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Strategic Cardiac Catheterization Lab Staffing in the Era of COVID-19: The Pod Initiative
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To the Editor:
The COVID-19 pandemic affected cardiovascular programs across Canada, with multiple professional organizations recommending deferral of all elective and semielective procedures to reduce exposures in the hospital setting and to save critical care capacity. Few recommendations directly addressed health care unit integrity.
We hypothesized that separate scheduling and physical separation of staff clusters would reduce the risk of a department outbreak. We divided the cardiac catheterization lab into separately functioning “Pods” of MDs, RNs, and medical radiology technologists (MRTs).
Should an individual in a Pod be suspected for COVID-19, their entire Pod would be taken off the schedule. Team members would then be assessed for fitness to return to work and subsequent future reactivation of their Pod. To avoid asymptomatic spread, only a fully cleared Pod would be reinstated.
Given the reduction of elective cases it was decided that 2 interventional cardiology labs (ICs) and 1 electrophysiology lab (EP) were sufficient for the planned workload. Pod sizes and compositions were considered while assessing the needs of the department. We determined that a minimum of 4 RNs, 1 MRT, and 1 IC was needed to perform an isolation case, and a 4-Pod system was developed.
Two Pods were constructed with the primary focus of EP expertise, with ability to perform IC cases on alternate days. Two Pods were constructed with combined transcatheter aortic valve implantation and percutaneous coronary intervention expertise. Pods included at least 3 bilingual team members (see Fig. 1 ).
Figure 1 Catheterization staffing restructuring and sample schedule. Cath, catheterization lab; CCL, cardiac catheterization lab; EP, electrophysiology lab; FTE, full-time equivalent; IC, interventional cardiologist; MRT, medical radiology technologist; TAVI, transcatheter aortic valve implantation.
The Pods were instructed to practice complete physical distancing. Shared storage space was eliminated. Arrival to work and breaks were staggered by Pod. Staff were discouraged from social interaction outside of work. All realistic and practical measures were undertaken to maintain social distancing of the pods.
Were a physician to require a second non-Pod physician for urgent assistance, the second MD would scrub and gown in proper personal protective equipment (PPE) and only then enter the lab being “run” by the first team. The physical intermingling of the 2 MDs from different Pods would thus only occur when in full PPE.
The Pod initiative was implemented April 6, 2020. The change of work hours caused struggles with child care, interfered with family time, and caused financial impact, but were tolerated by staff. One Pod had 2 individuals suspected for infection: 2 days later testing was negative and the Pod was reinstated. No active infections occurred in the staff.
Funding Sources
The authors have no funding sources to declare.
Disclosures
The authors have no conflicts of interest to disclose.
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To the Editor:
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p
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The COVID-19 pandemic affected cardiovascular programs across Canada, with multiple professional organizations recommending deferral of all elective and semielective procedures to reduce exposures in the hospital setting and to save critical care capacity. Few recommendations directly addressed health care unit integrity.
|
|
p
|
We hypothesized that separate scheduling and physical separation of staff clusters would reduce the risk of a department outbreak. We divided the cardiac catheterization lab into separately functioning “Pods” of MDs, RNs, and medical radiology technologists (MRTs).
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p
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Should an individual in a Pod be suspected for COVID-19, their entire Pod would be taken off the schedule. Team members would then be assessed for fitness to return to work and subsequent future reactivation of their Pod. To avoid asymptomatic spread, only a fully cleared Pod would be reinstated.
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|
p
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Given the reduction of elective cases it was decided that 2 interventional cardiology labs (ICs) and 1 electrophysiology lab (EP) were sufficient for the planned workload. Pod sizes and compositions were considered while assessing the needs of the department. We determined that a minimum of 4 RNs, 1 MRT, and 1 IC was needed to perform an isolation case, and a 4-Pod system was developed.
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|
p
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Two Pods were constructed with the primary focus of EP expertise, with ability to perform IC cases on alternate days. Two Pods were constructed with combined transcatheter aortic valve implantation and percutaneous coronary intervention expertise. Pods included at least 3 bilingual team members (see Fig. 1 ).
Figure 1 Catheterization staffing restructuring and sample schedule. Cath, catheterization lab; CCL, cardiac catheterization lab; EP, electrophysiology lab; FTE, full-time equivalent; IC, interventional cardiologist; MRT, medical radiology technologist; TAVI, transcatheter aortic valve implantation.
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Figure 1 Catheterization staffing restructuring and sample schedule. Cath, catheterization lab; CCL, cardiac catheterization lab; EP, electrophysiology lab; FTE, full-time equivalent; IC, interventional cardiologist; MRT, medical radiology technologist; TAVI, transcatheter aortic valve implantation.
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Figure 1
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Catheterization staffing restructuring and sample schedule. Cath, catheterization lab; CCL, cardiac catheterization lab; EP, electrophysiology lab; FTE, full-time equivalent; IC, interventional cardiologist; MRT, medical radiology technologist; TAVI, transcatheter aortic valve implantation.
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p
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Catheterization staffing restructuring and sample schedule. Cath, catheterization lab; CCL, cardiac catheterization lab; EP, electrophysiology lab; FTE, full-time equivalent; IC, interventional cardiologist; MRT, medical radiology technologist; TAVI, transcatheter aortic valve implantation.
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p
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The Pods were instructed to practice complete physical distancing. Shared storage space was eliminated. Arrival to work and breaks were staggered by Pod. Staff were discouraged from social interaction outside of work. All realistic and practical measures were undertaken to maintain social distancing of the pods.
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|
p
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Were a physician to require a second non-Pod physician for urgent assistance, the second MD would scrub and gown in proper personal protective equipment (PPE) and only then enter the lab being “run” by the first team. The physical intermingling of the 2 MDs from different Pods would thus only occur when in full PPE.
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p
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The Pod initiative was implemented April 6, 2020. The change of work hours caused struggles with child care, interfered with family time, and caused financial impact, but were tolerated by staff. One Pod had 2 individuals suspected for infection: 2 days later testing was negative and the Pod was reinstated. No active infections occurred in the staff.
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Funding Sources
The authors have no funding sources to declare.
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Funding Sources
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The authors have no funding sources to declare.
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Disclosures
The authors have no conflicts of interest to disclose.
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Disclosures
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The authors have no conflicts of interest to disclose.
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