Welcome to your next module. In this, we are going to discuss the cardiovascular procedures and imaging. My name is Jamie Warren. I'm the VP for Care Transformation Services with MedAxiom, and I have the honor and privilege to also be with my peer, Denise. Denise? Hey, thanks, Jamie. I'm Denise Bushman, one of the other vice presidents with Care Transformation and MedAxiom. We are really excited to bring this section to you because that's one of our passions. So looking forward to the session. These are our disclosures. For this module, we have four learning objectives to cover. Today, we will discuss identifying and describing the different types of cardiovascular imaging techniques and cath lab procedures that you may see ordered on your patients. Next, we will distinguish between different staff roles and responsibilities that you may see in these areas, again, with imaging and in our procedural areas. Understanding patient protocols on prep and identifying common reasons on why the procedure may be canceled or rescheduled. And then lastly, we will describe the impact of your role, the practice manager, on the safe, efficient, and effective procedure in imaging coordination. So let's get started. First of all, we'd like to make sure we're all on the same page when it comes to understanding the importance of diagnosing and treating various heart conditions. If we understand the four main condition types that we'll be dealing with when it comes to imaging or invasive procedures, those would fall under common types of either coronary artery disease, various arrhythmias, structural heart elements, or congenital heart issues. Those are four common types and everything will pretty much fit underneath those categories. Secondly, will be the significance of early diagnosis of those conditions, whether it be for prevention purposes, improving outcomes, or achieving cost-effectiveness within an organization. Understanding that prevention by detecting problems early, you can hopefully prevent more severe complications down the road. When it comes to improving outcomes, timely diagnosis really helps to lead to better treatment options for patients and improve prognosis in the long run. And then lastly, cost-effectiveness. Early intervention, of course, reducing long-term health care costs by avoiding emergency treatments and various hospitalizations. Now, the role of procedures and imaging in each one of these really could be one of three things. It might be a diagnostic tool that is finding out what the problem is by getting detailed pictures of the heart, understanding flow inside the chambers of the heart, leading to a more accurate diagnosis. Guiding treatment really helps by understanding just what's going on for the patient and then applying the appropriate treatment to treat that condition. And then lastly, monitoring a patient's progress. As you treat patients, regular imaging can help monitor the effectiveness of various therapies. It could be that a person, for instance, that's had a heart transplant, you want to go back and ensure that medications are maintaining that level of immunosuppression necessary for successful ongoing treatment. And then lastly, the role of the practice manager is one of making sure that there are operational efficiencies, coordinating staff, ensuring patient satisfaction, compliance with documentation to ensure that the required regulatory or appropriate use elements have been recorded, and then really problem solving. As a practice manager, you're there to make sure common problems are addressed in a timely fashion. So each one of these that you see identified here are really important to making sure that when a test is ordered or when a treatment is recommended, that that can be carried out. So here's a list of cath and EP procedures that your patients may experience. A right and a left heart catheterization really looks at the structure and function of the heart as a whole that many times is performed to facilitate treatment in heart failure. It might be in advance of a structural heart procedure like a TAVR or a MitraClip or an appendage occlusive device, things of that nature. And then one of, I actually just referred to a moment ago, an endomyocardial biopsy that is in the diagnosis of myocardial disease or tissue rejection if a person has had a heart transplant. Secondly, there's commonly what I think most people think of when they think of a cath lab procedure, and that is diagnostic angiography and or intervention, commonly referred to as a PCI or percutaneous coronary intervention. That's where they're going to take a look at the flow through the vessels in the heart and determine whether or not there is an obstruction significant to which needs to have a stent placed or maybe a balloon procedure to open up and to achieve better flow. Then there's device implantation. You'll see here a list of various sorts of things, be it a pacemaker, an implantable cardiac defibrillator or an ICD, or an implantable loop monitor or other type of cardiac monitor. There is an increasing number of these types of devices available these days. Sometimes I'll mention that these devices may even be implanted within a clinic space, so keep that in mind. Then lastly, when it comes to electrophysiology procedures, there are a whole host of ablation procedures that may be performed. Those are typically intended to reduce the likelihood of an arrhythmia occurring or to eliminate it altogether. In any regards, many times these are either diagnostic or therapy-related, and you'll see under ablation and other EP elements here that there are various types of arrhythmias that can be addressed. Moving over into the imaging perspective, you'll see a pretty robust list here of different imaging procedures that can be performed on your patients. Many times these can be performed in your outpatient centers or within your hospital departments. You may see them in a specific cardiovascular imaging or radiology area. So starting at the top, EKG, these are also performed within your office, but it is, you know, hooking up the electrodes and the wires and being able to look at the electrical pattern of the heart. Then Holter or event monitoring, that again is taking a look at the electrical activity of the heart, but over a longer period of time. Stress testing, you may see commonly for the patient to do this performed with a treadmill, but there are occasions where we will see a patient be placed onto a bike. Moving down into the imaging component to this, we also do echocardiography, where you think about this as the ultrasound of the heart. And this can be done through various formats, whether it is an echo, a TEE, which is where they take their probe down the throat area to view the heart from the inside of your body cavity. A stress echo and dobutamine echo are looking at the heart while it has had a stress test or an increase in its heart rate. We then move into nuclear cardiology where a patient will be injected with a radioisotope and then pictures will be taken. They will also have a stress test. Now that is the most common test that you would see under nuclear cardiology with a myocardial perfusion study, but you may also have a patient scheduled for a MUGA or an ERNA where they look at the EF or ejection fraction of the heart. They may also be scheduled for a viability or an amyloid scan. The next is a cardiac PET. So this is just a different type of camera that you would see within that nuclear cardiology department. And in this, the patient may also be scheduled for a myocardial perfusion imaging study with a stress test, a viability study, sarcoid, or infection. And again, the patient will be injected with a radioisotope. It is important to note in these last two categories that it is not an iodine contrast that the patient would be injected with. The next category is cardiac CT. There are multiple different exams that can be performed on the heart within the cardiac CT program. Note that the patient may be injected with an iodine contrast, and it is important to check to see if the patient has any allergic reactions. Next is cardiac MRI. And our last is with vascular ultrasound. And with this type of ultrasound, we are specifically looking at the veins and the arteries of the body. Please note that each one of these areas may have a separate team of individuals that will work with your patients as their testing is being performed. The various staff that you can expect to interact with in each of these areas are listed below. For the cath lab, I'll take this portion. This includes both pre- and post-care. In both areas, there are registered nurses. The registered nurses in the procedural area have a much more specialized role than the nurses might in the pre- and post-care area, all of which have a deep cardiovascular background. Cardiovascular technologists are assistants in the cardiovascular procedure lab itself. Those roles may also be filled by people with a background as a paramedic, an exercise physiologist, or other type of person that has a health science background. Then there are nursing technicians, a medical assistant, or a CNA that will assist in that pre- and post-care area when it comes to preparing patients for the procedure or caring for them in that initial post-procedure period. And then lastly, transporters helping to move the patient from one area to the next, either immediately post-procedure to an inpatient unit or then to if there's another recovery area available for patients. And then in the imaging space, it's important to note that each one of the imaging modalities, you will go to school or to an educational program where you will receive didactic and clinical hands-on approach. So in that, there are different professional titles that are used for those that are the professionals performing the imaging studies. Common that you will hear is technologist, sonographers, your RNs, nurses, imaging assistants. There's also the use of transporters and your cardiovascular tech. When it comes to patient preparation for the cath lab, several areas need to be attended to. Clear assessment of the patient on arrival to make sure that they're stable at their current baseline and to ensure that they're in a particular place in their care where they can safely undergo the procedure. In advance of the procedure, there will be various requirements that they're informed of, and this is where the office plays a key role, is making sure the patient understands fasting requirements and or dietary restrictions. If there are various medications that might need to be held or reduced in their dose, might be some physical preparation in terms of if it's cleaning, showering an area before a device is implanted, taking a prep bath or a wash to the skin, maybe even clipping hair. And then when it comes to sedation and the need for transportation, patients need to be very clear that if they've received any type of sedation, they will need a driver to make sure they can return home safely. For expectations for length of stay, it will really depend on the nature of the sedation received and on the type of vascular access for interventional procedures. Large bore access, so very large catheters typically put in the femoral artery or vein, many times will take a little longer for recovery, as opposed to a radial access, which is typically used now for PCIs, where they might only need to stay for a period of four hours after the procedure. All of this requires important communications to the patient, education to make sure they understand. It's that teach-back sort of methodology that can be used where the patient is given an explanation, and then you ask them to repeat back and say, now tell me what you understand. Also, providing that education in a variety of formats, be it in print, be it a text message through your portal, or be it a video or something like that, is important to deliver to patients as everybody has a different learning style. And then finally, day of procedure instructions, so the patients know what time they need to arrive, where they should come to, and who might need to be with them, and again, things to bring such as their medications. All of those things combine together to ensure a successful preparation for a procedure. And then moving on into the imaging space, you'll see a very similar list as to what Denise has discussed. One of the things to point out though, with the fasting requirement and or dietary restrictions, and combining that with the medication management, each of the exams within the imaging space will have its own set of criteria. We would recommend that there is information that is clearly provided to your practice manager, to your MAs, to those that are communicating with the patients about their testing and these requirements, to know exactly what will need to be followed the day or the day before the test. The other part with physical preparation, with this one in the imaging world, it's more about what they wear during the day of their testing. And again, information should be provided to them in multiple different formats, whether that's written or electronic. The next piece is with sedation and need for transportation. And it's exactly what Denise covered, but I'll add an additional piece to this. It does need to be a family or friend that would be with the patient during the procedure time, and then being able to transport them back home. It's important to communicate with the patient to not be using a car service to transport that patient back home. Expectations for length of stay, almost 100% of imaging procedures, the patient will have it performed in one day and go home immediately after. If there are any critical findings that are seen, the patient will stay within the department while the technologist or sonographer or nurse reaches out to the reading physician to determine next steps. And then that communication is given to the patient. Same thing with patient education and communication. Even though the patient may have had this test before, it is important to cover what the patient prep is, as that may have changed since the last time that they had the test. Day of procedure instructions, it is nice to be able to provide them with a written or electronic copy that they can then take that back home and reference. And also many times family members are interested in the prep or the type of test that they're having. The last piece is understanding when they'll get the test results or how they will get the test results, whether that is the MA or nurse or someone from the department contacting the patient with their results. For invasive procedures, as we've alluded to in the last section, it's really important to have more of a standardized pre-procedure planning approach. Many times this can be centralized, but depending on your situation, it may be something that's done by just a particular department. So once the order is placed by the provider who's ordering the procedure, it's important again that they're a clear trigger to provide patient instructions. And then once that patient has those instructions, that the procedure can be scheduled and then other appropriate labs or diagnostics are also ordered at that time. That way there can be that easy sequence of orders and procedures performed so that if there is one that relies on the other, that for instance a lab and needing to know a hemoglobin or a metabolic profile, that that is available prior to the diagnostic test being performed. Also scheduling the procedure is something that is important to share with the patient in terms of the time, wherein particularly with invasive procedures, there may be various things that can arise that can alter the actual time the procedure occurs. So giving patients an understanding that we've scheduled your arrival time for seven, your procedure we expect will begin at eight, but things can come up. So that you kind of give them a mental preparation for knowing that they may not have their test exactly at a certain time. And then if once the order is placed three and the procedure is scheduled three, about three, two, three days before the procedure, it's important that someone in the office is reviewing labs, managing them accordingly. So checking inbox messages to make sure if labs have been resulting, that someone can take a look at that and make sure that there's nothing awry or amiss that needs attention prior to being able to perform the procedure. It's always better to catch those in advance rather than having a surprise on the day of the procedure that might lead to a cancellation. If there are certain labs that cannot be obtained in advance, we should make sure that there's an order available so that that lab can be obtained on the day of the procedure. Many times this can lead to delays in the procedure starting. So as much as possible, we like to minimize those, but there are some instances where certain lab tests must be performed on the day of. And then making sure that the patient has an understanding of what time they're supposed to be there, what their preparation instructions are, and that they understand which medications to take or to hold. On the day of the procedure, we want to make sure that the patient is aware of what needs to happen, what will happen, that they're aware of where they should arrive to, things of that nature, and that they're presenting for the procedure well in advance of what time the procedure will take place. Each organization will have a slightly different amount of time in advance of the start of the procedure that they'd like patients to arrive. Typically, it's about an hour to maybe an hour and a half prior to the start of an invasive procedure, about that same amount of time for a non-invasive imaging procedure. It just allows time for the nursing staff to make sure the patient has an IV started, if need be, and or that their history and physical and assessment information has enough time to be collected. The next slide is going to cover some common reasons why a patient may cancel or need to reschedule. I would really put these into three categories. One, patient, two, physician or provider, or three, the department or the procedural lab. The important piece of this, especially from a patient perspective, is that they know who to contact if they have any questions prior to the test or if they know that they're not going to be able to make that. A lot of times, patients may have some concerns or anxiety about the procedure or even have some questions about patient prep that may prevent them from coming in for their exam. There may also be some patient forgetfulness, and in that, we would encourage that the procedural lab or the imaging areas have a process or workflow in place to contact the patient to remind them of their study. The next is with scheduling conflicts, and this really can sit in multiple categories with the patient, the patient's provider or physician, or even within the imaging or procedural areas. Transportation issues, and this often comes up when we have our extreme weather and being able to have backup plans like a plan B and being able to get the patient in for their procedure or their imaging study. Sometimes patients just aren't feeling well enough. It is important to communicate with them when they should continue to come in or contact their provider for next steps. Family or personal emergencies, again, important to provide them with contact information so they know who to reach out to if they need to cancel and reschedule. Financial concerns can also be a barrier for patients if they're unsure of what they're out of pocket or what their bill will be after a procedure or test has been completed. It is important to communicate that information to the patient prior to the day of their testing. Ensuring that you cover the preparation for the testing or for their procedure is important to make sure that when they show up for that day that they have followed all of the appropriate instructions. Language barriers. This is where the practice manager or the office plays a very important role when it comes to the procedural and imaging areas. If you are aware that an interpreter will be needed, please contact the areas so that they can proactively plan. We're going to cover pre-authorizations and documentations on the next slide, but the last piece here is missing order. Please note that if there is no order for the procedure or for the image, the team will not be able to start. Now let's start a discussion for pre-authorizations and the required documentation. So if you have a patient that has commercial or Medicare Advantage type insurance, many of these will require a phone call or an online inquiry to determine if the patient needs to have a pre-authorization prior to starting the procedure or the image. This could be done by verifying the different types of insurance coverage that they have or they may also have to provide them with the patient's history and the reason why the test is being performed. The insurance company will then provide back an approval. It could either be a combination of letters or numbers that then needs to be documented in the patient's chart indicating that that pre-auth has been obtained. When it comes to required documentation in advance of procedures, it's very important to attend to these four elements. First of all, a patient's medical history. This may or may not already be part of the clinic record for the patient. If the patient has been referred from outside of a clinic, it may be something that you have to request if it's not already present. Reviewing a patient's record well in advance of a procedure or a test is always helpful to ensure all of the documents necessary to inform those providing the procedure are available. Take for instance, sometimes there may be the proceduralist performing the test, be it imaging or be it a heart cath or something of that nature, may not have been the person who saw the patient in the clinic. Therefore, their performance of the procedure may be impacted by the nature of the information in their history. They might want to be aware of things that would be in that medical record that would influence the way in which they acquired images, the nature or the extent of testing that's performed. Next, consent forms. The consent form should always match the order for the test. If the test is clearly ordered as a transesophageal echocardiogram or a right and left heart catheterization, that should be included on the form for the consent. What the patient signs clearly reflects what the provider has ordered and what is expected to occur. And then secondly, shared decision making. Now, there are some procedures for which shared decision making is a requirement, but shared decision making should always occur, wherein the patient has a thorough explanation of what test is being recommended and if they could then decide to do something other than what's being recommended. Sometimes it may be that a patient is informed that you could always get a second opinion, so shared decision means the patient is provided with enough information to help them understand what is going to happen in the test and if there is an alternate choice available to them. It may be medication, it may be no treatment, it could be a variety of things, but that's part of what that shared decision making entails. And then lastly, having a pre-procedure checklist is always a valuable way. It's that whole checklist manifesto. There's so many things going on in a practice and in a clinic setting that if you don't have things written down, it's easy to forget things. These can be formed many times electronically within the electronic health record and then the staff person reviewing the patient's record can go through and quickly check and make sure all those pre-procedure elements have been attended to. Now, we'll put this under not required but important. In other words, you don't have to have a checklist but boy, it sure does help. Now, there are different types of orders that may be listed here for patients. There are diagnostic orders and then there are invasive or interventional procedure orders. Regardless of the nature of the order, they should contain elements that help give direction to the staff and the clinical care team that will be caring for the patient. There may be an opportunity within those orders to add additional information that would further guide the necessity of that particular order. We have appropriate use criteria that may be built into imaging orders or to interventional procedures that help ensure thorough documentation of the need for the procedure. And then there is the ability to integrate those orders in electronic health records so that there is transition of the order from the ambulatory setting to the procedure site itself and making sure that those orders are thoroughly and accurately completed. It's easy sometimes for providers to just click one box and think that they've done the whole thing. Having staff that may be there to review or then re-educating those that may be placing the orders to ensure that there isn't time wasted going back and doing double work when it maybe doesn't need to be done. Using pre-checked orders or pre-selected orders as they're sometimes noted can be very helpful. Paired with guidelines that are embedded then in those orders can be an extremely robust way to ensure standardization of patient care. Standardization is one of those key elements that we can't overemphasize. When there is reduced variation we increase safety and quality. So using orders as a way to standardize care can be very important. Let's use an example in a post-procedure setting where a patient is now on bed rest following the cardiac catheterization procedure and the placement of a closure device or manual closure. This standardization if we know that every time a patient has a closure device that means they are on bed rest for two hours unless of course there might be extenuating circumstances. That avoids what I like to call physician roulette where you never know what you're going to get based on whatever physician might be placing the order. Whenever you have standardization that allows all staff to anticipate the kind of care that patients would need under usual circumstances. For scheduling workflows and common issues we wanted to provide you with a high level of different areas that you may see especially as in your role you will be helping us with problem solving with our patients and ensuring that they get their procedure or their imaging exam done. The first part is with scheduling workflows and that is with the appointment setting. It's important to note that there is an arrival time versus the time that the procedure or the imaging exam may be performed and that is important to communicate with the patient when they need to arrive in to register or if they needed to fill out paperwork or if they had additional procedures that they needed to complete prior to having the procedure or the imaging exam. The second piece is often patients are coming in and having multiple things done. So for instance they're not coming in to just have an echo and then coming home and coming in a different day for a different procedure but often they're coming in and being coordinated between maybe a stress test, an echo, a halter. They may even be coming in and having a TEE and then going over into the procedural area for a cardioversion. So it's very important to map those times out to the patient on when they need to arrive, what they can expect as their day flows and then when they would be able to wrap up or be finished with their day. Some common issues that you may see are that the procedural areas or imaging areas have been overbooked and so a patient may have to wait a little bit longer to have their procedure done or if there was an emergency that was put on their case may be moved to a later time in the day or even to the next day. You may see that a patient last minute will cancel and in these moments you may be able to take this opportunity to do an add-on patient especially in the imaging departments. You may see some communication breakdowns. You may see this between the office, you may see this in the imaging areas, you may see this in the procedural lab or any combination between the three. From a physician or provider perspective, you may see that there are conflicts that pop up with the schedule where the clinic schedules the patient but the provider has time off. In these cases, it's very important from a practice manager to look at these schedules outside of the office to ensure that they also know that the physician or provider has been scheduled off. The last piece is with our procedural areas and understanding if the patient would need to stay for an admission for their post-procedure and ensuring that there is a bed available. Ways in which we can support performance really range from having things written down. Typically, we think of that as a policy or standard work. It may be providing educational resources and then it's really emphasizing overall quality management or quality evaluation. Back to the policy and procedure and standard work, I mentioned before the importance of reducing variation. If we take standard guidelines and merge those into order sets or guidelines or references that staff have as linked within a policy, that gives organizational teeth behind what's taking place. That really can help staff understand what their role is. It also can give them support if they are challenged with what their role or work may be in a particular area. Educational resources almost goes unsaid. There are a variety of ways in which you'll find educational resources and that means for staff of all different levels. It's not just the registered nurses or the technologists, but it would also be for the nursing assistants, the transporters, ways in which they understand the kind of care they're providing and how they can enhance the care delivered. There are educational resources that can be found places like this at MedAx in the academy. There are also obviously online courses for books and courses that can be taken, but it's just important to make sure that those are available for staff and that they are encouraged to participate. Lastly, as I mentioned, quality and safety management that really emphasizes safety and effectiveness is really important. Delivering care in an accurate and timely manner is what's going to make a difference for your patients. Those high reliability practices wherein you stop and you check and you double check and that you have that 200 percent accountability and you develop a culture wherein you've got each other's back is really critical in ensuring that you'll have safe provision of care. Following appropriate use to make sure again that it's appropriate to perform a particular test and that staff are all aware of what that should be so that they can help again raise that 200 percent accountability. Ask just curious questions to say gosh I wonder why we're not also doing this in this particular instance or did you want to do this doctor so and so because it's again it's a busy it's a busy place and team members being accountable to one another only increase the safety. I'll mention here just radiation exposure reduction, being aware of the fact that in a lab where you're doing procedures there is radiation and it's one of those things that's fairly ubiquitous it's like you know it's there but you don't pay attention to it so being aware of the scatter of radiation and taking appropriate precautions and not being too cavalier about whether or not you wear appropriate radiation protection and stay away from radiation whenever you can and then certainly avoiding complications making sure that there is that there are steps in place to reduce the likelihood of complications and understanding how to manage them as well as taking steps to improve patient and clinical team satisfaction. In summary, practice managers have a huge impact on the performance of procedures be they imaging procedures or be they invasive procedures. The first that we've somewhat addressed today has been efficiency and that would be evaluating workflows, talking to staff, understanding what it is that gets in their way and saying are there ways that we can improve the way patients either arrive or the way they are moved and roomed into a room or perhaps the way in which they're they're given information to make sure they're adequately prepared for their visit. If you get in and you would do what we call go to again by you go directly and see and walk the path of the patient he'll understand better where what sorts of efficiencies might be able to maintain. Reducing wait times for patients is critical in an environment where it can be very busy and patients can crowd a waiting room so things that help you improve efficiency will help many other ways in the long run. And with staff coordination from a patient's perspective we are all one team so it's important to be able to support the patient in that whether they're in the physician office, they're in an imaging area or in the procedural lab. It's important to ensure that you have adequate staffing in each of these areas. The training has been provided in support and I would also say that it's important to have a walk in the shoes that each one understands the role of the others as the patient is moving through their experience from the time that the procedure or exam has been ordered to the time that they're getting their test results. And speaking of patient experience making sure that patients are both informed and understand so you minimize cancellations as Jamie went through that whole list of reasons why you can have cancellations. The more you can prepare the patient to understand what their role is in a successful test the better off we'll be. Problem solving. You as the practice manager you are the problem solver and we are so grateful that you are here. You are the one that is able to address scheduling conflicts and operation issues. You're going to see these and be able to reactive or even proactive be able to solve. Well there's always documentation you can almost can't hammer that home enough. Documentation making sure that there is completeness of the record that really supports communication between the clinical team members and then not to forget that we've got bills and codes to apply to a particular procedure. So don't forget the vital importance of thoroughly documenting. You can use other tricks and tips when it comes to documentation. We mentioned checklists where things are listed in front of you and all you need to do is check them off. There may be other dot phrases as we call them many times where it's a pre-prepared sentence that people can click on and it helps to support. So documentation sometimes can be a little burdensome or perceived as burdensome but take a look and talk with your providers and other clinical team members to really understand what can be done to reduce that burden and to ensure thoroughness. Performance monitoring and quality assurance. As we are working with patients with people we do want to ensure that each step that we are doing is appropriate and that we are meeting best care for that patient. And as we are seen as one team it is super important for each area to be able to oversee and assure that their areas are following the appropriate workflows. And last but certainly not least, staff engagement and team culture. This again can't almost be overstressed. We like to say many times that culture eats strategy for lunch and culture eats staff for lunch too. So if you don't have staff that really have buy-in to the environment and understand the why, we're all here to take care of patients and to deliver high quality care as we do so. Providing them a say in the process, you know, making sure that staff have an opportunity to participate in decision making as much as possible, that they have an opportunity to identify glitches along the way and workflow improvements. That's ways in which you can engage staff further and really build a strong team culture that helps you deliver high quality care. So we'd like to leave this module with you with thinking about working as a team. Again, as that patient thinks of us as one team within cardiology, how can we ensure that the workflows and the back end that we have really set up our teams for success and being able to communicate. I'll give you a story in the imaging world and Denise probably also will say this in the procedural, is that when you're in the imaging department and you have that patient right in front of you and you're running into a problem, whether the patient's missing an order or you don't have a pre-op or the patient didn't follow the prep, having that lifeline of being able to call the practice manager, call someone within that office to help immediately problem solve and get that patient taken care of, is not only getting the patient successfully taken care of, but it is also building that team stronger and knowing that the next time they'll be able to solve and problem solve by having those relationships built between the practice and the imaging and procedural areas. I agree. That's so important, Jamie. You think about the number of times in which you feel like, now what do I do? If you have that in advance and have a list of people to call or better yet, hopefully you've addressed all the issues so that it doesn't arise. Knowing that you've got that person that's got your back really makes a difference. I would encourage you to develop relationships with the leaders in the procedural and imaging areas, have their contact information, even offer to do a walk in the shoes both ways, bi-directionally, that they can come to you and that you and your team would be able to come to them just to learn a little bit about each other's areas. I do think that that helps, especially with problem solving, with seeing all aspects that the patient will see. I'm going to add one more thing here. Many times these days between imaging and invasive procedures, one begets the other. A patient may have an imaging study that leads to an interventional study or there may be an interventional study that then begets an imaging study. We're not off on an island. We're all on one team and it makes a difference as to the successful treatment of a patient when we understand the roles that each of us plays. Thank you for being with us at this module over the procedural and imaging areas. If you have any questions, please reach out to the email academy at medaxium.com. Thank you for your time and attention.

cardiovascular procedures

imaging techniques

heart conditions

practice manager

patient preparation

procedure cancellation

team coordination

integrated care