Running a Hybrid Lab—Perspectives of a Physician and a Sonographer

Tasneem Z. Naqvi, MD, FRCP, FACC, FASE

Susana Perese, BS, RVT, FASE

Technological innovation over the last few years and development of hybrid procedures in the treatment of valvular heart disease, carotid artery stenosis, aortic aneurysms, and peripheral arterial disease have led to integration of cardiology, cardiac surgery, vascular surgery, and vascular medicine. This inevitably requires broadening of horizons for cardiovascular imaging laboratories. Expansion of cardiovascular training to include vascular ultrasound, magnetic resonance imaging, and cardiac computed tomography has produced an environment conducive to, and an opportune time for, cardiovascular diagnostic laboratories to expand. Over the last 5 years, the ASE has incorporated vascular ultrasound and has gradually expanded learning sessions, abstracts, and lectures on vascular ultrasound to its annual scientific sessions. ASE also published guideline articles on vascular ultrasound, carotid intima media thickness measurement, and preventive ultrasound.

From the dedicated lab where only one type of specialty examination is performed (such as non-invasive cardiology, pulmonary, vascular, or radiology), the new developments require multi-disciplinary or “hybrid” laboratories. In these hybrid labs, a wide array of examination specialties may be combined and offered at a single location.

The authors work in both a dedicated non-invasive cardiology lab and a dedicated non-invasive vascular lab at the hospital setting, as well as at a hybrid lab, the outpatient cardio-vascular diagnostic center. We’d like to offer our own perspectives on the merits and disadvantages of a hybrid lab.

Advantages of a Hybrid Lab

The most obvious and significant benefit of a hybrid lab is financial; it allows sharing of expenses and elimination of individual clinical, clerical, and administrative expenses inherent in each dedicated laboratory. There is sharing of space, supplies, staff, and equipment. Patients and referring physicians benefit tremendously from the “one-stop” shop set-up. Referring physicians don’t have to call different departments and send requisition orders to multiple departments. Patients prefer to go to only one diagnostic center. With the growing age of our patient population, having patients arrive at a single location makes good sense and provides good customer service. Patients commonly “get lost” and/or miss appointments in multiple laboratories within a large and complex hospital setting.

Operationally, patient flow is improved at the hybrid lab. Nursing and medical support is available at all times and for all examinations, leading to efficient and expedited service. There is an ease of performing multiple exams on a single patient in one room with one machine (for example: echo and carotid ultrasonography).

Another advantage is the cross-over in work that is required administratively such as combining policies and procedures, quality assurance and accreditation for multiple disciplines into one under a hybrid lab.

In a hybrid lab there is flexibility of using equipment and their peripherals. This prevents re-scheduling patients in case of technical failure of one system. Another advantage is the sharing of support systems. For example, a single PACS system may allow the reading of echo, vascular, stress, electrophysiology, and nuclear studies. Separate and distinct PACS systems can be quite costly, so there is a potential for significant cost savings in having an integrated system.

Hybrid labs lead to an improved relationship among the clinical and medical staffs, who historically do not work well together due to “turf” issues. Hybrid labs have a potential to bring together physicians from various disciplines (echo, electrophysiology, neurology, internal medicine, vascular surgery, and radiology) to work collaboratively. This inevitably leads to an improved patient care. They create an opportunity to provide unique cardiac/vascular/surgical training and to create hybrid fellowship programs that offer comprehensive cardiology and vascular diagnostic curriculum.

Last but not least, there is potential for collaborative diagnoses across the performance and evaluation of cardio-vascular examinations: coronary artery disease and peripheral arterial disease; hypertensive heart disease, aortic, renal disease, and peripheral arterial disease; aortic regurgitation and aortic root enlargement and disease of thoracic and abdominal aorta; pulmonary embolism and venous thrombosis; stress echocardiography and subclinical atherosclerosis; Patent Foramen Ovale and transcranial Doppler. Hybrid labs also provide an opportunity to extend research boundaries such as connecting links between diastolic heart failure and vascular stiffness, myocardial wall mechanical imaging and vascular wall mechanics, aortic root pathologies to peripheral vascular compliance, vascular remodeling to hypertensive and diabetic heart disease, coronary atherosclerosis, and early vascular wall changes and finally “vulnerable” patient and vulnerable peripheral vascular plaques.

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Jun 15, 2018 | Posted by in CARDIOLOGY | Comments Off on Running a Hybrid Lab—Perspectives of a Physician and a Sonographer

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