1. MTMC Diagnostic Lab Kelly A. Barker Middle Tennessee State University

2. Clinical Site  MTMC Diagnostic Lab MTMC is a private, non-profit facility  Includes: Cardiac catherization lab (angioplasty and stent placement) GI Lab (colonoscopy and bronchoscopy) Echo EKG Exercise treadmill test and nuclear stress test Pacemaker implantation

3. Preceptor: Cathy Alber  Role: Facilitation of the budget Professional recruitment Creating staff work schedules Visionary preparing for the future  Mixed leadership style (both democratic and autocratic)

4. Leadership Project  Purpose: determine the total cost effectiveness of the MEDRAD Avanta Injector system  Leadership project objectives: 1. Calculate the average savings per patient by using the Isovue contrast vs. the Vispaque contrast 2. Calculate the average monthly savings by using the Isovue contrast vs. the Vispaque contrast 3. Calculate the average monthly savings of patients not requiring femoral artery closure devices after cardiac catherizations secondary to smaller catheter size 4. Evaluate the monthly cost effectiveness of the MEDRAD Avanta Injection system

5. MEDRAD Injector (Old)MEDRAD Avanta Injector (New) - Vispaque contrast: $1.00/mL - Average amount of contrast used: 107 mL/patient - Contrast waste with each procedure - 6F catheter (larger diameter) - Increased usage of femoral artery closure devices (approximately $200 per device) - Isovue Contrast: ¢0.67/mL - Average amount of contrast used: 90 mL/patient - No contrast wasted during procedures - 4F catheter - Decreased usage of femoral artery closure devices

6. Monetary Savings Using Isovue Contrast vs. Vispaque Contrast  The Isovue contrast used with the MEDRAD Avanta System is ¢0.33 cheaper than the Vispaque contrast  Saves an average of $47 per patient and $2,700 per month.

7. Monetary Savings from Decreased use of Femoral Artery Closure Devices  The smaller 4F catheter used with the MEDRAD Avanta Injector as opposed to the 6F catheter reduces the amount of femoral closure devices used during each cardiac catherization.

8. Monetary Savings from Decreased use of Femoral Artery Closure Devices  The average cost of femoral artery closure devices in July and August was $6,100 per month  The average cost of closure devices in September was only $2,000  The MEDRAD Avanta Injector will save an average of $4,100 by using fewer closure devices

9. Monthly Cost Effectiveness of the MEDRAD Avanta Injection System  Overall, the MEDRAD Avanta Injector will save approximately $6,800 per month  The MEDRAD Avanta Injector cost roughly $24,000  By saving $6,800 per month, the injection system should recoup its cost in 4 months

10. Unique Aspect of the Diagnostic Lab  The most unique aspect of my experience at the diagnostic lab was Cathy’s excellent leadership style.  She is willing to help in anyway possible, from assisting with GI procedures to changing linens on a bed.  She communicates well with the staff members and involves them in decision making.

11. Strengths and Opportunities for Improvement in the Diagnostic Lab  Strengths: Experienced nurses and staff members Excellent director Technologically advanced equipment Large lab with multiple procedure rooms  Opportunities for improvement: Staffing Cross training nurses to work in all labs Excess on-call hours Transport difficulties and excess waiting time for patients to leave the facility

12. Recommendations for the Diagnostic Lab  Hire more nurses thus decreasing on-call and OT hours for other staff members  Cross train nurses to work in all labs  Take patients out of the facility when transport is busy to decrease waiting time for patients and family members

13. PICO Question PICO In patients undergoing cardiac catherizations will using a 4F catheter instead of a 6F catheter affect patient outcomes (holding manual pressure, hemorrhage, ambulation)