Outpatient/Inpatient Cath

[Fran__0]

  With all of the new cath labs springing up onsite at cardiologists offices, what is your opinion on the pro/con of using these sites instead of having the procedure performed in a hospital setting?  While I realize that the majority of caths are performed with no problems arising, the close proximity of specialized emergency medical care IF there is a problem would seem to me to weigh heavily on the side of the hospital.  As I will be facing this choice in the very near future and since my cardio group has just finished a spiffy new cath lab, I would appreciate your views.  

[Cleveland Clinic, MD]

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Dear Fran,
Thank you for your question.  The question is really freestanding cath lab vs. hospital based lab as procedures done in a hospital lab can be done as an outpatient.  The answer is somewhat controversial and will depend greatly on the patient.  I tend to agree with you that access to emergency services including surgery weighs heavily on the side of hospital based cath labs.  Obviously a higher risk patient should be done there.  As for the low risk patient - if they are very low risk they may not need a heart cath in the first place - but if there is a need then a free standing site may be appropriate.  Financial issues are a concern as the doctor's group will make money from a freestanding center and the hospital will make money from a hospital based lab. This raises the possibility that a physician may be biased to "self-refer" to his own lab a patient that would be better served at a hospital lab.  Freestanding centers are more common in places where individuals are not near a hospital with a cath lab and this makes things easier for the patient.  Where do you live?
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