Savvy organizations can realize great success with cardiac procedural volumes in their cath labs with clinical excellence, operational efficiency, and positive impact on the bottom line. But sustaining volume or growing for the future can be a bit more challenging, especially in these uncertain times. Discussions around program growth are usually accompanied by questions about whether to expand by space or scope: adding additional labs or adding additional clinical offerings. Making the determination can be quite difficult unless you understand whether the market potential is available to support expanded program inclusions, then followed by the organization’s ability to support the effort, in terms of human, monetary, or other required resources.
As the incidence of stroke continues to rise, hospitals will need to consider what level of service is offered to the community at large. For organizations that already provide best-practice care to stroke patients through certification as a Primary Stroke Center, the transition to offering neuro-interventional services (with program classifications such as Thrombectomy-capable and/or a Comprehensive Stroke Center) can be a natural progression. The innate challenges of expansion to offering a higher level of service can be lessened by using the existing infrastructure, administrative leadership, as well as current cardiac cath lab staffing – all critical components to consider. In fact, many organizations cross train their cardiac cath lab staff to care for the complex neuro-interventional patients, as the standards of care and clinical program requirements are very similar. This approach raises the bar across both programs and allows for increased coverage overall.
Even with the seemingly natural progression between cardiac and neuro-interventional programs, there can be significant capital investment required to meet the needs of both. Concerning equipment, installing a dual-use room can allow patients previously transferred out to remain. Configured appropriately, dual-purpose equipment can provide full run-off views and the high-level imaging needed for intracranial procedural work. The addition of bi-plane capability can allow the neuro interventionalist to perform the most complex therapies available.
Depending on an organization’s move from a primary stroke center to one that is thrombectomy-capable or a comprehensive stroke center, the recruitment of specialists will be necessary. Recruitment of endovascular specialists can be challenging, as there are not enough graduating fellows to meet the demand on a national level. Recruitment of advanced practice providers and hospitalists that are specifically neuro-trained will also be necessary. Further, centers that want to offer more comprehensive care will need to have critical care neuro-intensivists available for coverage within the ICU on a 24/7 basis. These recruitment challenges will likely be the most significant of the process, depending on the size of the market you’re in and the relative location of large urban markets with access to academic centers, fellowship training programs, etc.
Although the idea of integrating neuro-interventional capabilities into a fully-functional cardiac cath lab may be received with initial skepticism, with the proper planning, and consideration of the many synergies that exist between the coronary and neuro interventional spaces, expansion can be planned and executed smoothly, with case volume and revenue increases relatively quickly. The installation of appropriate equipment, recruitment of physicians and advanced practice providers, and then training of staff, all coupled with strong administrative leadership, will allow an organization to build an extraordinary service – one with quality at the forefront and one able to act nimbly and safely to provide both heart attack and stroke patients with the life-saving interventional care required for best-practice access.
No doubt the incidence of stroke will continue to rise and hospitals will need to consider the addition of programs that address the clinical care needs of their communities. The traditional cardiac cath lab setting is definitely an area that can be modified as a means to move forward with expansion of services. With the proper planning and support, hospitals can capitalize on the success of their cardiac cath labs and evolve into offering a new model of care with the addition of neuro-interventions.
We believe this is where the future is headed, as stroke is finally gaining traction as a time-critical condition like heart attack, and finally being given the due attention for program development and improvement, along with care access. The quicker a patient is triaged and treated, the better the long-term outcomes will be. When both cardiac and neuro intervention is available on-site without transfer, the patient is more likely to survive the critical event and thrive for the years to follow. We recommend evaluating your CV program to consider the benefits of adding neuro-intervention… the dual approach has benefitted many clients and as technology advances, dual-use labs will be on the forefront of strategic approaches for care (and space!) optimization.
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