Abstract 322: Optimizing Cardiac Catheterization Laboratory Utilization

Abstract

Background: Optimizing efficient utilization of the catheterization lab is an important concern. Inefficient use of this limited resource increases costs and can compromise patient care. At times of high hospital and specialty care unit census, cath lab throughput is also limited by the availability of recovery beds which may further compromise efficient throughput. At SBUH the cardiac cath lab is staffed from 0630-2300 daily Monday-Friday with an on-call team to provide 7 x 24 hour coverage for STEMI’s. Lab usage was evaluated to determine if this was an efficient and effective use of this limited resource. Methods: All cardiac catheterizations during the period of 10/1/12-12/31/12 were reviewed. The distribution of daily cases, mean and median hours to catheterization by day of the week and median length of stay (ALOS) were determined. Elective outpatient, inpatient, and emergent cases were included. Results: There were a total of 997 cases during this quarter. Average weekday case volume ranged from 13-17 cases/day with the greatest average number of cases performed on Mondays (24% of the weeks cases). Median hours to the cath lab averaged 4.2 hours with the greatest delay on Mondays (5.4 hrs) and Fridays (5.7 hrs). The median number of hours to the cath lab was 31.3 hours with the greatest delay on Fridays (38.5 hrs) and gradually decreasing times from Monday through Thursday with the lowest time delay being on Thursdays (18.9 hrs). The median length of stay averaged 1.11 days, with Mondays patients averaging the longest stays at 1.26 days. There were 45 emergent STEMI cases (5% of the total) during the reviewed period. Conclusions: The marked disparity in mean and median hours reflects a skewed distribution, with many inpatients delayed in going to the CCL. Both median and mean hours were prolonged on Mondays and Fridays along with median length of stay. Further drill down suggested hand-offs, inter-hospital transfer delays, high bed occupancy, and high patient volume contributed to delays on these days. Operator availability, procedure variance, and case mix also contributed to distortions in scheduling and the effective use of lab time. Mid week, Wednesday, was the most efficient day. Block scheduling has since been implemented to better accomodate operators and procedure types within the current staffing constraints. Also as a result of this analysis fewer outpatients are being scheduled on Mondays, changes have been made in ACS protocols, hand-offs, rounding and transfers, and opening the cath lab on a weekend day for inpatients is planned.