SCAI Publishes Best Practices For Cardiac Catheterization Laboratories

March 20, 2012—The Society for Cardiovascular Angiography and Interventions (SCAI) announced that the paper, “Clinical Expert Consensus Statement on Best Practices in the Cardiac Catheterization Laboratory,” was published online ahead of print in Catheterization and Cardiovascular Interventions.

“Interventional cardiologists are guided by a number of quality improvement tools, including guidelines and appropriate use criteria, but consensus opinion on best practices for how to run these cath labs has been missing until now,” commented Srihari S. Naidu, MD, who is lead author of the paper. “This paper represents the most current, evidence-based approach to continually improving the safety and care of interventional cardiology patients in cath labs across the country and the world.”

According to SCAI, the paper recommends best practices that should be upheld by interventional cardiologists and other medical staff performing procedures in the catheterization lab setting. The best practices are divided into three categories: before the procedure, during and after the procedure, including follow-up evaluation. The recommendations address the following:

• Assembling an optimal cardiac catheterization team. Physicians should maintain proper credentialing and other members of the medical staff should also have the proper certifications and experience. In addition, procedure outcomes, including success rates and observed complications, should be documented.

• A preprocedure checklist for cardiac catheterization that guides the attending physician through a list of questions to review and verify prior to initiating the procedure. A common tool used in other medical specialties, the checklist includes affirmation of the procedure type, precatheterization assessments, as well as reviewing the patient's health history, ability to adhere to medication regimens, informed consent, sedation, and allergies.

• Receiving informed consent. Included within preprocedure best practices is the importance of receiving informed consent from the patient, ideally with a third-party witness. The paper points out the importance of verifying the patient fully understands what the procedure entails; the risks, benefits and alternatives to the treatment proposed; as well as potential outcomes and complications that may occur during and after the procedure.

• A recommended “time out” protocol to be performed immediately before the procedure and when all members of the medical team are present. During this “time out” period, patient identification is verified, as is procedure route, procedure equipment, patient allergies, and special medical conditions.

• Patient preparation in the procedure room. Best practices during the procedure include a thorough review of the patient's medical record, access site concerns, allergies, blood test results, recent medications, advance directives, informed consent, and living wills.

• Appropriate postprocedure communications and evaluation. After the procedure, the patient must be carefully monitored during the hospital stay. The physician should discuss the results of the procedure, as well as complications, unexpected findings and events with the patient and family as well as with the healthcare providers who will assume care of the patient. The physician should also explain the important role of patient adherence with prescribed medications.

• Planned follow up. Best postprocedure practices include scheduling the patient's follow-up appointment 2 to 4 weeks after discharge to confirm the access site is healing, ascertain that there are no medication complications or problems with adherence, evaluate current lifestyle limitations and enroll in cardiac rehabilitation.

• Quality assurance protocols. Each cardiac catheterization lab should have processes in place for nonbiased, education-based peer review of procedures.

“SCAI's commitment to quality improvement is unwavering, and we are confident this paper will only serve to improve cath labs and the work we do for our patients,” stated SCAI President Christopher J. White, MD. “This paper will provide a benchmark for cath labs to base their current practices on and help set future goals elevating the standard of patient care across the practice.”