Christchurch City is sited on the Canterbury Plains between the Southern Alps and the Pacific Ocean and has a population approaching 400,000 people. The surrounds offer beach suburbs, protected bays, and snow-capped mountain ranges for skiing, hiking, mountain biking and climbing. The city itself has a relaxed and cosmopolitan centre with historic trams rattling along several streets, a great bar and restaurant scene, theatres, street buskers, museums and art galleries.

Christchurch, named after Christ Church College in Oxford University, is the largest city in the South Island of New Zealand and is often referred to as the most English of New Zealand’s cities and the gateway to the South Island. The atmosphere is reminiscent of an English university town, offering punting on the River Avon, a grand Anglican cathedral dominating the central square, elegant Victorian architecture and numerous parks and exquisite gardens. Christchurch City is recognised as New Zealand’s ‘Garden City’ with over 740 parks and an extensive system of rivers, streams and wetlands. It offers a temperate climate and knows all four seasons, often in the one day.

Christchurch Hospital located within a 10 minute walk from the central city and is surrounded by the Avon River, Botanic Gardens and Hagley Park. Hagley Park is renowned for its extensive area of 165 hectares (407 acres) containing a golf course, tennis courts, numerous sports grounds, tree-lined walking and cycling tracks and artificial lakes. Hagley Park is also the location for Christchurch Hospital emergency helipad.

Interview

What is the size of your Cath Lab facility / Hospital?
Christchurch Hospital is the largest tertiary, teaching and research hospital in the South Island employing 3,400 staff and providing services to over 35,600 inpatients each year. The hospital operates 600-650 beds. Doctors and specialists from here also travel to major centres in the South Island providing specialist clinics and operations. In addition, Christchurch Hospital has the busiest Emergency Department in Australasia treating more than 65,000 patients a year.
Currently there are two Cath labs at Christchurch Hospital, one used principally for electrophysiology but also used for diagnostic angiograms and angioplasties and the other for diagnostic coronary, angiograms and PCIs and other interventional procedures. There are two cardiology wards (55 beds in total) and one Coronary Care Unit (9 beds).

How many staff? Roles?

Cardiologists: There are 10 cardiologists including 5 interventional specialists and 2 electro-physiologists. There is also 1 EP Fellow, 1 Research Fellow and 3 Advanced Trainees assisting the consultant cardiologists.

Nurses: A total of 16 nurses (12 FTE) are employed on full time, permanent part-time and a casual basis. 2 nurses are assigned to care for the patients in our 7 bed Day Ward attached to the Cath lab; the other nurses are rostered to the labs and are responsible for circulating and scrubbing during procedures. The nurses are also responsible for pre-admission checks. TOEs and DSEs are performed adjacent to the Day Ward and our nurses assist with these procedures also. Some of the nurses participate in a nurse led pre-admission health assessment clinic for EPs patients.

Radiographers (MRT): There are 7 cardiac radiographers (4.8 FTE) employed solely by cardiology to work in the labs. All work on a part-time basis and are responsible for radiation safety, operation of the x-ray equipment, image archiving and assist with preliminary reporting for the cardiologists. The radiographers also ensure that old studies are transferred from the old GEMNET archiving system to the new ProSolv system.

Cardiac Physiologists: 11 cardiac techs (8.5 FTE) are rostered to the Cath labs on a rotational basis and they also staff the pacing clinic and the ECG department. The techs are responsible for monitoring the ECG and hemodynamic status, as well as recording the equipment used during the procedures. They also assist with IABP management and temporary pacing wire insertions.
For most procedures, the team consists of a cardiologist, 2 registered nurses (1 scrub and 1 circulating), 1 radiographer and 1 cardiac tech.

Types of procedures:
We perform diagnostic C/Angios, PCIs, IVUS, Rotablator, Septal Ablations, Pericardiocenteses, Pericardial windows for malignancy, EP studies, Ablations, Pulmonary Vein Isolations, ICDs, and PPIs including CRT. We are also involved in several ongoing international clinical trials.

We do not officially operate a 24 hour PAMI service as yet due to limited funding. Patients are thrombolysed between 2200 and 0600 however; the On Call team are called in for major infarcts, failed thrombolysis, cardiogenic shock and on a case by case basis. Once funding is approved, we will be able to provide a 24 hour PAMI service.

Equipment:
The EP lab has a GE Advantx LC+ x-ray system with a Prucka hemodynamic system. This lab was installed in 2000 and is due for an upgrade in the very near future. The interventional lab was upgraded July 2007 and a Siemens Artis dFC and Sensis hemodynamic system was installed. A ProSolv Cardiovascular archiving and reporting system was implemented at the same time as the lab upgrade and replaced a GEMNET archiving system. An OEC 9600 mobile image intensifier is located in the Coronary Care Unit for insertion of Temp Wires, Swan Ganz and IABPs. We also have a Volcano s5i IVUS system and a RADI Pressure wire system.

Procedures performed per year:
In 2008 we performed 2,931 cases. This included 900 PCIs, 1313 C/Angios, 220 EPs (85 of these were 3D mapping), 80 ICD implants (20 of these were CRT-Ds), 230 PPI (20 of these were CRT-P).

Cross-training of staff:
Not at present but all disciplines assist one another as required. Cross training may be implemented in the future.

New procedures implemented:
One cardiologist has recently started performing PFO closures, Valvuloplasties and the occasional peripheral stenting. We are also about to participate in a clinical research trial involving the use of OCT (Optical Coherence Tomography). We have also recently implemented same day discharges post PCI on suitable patients.

Inventory Management:
Barcodes are removed from the equipment as it is used and the purchasing officer is responsible for ensuring our stock is replaced. Some stents are on consignment.

Haemostasis Management:
The majority of our diagnostic procedures have manual compression. We use Angioseals and Starclose closure devices for most of our PCIs but it is very much operator and patient dependent. Syvek, M-Patch and FemoStop are used if there is difficulty obtaining haemostasis. TR bands are used on all radial access patients.

Measures implemented to cut costs:
Budget constraints and constant ‘blow-outs’ are an ongoing concern. We have implemented same day discharge for some PCIs and are considering the purchase of an ACIST device to reduce our contrast budget as 99% of our patients receive Visipaque.

Training for new employees:

• Nurses have a 6-8 week preceptorship programme tailored to suit individual needs. Ongoing supervision continues until proficient practice is achieved.
• Radiographers are paired with an experienced radiographer for on-the-job training and must have competencies signed off before working independently.
• Cardiac techs have on-the-job training and are expected to complete a Post Grad Diploma in Medical Technology within the first 3 years of employment.

Continuing education programs available to staff:
We try to have weekly in-house training sessions, product training from reps and our clinical nurse educator organises regular study days for all cardiology staff. As many staff as possible attend annual Australian and New Zealand conferences. Each discipline is also responsible for ensuring competencies are kept up to date.

Kinds of competency checks staff have to undergo once employed:
All staff undertake annual CPR training and assessments. Each discipline must supply evidence of participation in ongoing professional development to obtain annual registration with their relative professional body.

Department Management structure:
Nurses report to the Charge Nurse, radiographers report to the Charge Radiographer and techs report to the Charge Cardiac Physiologist. In turn, the Charges report to the Clinical Director and the Cardiology Service Manager

Dealing with late finishing of cases:
Late finishes are becoming more common place as greater demands are put on the Cath lab service. At present, dealing with late finishes relies heavily on the goodwill of staff volunteering to work overtime. Some disciplines call in their On Call person and others alter their shifts to cover the end of the day. We all try to do the best we can to enable patients to get home as early as possible. In addition, planned ‘late lab’ and weekend sessions occur from time to time to cope with increased waiting lists.

Policy for company reps within the labs?
Company reps are generally welcome and are supposed to contact the Charge Nurse and arrange an appointment to visit the labs to ensure that reps from different companies are not present at the same time.

What is the best part of working at your facility?
We have an awesome group of people who all possess a great sense of enjoyment and team ethic. This is reflected by the positive comments from patients who have experienced our professional attitude combined with a wonderful sense of humour.