Hospitals around the world are seeing a demand surge, stressing capacity across multiple inpatient units. In addition to throughput and strained nursing care and supplies, diagnostic and interventional cardiovascular departments are also feeling the impact. Let’s look at some of these conditions as well as some steps that can be taken to remedy or reduce the impact.
With the volume increase in critical care patients, coupled with the now-known effects of COVID-19 on the heart, some hospitals are seeing an upswing in isolation patients requiring cardiovascular care. These factors, in addition to the regular day-to-day operational challenges, show that the stressors are clearly there.
Increased Number of Portable Echocardiograms
In facilities seeing an increase in isolation patients, any diagnostic study that can be done portable will most certainly do so. For departments that have developed a process to perform inpatient studies in a controlled environment in the cardiology department, this can pose several challenges and considerations.
Key Challenges of Performing Exams
1. Technical difficulties
There is a greater chance for a technically difficult study. Technologists will be somewhat physically restricted with personal protective equipment (PPE). Depending on the size and layout of the room, adequate positioning of the machine may be challenging. Additionally, natural and artificial lighting can affect good visualization.
2. Exam time considerations
Portable exams will take an extended amount of time to perform. Plan for additional time when making assignments and consider evenly distributing the amount of isolation patients and, of course, location. If COVID-19 patients have been cohorted, consider assigning those studies together as best as possible.
3. Disinfection protocols
There should be clear instructions to the staff on proper and thorough disinfecting of the machine and all attached pieces immediately after performing the study. Also take this additional time under consideration when planning assignments.
4. Equipment care and maintenance
Increased portable studies pose increased risk to both employee injury and machine damage. Assess for staff knowledge for proper ergonomics to prevent unnecessary strain or injury. Also, it may be worth conferring with BioMed regarding things to look out for and do to minimize wear and tear and damage to the machine, most often noticed in the steering and locking mechanisms.
Stat orders are already a bone of contention for many. Facilities dealing with larger numbers of COVID-19 cases are seeing an even higher rate of stat orders that may seem questionable. Now may be a good time to review these cases with your cardiology medical director and consider methods for stratification such as implementing guidelines or criteria for stat orders. Strong consideration should be given for providing options to confer with the cardiology medical director or capabilities to order a stat outside of criteria so as not to hinder care.
Cardiac Cath Lab for Confirmed or Suspected COVID-19 Patients
The Society for Cardiovascular Angiography and Interventions (SCAI) has provided the following recommendations for consideration during the COVID-19 pandemic*:
- All STEMI patients, including transfers, should initially undergo clinical and COVID-19 screening evaluation in the Emergency Department.
- All STEMI patients should be brought to the CCL for primary PCI.
- Alternative therapeutic options such as systemic fibrinolytic therapy may be considered for low risk STEMI, bearing in mind the need for prolonged ICU level of care, potentially utilizing vital finite resources.
- When possible, bedside procedures are preferable (e.g., intra-aortic balloon pump, pericardiocentesis, ECMO, temporary venous pacemakers); CCLs should create COVID-19 carts with the needed supplies.
- For treatment in the CCL, maximal protection to prevent staff exposure should be employed including effective PPE.
- Percutaneous coronary intervention (PCI) should only be performed to the culprit vessel unless a non-culprit lesion is deemed unstable or multiple culprit lesions are present.
- Performing intubation in the CCL should be avoided. If intubating in the CCL, all non-essential personnel should exit. If cardiopulmonary resuscitation (CPR) is required, consider using automated CPR.
- High-flow nasal cannula, non-invasive ventilation, and use of an ambu bag should be avoided to minimize potential aerosolization and dissemination of virus.
- Within the CCL, designate a procedure room for the care of COVID-19 patients, modify air flow to negative pressure, if able, and develop strategies for safe containment and elimination of the virus.
* For full details, see Considerations for Cardiac Catheterization Laboratory Procedures During the COVID-19 Pandemic Perspectives from the Society for Cardiovascular Angiography and Interventions Emerging Leader Mentorship (SCAI ELM) Members and Graduates
Rolynn brings over 23 years of experience as a CV Service Line Administrator. She specializes in clinical/operational process improvement, joint commission compliance, and CMS quality measures achievement. Rolynn is known for building cross-boundary communities of practice on multiple scales; between corporate health enterprises and reading groups, and between administrators, referring physicians, and cardiologists.