Patient Returns from Cath Lab and Nobody Knows What Happened

I was getting report on a patient who underwent a heart catheterization.

Day RN: This is Mr. Smith. He’s a 70 yr old male, full code, no known allergies. He came in yesterday complaining of chest pain. They took him to the cath lab today. He’s A&O x4, on room air, sinus rhythm, regular diet, and has a 20g in the left AC.

Sounds great. What did they find in the cath lab?

Day RN: I don’t actually know.

*awkward stares*

Day RN: They used the right wrist and he has a TR Band.

I immediately click on the reports section of the patient’s chart and scan for the cardiologist’s procedural note. Nothing.

I assumed care of the patient without knowing the following:

• Who did the procedure
• What were the findings
• What interventions were done
• Were there any complications
• What time did the procedure end
• What is the plan moving forward

Why this is a problem: In this procedure, an interventional cardiologist threads a catheter through the patient’s radial artery and up to the heart. An x-ray machine is used to visualize the catheter while small amounts of dye are injected through the coronary arteries. The dye helps any occlusions become immediately apparent. Then, the provider determines the appropriate intervention to restore blood flow.

The findings and interventions done for this patient are critical pieces of information when planning and implementing care. It helps us determine the best course of action if complications arise.

What if this patient developed sudden 10/10 chest pain? Well, based on the findings during the heart catheterization, we may react differently.

Scenario 1 : The patient had a “clean cath” and the coronary arteries were clear; no intervention done. In this situation we could be confident the 10/10 chest pain was not caused by a “heart attack” and myocardial ischemia was not taking place. Maybe the patient developed a pulmonary embolus – a clot in the lungs.

Scenario 2 : The patient had an occluded coronary artery and a stent was deployed to restore blood flow. A new onset of severe chest pain in this situation could indicate an issue with the stent. Did a new clot develop? Was the artery perforated, causing a bleed and cardiac tamponade?

Scenario 3 : The patient’s heart catheterization revealed occlusions in multiple coronary arteries and the patient is going to be considered for a Coronary Artery Bypass Graft surgery. For this patient, the sudden 10/10 chest pain would probably be expected. We might just treat this patient with pain medication, vasodilators, and blood thinners until surgery can take place.

Timely procedure notes by the provider are another critical component for patient safety. The procedure note will clearly state who performed it, the name of the procedure, what the findings were, what interventions were done, if there were any complications, and the patient’s condition at the conclusion of the procedure. It should be submitted to the chart as soon as possible at the conclusion of the procedure to aide in seamless care.

On this particular shift we got very lucky. My patient recovered from his heart catheterization without any complications. However, this blatant lack of communication is a huge patient safety hazard and should never happen. What if that patient was you? The hospital is a scary place.