Author + information
- Received July 11, 2017
- Revision received September 5, 2017
- Accepted September 11, 2017
- Published online February 19, 2018.
- Grant W. Reed, MD, MSc,
- Scott Hantz, RN, MBA,
- Rebecca Cunningham, BSN, RN,
- Amar Krishnaswamy, MD,
- Stephen G. Ellis, MD,
- Umesh Khot, MD,
- Joe Rak, MBA and
- Samir R. Kapadia, MD∗ ()
- Heart and Vascular Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
- ↵∗Address for correspondence:
Dr. Samir R. Kapadia, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J2-3, Cleveland, Ohio 44195.
Objectives This study sought to report outcomes from an efficiency improvement project in a large cardiac cath lab.
Background Operational inefficiencies are common in the cath lab, yet solutions are challenging. A detailed report describing and providing solutions for these inefficiencies may be valuable in guiding improvements in productivity.
Methods In this observational study, the authors report metrics of efficiency before and after a cath lab quality improvement program in June 2014. Main outcomes included lab room start times, room turnaround times, laboratory use, and employee satisfaction. Time series analysis was used to assess trend over time. Chi-square testing and analysis of variance were used to assess change before and after the initiative.
Results The principal changes included implementation of a pyramidal nursing schedule, increased use of an electronic scheduling system, and increased utilization of a preparation and recovery area. Comparing before with after the program, start times improved an average of 17 min, and on-time starts improved from 61.8% to 81.7% (p = 0.0024). Turnaround times improved from 20.5 min to 16.4 min (trend p < 0.0001), and the proportion of days at full lab utilization improved from 7.7% to 77.3% (p < 0.00001). There were no increases in overtime, night, or weekend cases. There was a reduction in full time employees from 36.1 in 2013 to 29.6 in 2016, with an improvement in employee satisfaction.
Conclusions A systematic approach to reducing inefficiencies can improve cath lab start times, turnaround times, and overall productivity. This knowledge may be helpful in assisting other cath labs in similar efficiency improvement initiatives.
Dr. Khot is a consultant for AstraZeneca. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 11, 2017.
- Revision received September 5, 2017.
- Accepted September 11, 2017.
- 2018 American College of Cardiology Foundation