Building a Top Cath Lab in 10 Not-So-Easy Steps

The interventional cardiology program at The Mount Sinai Hospital in New York has grown from a total catheterization lab volume of just over 14,000 annual cases per year in 2007 to almost 20,000 last year. In that same time, as volume has grown, complication and mortality rates have been among the lowest in the region. Over five years, mortality in percutaneous interventions is at 0.21% and major complications at 0.52%.

Samin K. Sharma, MD, director of clinical cardiology and president of the Mount Sinai Heart Network, has broken down the program's success into 10 reasons and goals, from teamwork to a commitment of investment by leadership. Among the most critical has been "uniform standardized medical and non-medical protocols" which have been installed throughout the catheterization lab, from the senior interventionalists to everyone on the care team. Sharma says he knew the protocols were working when the health commissioner of New York state came to tour the lab to see for himself how they worked.

"I mentioned about the protocols and we showed the book to the health commissioner at that time," Sharma says. "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 this150-page book.' They opened it, asked questions, and the answers were perfect. That is why we emphasize so much teaching."

Sharma says having an enforced, communicated set of protocols is the key to success, but even with that there is no single set that will work for every cath lab team.

"I'm not saying that people should duplicate what we have, but clearly there should be a set protocol," Sharma says. "In this field, there is more than one right way to do things. At the same time, by and large, the concept has to be that when the variation occurs, that's where the trouble occurs."

Mount Sinai's protocols themselves are open for new evidence and team input, whether by a senior staff interventionalist or another clinician.

"Many times one of the voluntary physicians makes some good suggestions, so we will change our protocol based on incorporating their opinion," Sharma says. That sense of full teamwork extends to any communication following complications, he adds. "If an issue occurs, we discuss it openly. That is a key—that open communication. If you have a closed-door discussion with one or two people, then other people on the team don't know. On any major complications, we speak the next morning. Then monthly we have a one-hour discussion to review."

Learn more about the 10 steps to cath lab growth. Download a FREE copy of the HealthLeaders Media Rounds case study,Excellence in Cardiac Care: Elements of Success from the Mount Sinai Medical Center.

Don't miss this unique, interactive event for a deep-dive into cardiovascular excellence with world-renowned leaders. Register now for the July 18 live event featuring Samin Sharma, MD, and five leaders from Mount Sinai's internationally recognized cardiovascular program.