SCAI: How to start PAD & CLI programs
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| Source: Spectranetics |
Expertise
You must be comfortable with most aspects of vascular medicine and intervention. Obtaining certification from the American Board of Vascular Medicine is recommended, and it is important to be very familiar with interpretation of vascular ultrasound and physiological testing (ABI, PVR). Obtaining Registered Physician in Vascular Interpretation (RPVI) certification will add legitimacy to your practice.
Commitment
Commit to treating vascular disease by establishing a dedicated clinic and practice. Establish yourself as the local expert who is passionate about taking care of vascular patients. Your staff must be familiar with managing vascular patients, and your administrators must be on top of an ever-changing billing structure.
Collaboration
Ally yourself with a vascular surgeon whom you can work with as a partner. Your skill should be complementary. You can establish relationships with local primary care physicians, podiatrists, and rehabilitation physicians by offering them easy access to services and good follow-up. Ensure good communication of procedural results in a timely manner. This is good practice for any physician who refers patients to you. You should also establish appropriate relationships with local industry representatives, as they can offer expertise on inventory, help train staff, and provide access for rapidly evolving technology.
Quality
Review your procedural outcomes frequently, and make sure you maintain the highest level of care and safety. Do not perform difficult or controversial interventions in your first two years. If you are faced with complex decisions or interventions, collaborate with an endovascular surgeon or an experienced interventionalist.
Critical Limb Ischemia
CLI is one of the most devastating complications of advanced PAD. It is responsible for 185,000 amputations per year in the U.S. As more interventional treatment options are becoming available and our understanding of revascularization techniques for infrapopliteal vessels continues to advance, we have an opportunity to impact CLI outcomes by improving limb salvage rates.
The first step in integrating CLI treatment into your program will be to educate your own team. Nurses, medical assistants, and front desk staff should be educated regarding the impact of this illness and the importance of treating patients promptly. The whole team needs to understand that patients with rest pain, ischemic ulcers, or gangrene should be identified and treated urgently. Train your staff to prioritize these patients similar to those who call with chest pain and to schedule accordingly.
It should be routine for all patients to be instructed to remove shoes and socks during their first visit. Staff should receive proper training in wound dressing removal and redressing techniques, and a Doppler ultrasound should be readily available.
If your practice is in a hospital environment, you should educate and inform primary care physicians, wound care and infectious disease specialists, podiatrists, endocrinologists, orthopedic surgeons, neurologists, and nephrologists about the type of work and level of expertise that you are able to provide. Lectures, grand rounds, as well as lunch and dinner programs are excellent tools for introducing other clinicians to CLI diagnosis and management.
Strategies for raising awareness of PAD and your services include free screening programs, community seminars, local media outreach and collaboration with your community service liaison and hospital foundation.
Finally, it is crucial that you and your team stay current. Attending relevant PAD conferences is critical and, as you expand into treatment of CLI, participating at wound management conferences can improve your approach and understanding of your patients. If you want to be considered a thought-leader and pioneer during this revolutionary stage in PAD and CLI management, you must also participate and contribute to clinical research as well as educate fellows.
Dr. Sokol directs cardiac catheterization and endovascular services at the Jacobi Medical Center in the Bronx, N.Y., and is the assistant program director for the cardiology fellowship training program for the Albert Einstein College of Medicine/Montefiore Medical Center. Dr. Diaz is an interventional cardiologist at the Metro Heart and Vascular Center at Metro Health Hospital in Grand Rapids, Mich. Both are members of SCAI’s Interventional Career Development Committee.