Why would a cardiologist want to have patients drive into the heart of Philadelphia to a tall medical building (Hahnemann University Hospital’s Bobst Building) on a busy downtown corner (Broad and Vine Streets) to have a heart catheterization performed?

Good question, says Joseph Stern, but there also is a good answer: in fact, there are many reasons. Stern was one of the original proponents of the freestanding catheterization laboratory. “In a hospital setting, cardiologists have to contend with a logjam of patients at various levels of risk, and diagnostic cases often get bumped,'” he explains. “With the opening of the freestanding Cardiac Care Center, which specializes in cardiac catheterizations, cardiologists can do these procedures in one place instead of several different hospitals. In addition, with the state-of-the-art equipment there is no downtime, and the enhanced work flow ensures even greater time-efficiency for cardiologists. They find they can complete many more procedures within a 4-hour block of time at the center than at other facilities.”

The quality of the facility has been officially recognized by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), which awarded it a rating of 97 (out of 100) and its gold seal. “Physicians know that we monitor our protocols very carefully,” Stern says, “And even though we are not affiliated with the Hahnemann Hospital, they like knowing that a hospital operating room is so close at hand if it is needed.”

The accreditation is in effect for 3 years, but as part of ongoing JCAHO compliance, certain performance improvement tasks are undertaken at the center. These include performing studies, such as a recently completed year-long analysis of rates of complication following cardiac catheterizations performed at the facility. Among the 1,027 patients studied, the rate of complications (such as infection) was 0.013. In another study, it was determined that the use of 4-French catheters allowed the postprocedural bed-rest time to be reduced by one half (see Clinical Protocol).

As another feature of JCAHO compliance and performance improvement, physicians are given reports on particular aspects of the catheterization procedure. For instance, one monthly report details the “fluoro time,” ie, the interval between the patient’s arrival in the procedure laboratory and the completion of the procedure. Other reports analyze contrast use and patient satisfaction. Physicians also receive a quarterly survey for reporting rates of infection among the patients who have undergone a catheterization at the Cardiac Care Center during that quarter.

One recent study at the center showed that of the patients who are seen there for diagnostic catheterizations, the proportion who must then undergo angioplastic interventions, such as angioplasty or coronary artery bypass graft surgery, is approximately 25%. “This is right in line with the national average of about 30%,” says Christine Coyne, director of the Cardiac Care Center. “All of our patients have been screened and have undergone stress testing before their visit is scheduled, so we know that they are viable candidates for diagnostic catheterization.”

Any physician who performs procedures at the Cardiac Care Center must first become credentialed at the Hahnemann Hospital catheterization laboratory. This ensures that he or she will be able to follow through with the care of a patient who needs to be transferred emergently to the hospital. n

Seleen Street Collins is a contributing writer for Decisions in Axis Imaging News.