The Society for Cardiovascular Angiography and Interventions (SCAI) has released an expert consensus statement providing cardiologists, cath lab directors, and hospital leadership guidance for contemporary cath lab standards.
The document, “SCAI Expert Consensus Update on Best Practices in the Cardiac Catheterization Laboratory” was presented at the SCAI 2021 scientific sessions (28 April–1 May, virtual) with simultaneous publication in Catheterization & Cardiovascular Interventions. The statement has been endorsed by the American College of Cardiology (ACC) Clinical Policy Approval Committee, American Heart Association (AHA), and the Heart Rhythm Society (HRS).
“First released in 2012, then updated in 2016 and now 2021, the document highlights a patient- centric approach to procedures in the cardiac catheterization laboratory, incorporating all the latest advances and standards,” said Srihari S Naidu, New York Medical College, New York, USA, chair of the writing committee. “Dividing the logistics into the pre-procedure, intra-procedure, and post-procedure periods, and including staffing, quality metrics, industry relations and governance, the document should hopefully further serve as a contemporary look at the optimal running of these busy areas. We have also included areas where operators overlap, such as interventional cardiologists and electrophysiologists, for a more collegial collaborative spirit towards these complex patients and provided guidance on procedures performed in various settings including outpatient labs.”
The new 2021 recommendations include:
- Emphasis on practical recommendations to optimise quality & outcomes through best practices, registries, risk calculators, and vascular access (radial first, vascular ultrasound)
- Updated discussion of ambulatory surgery centres and settings without on-site surgery
- Expanded section on CCL governance, including dyad leadership, respective roles, “culture-setting”, industry relationships, and patient experience optimization
- Emphasis on the heart team for various patient subsets, and new recommendations for coordination and collaboration with EP
- Updated pre-procedure checklist and pre-PCI time out
- Updated discussion of staff qualifications, certification, and optimal CCL team
- Updated timing and discussion of H&P, informed consent, and required blood work
- Updated infection control guidance, including use of PPE and hand anti-septic solutions
- Emphasis on same-day discharge for select patients, with discussion of long-term GDMT and lifestyle modification, and bedside delivery of medications to improve adherence
“This comprehensive statement, prepared by experts across a range of disciplines, builds on prior consensus statements and provides updates focused on current patient-centered and evidence-based approaches to care,” stated Daniel Kolansky, University of Pennsylvania, Philadelphia, USA, vice-chair of the writing committee and SCAI 2021 programme chair. “The document covers topics ranging from pre-procedure assessment to intraprocedural best practices and safe discharge and follow-up needs of the patient. The document highlights regulatory and accreditation requirements for cath labs, a heart team approach to complex care, and discussion of what constitutes an optimal cath lab team. It also addresses collaboration between disciplines such as interventional cardiology and cardiac electrophysiology. This document will serve as a guide for lab directors, hospitals, and health systems in establishing current best practices for catheterization labs.”