where they are doing things well and where they need to improve. With TAVR, in particular, it’s a fast and evolving field, so we look at every interval in the process with a goal of minimizing lag time and optimizing workflow. One big obstacle is how busy we are because we have seen a huge growth in the volume of our structural procedures. We sometimes are having to overlap cath lab teams to minimize delays between cases, and that's a challenge for us right now.
Another thing we do is we have a 2-hour period reserved every week for the entire cath lab team to learn about new devices and new technologies. We also have daily touch-base meetings with managers, so they know what's coming up each day and can plan ahead to match staff skills with the cases. The best way to be prepared is to know what is coming our way and keep everyone in the loop.
You recently participated in your first live case, which was broadcast at TVT 2019 in June. How did that go?
Cantrell: It was a big collaboration with our CVOR department, valve coordinators, and physicians. We were honored to be asked to participate. The procedure was a transcarotid TAVR case performed by Eric Kirker, MD, and Ethan C. Korngold, MD, in our hybrid cath lab. We’re pleased to say that it was a very successful case. In addition to the cath lab and CVOR teams preparing for the specifics of the case itself, we also got a lesson in satellite signals and other technical aspects of participating in something that is being broadcast live thousands of miles away.
What are some of the clinical trials and novel technologies in which you are involved?
Cantrell: We are an official study site for the PARTNER 3 trial, and its mitral valve-in-valve and aortic Valve-in-Valve (AVIV) studies. ILUMIEN IV—which utilizes OCT—is another of our ongoing studies. We will also be participating in the APOLLO trial of the Intrepid Mitral Valve Replacement system (Medtronic), and we also were one of the early sites using the Impella CP with SMART ASSIST (Abiomed).
Is there a particular case or patient that has been memorable to the team?
Cantrell: Several years ago we collaborated with a team from maternity to deliver a baby via C-Section. The mother had a bleeding disorder, and there was concern about bleeding during the procedure. We accessed both groins and placed balloon catheters into each hypogastric artery to control bleeding. The maternity team was in awe of our technology, which is a relatively simple aspect of our responsibilities. At the same time, our team had the opportunity to see obstetric technology being carried out as a new life was brought into the world. It was a very special shared event of two separate, unrelated medical teams from our facility.