Coffs Harbour is a 202 bed hospital on the Mid North Coast of New South Wales, Australia. It is part of the North Coast Area Health Service, combining the Northern Rivers and Mid North Coast Areas.

The Coronary Angiography Unit was opened on the 28th September, 2006. It currently operates two days per week undertaking mainly day only angiograms. It is a self contained Unit with a four bed recovery area and direct admission and discharges from the Unit. It is supported in the hospital by an inpatient stress testing department and 10 bed combined ICU/CCU.

Interview

1) Cath lab facilities?
We have one Siemens Axiom Artis Lab with a four bed recovery area. There are three chairs that are used for patient admission/preparation as well as part of the recovery phase.

2) Staff numbers?
We have one full time Nurse Unit Manager, and 6 part time RN’s.
We have one part time radiographer based in the Unit as well as one casual relief radiographer. We are completely separate from the radiology department. Haemodynamic monitoring is looked after by the Cardiac Technician/ Scientific Officer who is employed on a consultancy basis.

3) Main staff roles?
The RN is responsible for patient admission and preparation, as well as rotating through scrub, scout and recovery of the patient. The scrub nurse is responsible for the pressure injector (all coronaries are injected by pressure injector), or hand injections if required.
The nurses are responsible for sheath removal once in recovery. The scrub nurse usually follows the patient out to recovery for sheath removal for continuity of care. Radiographers are responsible for imaging. The Cardiologist is responsible for the manoeuvring of the camera and table.
The Cardiac technician is responsible for all monitoring, valve studies etc.

4) Procedures?
Having recently opened in September 2006, we currently perform diagnostic angiograms only.

5) Procedures performed in a year?
We are currently averaging 60 cases per month, and are aiming for 700-800 for the year.

6) Emergency cases?
We currently do not do emergency cases, but we do have a balloon pump in the Unit for emergencies.

7) Day cases?
70% of patients are performed as day only cases. The remainder are current inpatients.

8) Surgical back-up?
Coffs Harbour is a rural Cath Lab that has no surgical backup. If needed, patients are transported via Air Ambulance to a tertiary centre in Sydney, 500 kms away.

9) Do patients arrive via air ambulance, helicopter etc, from outlying towns?
Patients from our feeder hospitals arrive via road ambulance or internal transport for day only procedures.

10) Private cases? Any special considerations?
We are a Public Hospital and primarily do public patients; however we do approximately 20% as private cases.

11) New procedures recently implemented?
Being a completely new service to the area, everything is new and has been a big learning curve for the hospital.

12) Inventory management?
Inventory is managed by the Unit Manager or RN delegate on a weekly basis. All stock is ordered online. Prosthetics and some interventional products are managed on a consignment basis.

13) Haemostasis?
RN’s remove the sheaths, and use Femostops and CompressARs depending on patient needs and RN preference. Digital pressure is rarely used. Angioseals are also used depending on patient need.

14) Measures implemented to cut costs?
All interventional balloons and stents are on consignment. Otherwise, careful monitoring of budget.

15) Some of the challenges setting up the department?
Coffs Harbour is the fourth rural Cath Lab Site in New South Wales to be established under a Rural Health Plan. A purpose built extension to the 5 year old hospital was needed to house the new Unit. This provided the challenge of building and commissioning the new Unit under budget within a short time frame.

Finding experienced staff to work in the Unit was also a challenge due to geographical isolation from the major tertiary centres and limited number of staff that had worked in the Cath Labs previously who were currently employed in the hospital. Added to this was the inability to offer full time positions in the Unit at the present time, which was no incentive for prospective staff to relocate to the area.
The other major challenge has been the education process for General Practitioners, Hospital Staff and the community regarding the safety and efficacy of diagnostic angiograms without on site surgical backup. Previously, all patients requiring angiography had been flown out to Sydney, and it has been a steep learning curve in some areas to change to the idea of onsite angiograms.

16) Cross Training?
All nurses and radiographers are being trained in haemodynamic monitoring. We also encourage the Radiographers and Cardiac Technician to cross train in the scouting role.

17) Training new employees can expect to receive?
Full orientation to the Unit, with an orientation handbook covering all aspects of angiography, and PCI with competencies for staff to achieve. In-service prior to being buddied up with a senior staff member for training in all roles in the Unit.

18) Continuing education programs available to staff?
Staff are encouraged to attend any in house education, as well as accessing NSW College of Nursing and Area Health service courses as they feel the need. They are also encouraged to attend local and international meetings with support.

19) Competency checks staff undergo once employed?
Annual competencies include Advanced Life Support, whilst staff must also be assessed for competency in IV cannulation, scrubbing, scouting, recovery and sheath removal.

20) New training initiatives implemented?
Prior to opening the Unit, we sent our RN’s to Nepean Hospital, in Sydney, for training in their Unit. We are very grateful to them; they did a wonderful job and were very accommodating. We also accessed the University of New South Wales School of Rural Health training

21) Growth potential of the Unit?
Currently, we have one Cardiologist performing diagnostic angiograms. He is currently the only Cardiologist covering an area with over 140 000 people.

There is a significant elderly population in the area, and previously, the hospital had needed to send to Sydney over 800 people per year for diagnostic angiograms. This did not include those who needed interventional procedures, and we expect the numbers of people requiring purely diagnostic angiography will increase with the establishment of the Unit.
We are in the process of advertising for and recruiting another cardiologist with interventional skills, and plan to hopefully start interventional cases after that.

22) Training facility for cardiac registrars (fellows)?
No.

23) What is the best part of working at your facility?
Wonderful staff, and a great new Unit in a beautiful part of Australia.