“WORK FLOW OF CATH LAB PROCESS”

AT FORTIS MEMORIAL RESEARCH INSTITUTE

Prepared By: Mr.KULDEEP SINGH

27TH January 2016

Mob NO :9718386778

HOSPITAL INTRODUCTIONFortis Memorial Research Institute (FMRI) is a

multi-super-speciality, quaternary care hospital with an enviable international faculty, reputed clinicians, including super-sub-specialists and speciality nurses, supported by cutting–edge technology.

A premium referral hospital, it endeavours to be the ‘Mecca of Healthcare’ for Asia Pacific and beyond. Set on a spacious 11-acre campus with 1000 beds, this ‘Next Generation Hospital’ is built on the foundation of ‘Trust’ and rests on four strong pillars: Talent, Technology, Service and Infrastructure

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HOSPITAL’S SPECIALITIES Minimal Access, Bariatric & GI

Surgery Plastic Surgery Ophthalmology Pulmonology Plastic Surgery Dental Sciences Internal Medicine Cosmetic & Plastic Surgery Medical Oncology Invasive Cardiology Ophthalmology Pediatrics Minimal Access Surgery (Gynae)

Neonatology IVF Liver Transplant, GI

&HepatoPancreato Biliary Surgery

Mental Health & Behavioural Sciences

Radiation Oncology Radiology Invasive Cardiology Rheumatology Newborn and Child Specialist ENT C-DOC (Centre of Excellence for

Diabetes, Metabolic Disorders and Endocrinology)

Gastroenterology &Hepatobiliary Sciences 3

FORTIS MEMORIAL RESEARCH INSTITUTE

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CATH LAB Cath lab

definition: Cath lab is an examination room in a hospital or clinic with diagnostic imaging equipment used to visualize the arteries of the heart and the chambers of the heart and treat any stenosis or abnormality found.

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“WORK FLOW OF CATH LAB PROCESS”

Patient admission processPatient financial counseling Coordinate with TPA processPatient discharge processTo prepare and maintain Cath lab data record

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PATIENT ADMISSION PROCESS

Admission request form to be filled by Treating Doctor

Allocation of bed by Bed manager General consent form to be filled and signed by

Patient attendant Estimate of the advised procedure to be prepared Face sheet to be generated after getting all

information & document from the patient Stamp needs to be put on face sheet for financial

clearance of the procedure In case of TPA policy, Patient needs to submit TPA

paper. TPA paper needs to be submitted in TPA desk for

initial approval of recommended procedure7

PATIENT FINANCIAL COUNSELLING

Once completion of diagnostic test (CAG) if Dr recommends for next procedure than service coordinator needs to do financial counseling For further procedure (PTCA) or other procedures.

Main points to be explained during financial counselling:

• About room categories• Package inclusions and exclusions• About extra charges if there is an extra

stay or cross consultation done

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PATIENT FINANCIAL COUNSELING

Stent charge, it will depend number of stents used in procedure

Drug & consumable used in procedure (approx)

Finally do the sum of total and tell to attendant and get a sign on patient financial counseling paper

Note: In case of patient goes out of package than charges will be extra for specific concern such as Cross consultation Number of days stay in room or ICU.

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TPA PROCESS

Prescription of the Drs Pre authorization form of TPA Dully fill up of pre authorization form by Drs Undertaking form for TPA insurance Estimation of procedure ECG report or CAG report or other investigation report Current ID card of the patient TPA policy & Card of the policy Finally send the original document to TPA office to get

an approval from TPA In case of further approval of TPA needs to do the same

as above10

PATIENT DISCHARGE PROCESS

In progress sheet Dr. needs to write discharge note in patient file

According to progress note, nursing staff needs to send the billing papers to billing desk & needs to update discharge intimation in the system

Discharge summary to be prepared by Dr and dually signed by treating Dr.

In case of cash patient, patient attendant needs to do final clearance in billing department or

In case of TPA patient all the original documents, final bill and discharge summary needs to be submitted to TPA desk to get the final approval

After getting the final approval from TPA billing will be closed

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PATIENT DISCHARGE SUMMARYDischarge Summary: is a patient’s history

document, which describes whole history about patient during stay in hospital. There are few points such as:

DIAGNOSIS CHIEF COMPLAINTS HISTORY OF PRESENT ILLNESS PAST MEDICAL HISTORY SIGNIFICANT FINDINGS On examination COURSE IN HOSPITAL INVESTIGATION DONE CONDITION AT THE TIME OF DISCHARGE MEDICATION ON DISCHARGE FOLLOW UP ADVICE WHEN TO OBTAIN URGENT CARE IN CASE OF EMERGENCY PLEASE CONTACT FMRI EMERGENCY ON 0124 4962200,

0124 716 2200

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TO PREPARE & MAINTAINED CATH LAB DATA RECORDS

Month wise types of procedures done in Cath lab

To prepare and maintained month wise TAT report of procedures

.

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MONTH WISE TYPES OF PROCEDURES DONE

Oct-15   Nov-15   Dec-15   Jan-16

S N Procedure name Done   S N Procedure name Done   S N Procedure name Done   S N Procedure name Done1 ASD DEVICE CLOSURE √   1 AORTIC STENTING √   1  CAG+IABP √   1 2ND SITTING PTCA √2 CAG √   2 ASD D/C √   2 ASD DEVICE CLOSURE √   2 ASD DEVICE CLOSURE √3 CAG+PAG √   3 ASD DEVICE CLOSURE √   3 BPV √   3 CAG √4 CAG+PRIMARY PTCA √   4 BPV √   4 CAG √   4 CAG+BMV √5 CAG+PRIMARY PTCA+IABP √   5 CAG √   5 CAG +PRIMARY PTCA √   5 CAG +PRIMARY PTCA √6 CAG+PTCA √   6 CAG +PRIMARY PTCA+IABP √   6 CAG+ PTCA √   6 CAG+PRIMARY PTCA+TPI √7 CAG+TPI+PPI √   7 CAG+PRIMARY PTCA √   7 CAG+CATH STUDY √   7 CAG+PRIMARY PTCA+TPI+IABP √8 CATH STUDY √   8 CAG+PTCA √   8 CATH STUDY √   8 CAG+ PTCA √9 CRTP REPLACEMENT √   9 CAG+ROTA+PTCA √   9 EPS √   9 CAG+PTCA+IABP √

10 EPS+RFA √   10 CATH STUDY √   10 EPS+RFA √   10 CATH STUDY √

11 ICD (S/C) √   11CATH STUDY+COARCT

BALLOONING √   11 EPS+RFA+CAG √   11 CATH STUDY+CAG √12 P TAPPING √   12 CHECK ANGIO √   12 ICD SINGLE CHAMBER √   12 CRTD √13 PDA DEVICE CLOSURE √   13 CRT-D √   13 PERICARDIAL TAPPING √   13 EPS+RFA √14 PERICARDIAL TAPPING √   14 EPS+RFA √   14 PTCA √   14 PDA DEVICE CLOSURE √15 PPI (D/C) √   15 ICD (S/C) √   15 PTCA+ROTA ABLATION √   15 PPI DUAL CHAMBER √16 PRIMARY PTCA √   16 PDA D/C √   16 RENAL ANGIOGRAPHY √   16 PTA √17 PTA √   17 PTA (ASD) √   17 SVC STENTING √   17 PTCA √18 PTA (VSD) √   18 PTCA √   18 TPI √   18 PULMONARY ARTERY STENTING √19 PTA(BMV) √   19 RENAL ANGIOPLASTY √   19 VSD  D/C √   19 TPI √20 PTA(SEPTSTOMI) √   20 ROTABLATION+PTCA √              21 PTCA √   21 TPI √            

  22 VALVULOPLASTY √              23 VENOGRAPHY √                    24 VSD CLOSURE √                

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MONTH WISE TURN AROUND TIME OF PROCEDURES

TURN AROUND TIME OF EACH PROCEDURES IN MONTH WISE

S N Procedure name Oct-15 Nov-15 Dec-15 Jan-161 ASD DEVICE CLOSURE 01:25 02:20 01:22 01:222 CAG 00:38 00:42 00:48 00:483 CAG+PRIMARY PTCA 01:23 01:09 01:33 01:334 CAG+PTCA 01:35 01:08 02:04 02:045 CATH STUDY 01:08 01:25 01:21 01:216 PTCA 01:47 01:09 01:22 01:227 EPS+RFA 01:50 01:15 02:08 02:088 ICD (S/C) 02:30 01:20 02:30 02:309 ROTABLATION+PTCA NA 01:30 01:55 01:55

10 PERICARDIAL TAPPING 00:50 NA 00:50 00:5011 TPI NA 01:00 00:50 00:38

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WAYS TO REDUCE TAT OF PROCEDURE

TPA patient In this case preauthorization form of TPA can

send directly to cath along with patient file instead of sending to TPA desk.

Here we can save time because Duty Doctor can fill up patient history and send to TPA desk

TPA desk employee can submit it fast for approval of procedure where as we generally send it to first TPA desk and TPA desk send to cath lab for patient history and cath lab send it back to TPA desk for approval of procedure

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WAYS TO REDUCE TAT OF PROCEDURE

Cash patient for day cath procedureWe can save time if patient come along with

attendant In this case we can send to patient directly to

cath lab instead of PCS office along with patient’s attendant.

Patent’s attendant can go PCS office and do admission formalities of patient

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CHALLENGES DURING TRAINING

Maintaining the Cath lab scheduling

Responsible for efficiently patients financial counseling till discharge of patient

Responsible for complete of MRD deficient files of the patients

Coordinate with attendants and front office staff for clearance of the procedure 1

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EXECUTIVE SUMMARY OF PROJECT My project is on "WORK FLOW OF CATH LAB" At

where cardiac invasive procedures gets done by Drs with support staff. I did work on how to improve TAT and learned couple of things such as:

Patients admission process Coordinate with TPA process Patients financial counselling services Patients discharge process  To prepare and maintained Cath labs data record Doing patients round along with Doctor

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EXECUTIVE SUMMARY OF PROJECT

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THANKING YOU !!!

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