But having senior physicians around to mentor and guide is only a supplement to a program based on evidence-based protocols.
"We have a set protocol for all the routine and complex procedures," Sharma says. "If a complication should occur, we have protocols for how the procedure should be done from a technical point of view. Everything is standardized despite having up to 19 interventionalists who come and do the cases." Sharma says the protocols are followed by all physicians, even the voluntary physicians, who perform procedures at Mount Sinai. The key to adherence is constant teaching, he says. Sharma recalls a visit by the health commissioner of New York state who came to tour the lab to see how it worked.
"I mentioned about the protocol and we showed the book to the health commissioner at that time. He said, 'You're telling me that your interventional fellows know about the book?' I said, 'No problem. We can go back to the cath lab and you can ask my intervention fellows anything from this 150-page book.' They opened it, asked questions, and the answers were perfect. That is why we emphasize so much teaching for our interventional fellows who are the backbone of the success of the program."
The protocol adherence extends beyond the physicians to the entire cardiac intervention team.