The Department of Veteran’s Affairs approach to transradial catheterization

1. A Review of the Progression of TransRadial Adoption
Bernadette Speiser, MSN CCRN
Cardiology Nurse Manager
Department of Veteran Affairs

2. 


Largest publicly funded hospital system in
the United States
Provides care to 8.3 million veterans
Approximately 500,000 veterans have a
diagnosis of ischemic heart disease and it is
the leading cause of mortality and
hospitalization for Veterans
Gutierrez et al., Circ 2013

3. 
CART-CL:
Clinical Assessment, Reporting, and Tracking:
VA national clinical quality initiative (2005)
Data is collected in a standardized fashion on all
diagnostic and interventional catheterizations
into this centralized system
▪ Pre Procedure Assessment
▪ Diagnostic Report
▪ Interventional Report
Reports data points directly to FDA
Real-time reporting

4. 45000
40000
35000
30000
25000
Numbers of Patients
20000
15000
10000
5000
0
2009
2010
2011
2012

5. 20
18
16
14
12
Diagnositc Radial
Percentage
10
8
6
4
2
0
2009
2010
2011
2012

6. 12000
10000
8000
6000
Numbers of Patients
4000
2000
0
2007
2008
2009
2010

7. 18
16
14
12
10
8
Radial PCI Percentage
6
4
2
0
2007
2008
2009
2010
2011
2012

8. Didactic lectures plus live radial cases held at
one selected VA center (Chicago)
 Team approach/concept for education
 Utilized the national VA e-mail system to alert
personnel of upcoming TransRadial Courses
 National Procedures for TR care-standardized
TR Band RemovalProcedure/Flowsheets
 VA placed leaders in the field of TransRadial to
the forefront
 VA Pilot Training Program (didactic, live case
presentation) followed by an on-site
proctorship by an experienced radial operator
and cath lab nurse
 Post training surveys were conducted


10. Chicago
1.Sherman Hospital
2.Cook County Hospital
3.University of Illinois
4.University of Chicago
5.Northwestern Memorial Hospital
6.Rush Hospital
7.Good Samaritan Hospital
8.Springfield Memorial
9.Edwards Hospital
10.Elmhurst Memorial Hospital
11.Carle Foundation Hospital
12.Palos Community Hospital
13.Thorek Hospital
14.Rush Oak Park Hospital
15.Swedish Covenant
16.Lourdes Hospital
17.Lutheran General Hospital
18.McHenry Hospital
19.Norwegian Hospital
20.Illinois Masonic
21.Dreyer Medical Center
22.Saints Mary and Elizabeth Medical Center
23.Our Lady of Resurrection
24.St Mary’s Hospital
25.Highland Park Hospital
26.St James Francis Hospital
27.Advocate BroMenn Medical Center
28.Central Dupage
29.Presence of Mercy Medical Center
30.North Shore Hospital
31.Northwestern Lake Forest Hospital
32.Glen Oaks Hospital
33.Provena Aurora
34.Freeport Hospital
35.Mt. Sinai
36.Mercy Hospital
37.St Alexius
38.Midwest Heart
39. Quincy Hospital

11. Helfrich et al. submitted for publication

12. “Interventionalists are largely aware of benefits
of TRI, but likely never engaged in a sustained
effort to use TRI and become sufficiently
proficient. They believe TRI takes longer and is
more likely to fail, because in their experience, it
probably does”
 Lesson Learned:
1) Any educational interventions need to
emphasize completing sufficient cases to
become proficient
2) Extended support and encouragement for staff
3) Committing to a “radial first” attitude
4) Proctorship at the facilities identified gaps in
the traditional approach to training


13. Dr. Pinak B Shah

26. US Operators
Radial First
Take the
Plunge