IRMC Expands Cardiac, Nuclear Medicine Center

INDIANA--Area residents with circulatory concerns can take heart: Indiana Regional Medical Center has opened an expanded Center for Cardiac and Vascular Care.

Moving from the right side to the left side of the main lobby, the combined diagnostic area includes cardiac, vascular and nuclear medicine functions. The move has nearly doubled the space for those services.

IRMC's cardiac care center is taking over a second-floor space formerly occupied by the medical center's emergency room. The cardiac center also has expanded into part of an adjoining building addition, located above the new emergency department.

Gutting and installing a series of new medical rooms in the former ER cost about $1.4 million. IRMC officials were unable to break down the cardiac center's portion of the new emergency department construction, which also cost about $1 million.

While cardiac patients began using the new center July 15, transfer of the nuclear medicine facilities was still under way this week. An open house is set for noon to 2 p.m. Sunday.

Lancy Brunetto, director of the cardiac and vascular center and of its predecessor, known as special services, said the revamped area will provide a brighter, more spacious environment for both patients and staff.

"It had to be updated," he said of the center, noting the new, larger location "allows for the future expansion of services." The renovations also are intended to make patient visits

"more convenient and more aesthetically pleasing. It gives the patient more privacy."

Brunetto explained the new center provides separate rooms for individual patients receiving cardiovascular testing services. In the previous location, a few large rooms were divided using curtains.

New health industry regulations stress the importance of keeping patient information confidential.

Brunetto noted, "The only one who needs to know about a patient's condition is the person who is testing him." But, when multiple patients are being examined in the same room, "You can hear what's being said through the curtain."

Totaling about 8,500 square feet, the new center is split fairly evenly between space dedicated to nuclear medicine--which employs radioactive materials to track functioning of the heart and other major organs--and several rooms used for less invasive diagnostic procedures--such as treadmill stress tests, echocardiograms (ECHO) and electrocardiograms (EKG).

EKGs, through electrical impulses, check for abnormal heart rhythms.

Brunetto explained an ECHO, which is similar to a sonogram, evaluates other heart functions: "It looks at the heart valves, to see if they're opening well, and the blood flow in the heart, to make sure there's no leakage backwards."

Brunetto noted the previous special services area covered about 4,400 square feet. Though adequate at one time, it became an increasingly tight fit as patient numbers increased.

During the 2002-03 fiscal year, which just ended, IRMC performed about 11,000 cardiac studies and 8,000 nuclear studies for patients, Brunetto said. That has grown over the past two decades, from just 1,000 cardiac studies and a few hundred nuclear studies per year.

Brunetto acknowledged an aging population is naturally adding to demand for his department's services. "Over 50 percent of those we see are Medicare patients," he noted.

But, he said, "Our (patient) volumes have been increasing partly because of newer equipment and better testing."

He indicated a big boost in the hospital's cardiac-related business occurred two years ago, with the introduction of a cardiac catheterization and angiography lab.

Brunetto noted, "It's made it more convenient for patients. Now we can provide them services that they previously had to go elsewhere to obtain."

In the catheterization procedure, a dye administered through a catheter produces an x-ray image, which reveals how well blood is flowing through the heart and associated arteries. The angiography process is used for other blood vessels in the body.

According to Brunetto, radiologists and a vascular surgeon associated with IRMC are able to treat problems revealed through angiography.

"We're doing some interventional work," he said. "If a patient comes in with leg pain and we find there is a (blood vessel) blockage in the leg, we can fix that.

"If an artery is closed down or partially blocked, a stent can be put in to open it back up."

Completion of the new cardiac center, which was receiving final touches this week, is the next step in the hospital's efforts to improve efficiency and convenience of care, Brunetto said.

The improvement is immediately apparent when patients arrive in the new cardiac waiting/reception area, which provides more than twice the seating available in the old location.

While ultimate plans were yet to be determined for rooms vacated in the cardiac/nuclear medicine move, Brunetto noted the respiratory department will continue to use the smaller waiting room it once shared with the other diagnostic areas.

With the move to the other side of the second floor, IRMC has added a third cardiology testing room.

In stress tests offered there, a patient's heart rate is assessed during physical activity. "We look at the blood flow to the heart muscle itself," Brunetto said.

At the new cardiac center, patients also may be fitted with devices which monitor their heart rate for 24 hours or up to 30 days. About $130,000 has been budgeted for the purchase of a new ECHO unit.

In conjunction with the move of its nuclear medicine facilities, the hospital is replacing two of its three "gamma camera" units.

Unlike x-ray machines, Brunetto said, the gamma cameras themselves don't generate radiation. They allow technicians to capture either static or moving images of a selected organ's function by detecting small amounts of radioactive tracer materials injected into the patient.

He explained, the technician gives the patient material that normally is consumed by the area of the body to be examined: "If we want to look at bone, we use a radioactive form of phosphorus."

Replacing cameras which are between eight and 13 years old, the new gamma units are valued at more than $1 million combined.

Brunetto explained the smaller of the new units will be used solely for cardiac imaging. The larger device can create images of any portion of the body, equipped with two heads which rotate around the patient.

According to Brunetto, the larger unit will mostly be used for examining a patient's bone structure or such organs as the liver.

An existing medium-sized camera is being retained and will be used for imaging the heart as well as other organs.

"At least 50 percent of the (patients) coming through our nuclear medicine program are cardiac patients," Brunetto said.

He explained insufficient blood flow through the heart muscle usually indicates a patient is a candidate for nuclear medicine.

Brunetto noted one of the advantages of the new gamma cameras is a more open design, which should alleviate claustrophobic feelings some patients experience when being examined in the units.

"Over the years, nuclear medicine and cardiology have evolved," Brunetto said. "We want to continue to improve the process of diagnosing and treating cardiac and vascular patients."

IRMC's new cardiac center provides increased space for physicians to read EKG tracings and to view gamma camera images.

An area also has been set aside as a pacemaker clinic.

Brunetto explained, patients with pacemakers come to the facility quarterly to have the implanted heart-regulating devices serviced: "We do an extensive check of the operation and battery life of the pacemaker and make any adjustments that are needed."

Also, the new center provides a centralized space for conducting a Transesophageal Echo-cardiogram (TEE). A standard ECHO involves placement of sensors on a patient's chest, but Brunetto explained a TEE probe is lowered down into the esophagus to take heart readings from a different angle.

"Now we're doing those procedures either in our ambulatory treatment area or in the cath lab holding area," he said.

There still will be some separate areas of the hospital involved in cardiac care.

The cath lab is on the fourth floor, while a telemetry unit which provides patient heart monitoring is on the seventh floor.

But Brunetto said the im-proved cardiac center is the start of integration of all of the cardiac-related functions.

Eventually, "We want to turn all areas dealing with cardiac care into a service line. The goal is better coordination in moving patients through the system"--from their arrival through diagnosis, assessment and either treatment on-site or referral to other facilities.

"We can become more efficient with not too much more equipment," he said.

IRMC's cardiac and nuclear medicine facilities are staffed by 20 full and part-time employees. There are no immediate plans to add staff, but that could change based on expansion of the departments' services.