December 20, 2016/Nursing/Nursing Operations

In a Large, Dynamic Health System, Affinity Groups Bring Focus and Efficiencies

A closer look at the Cardiac Cath Lab and Dialysis groups


Over the last nine years, Zielony Nursing Institute nurses have organized affinity groups of various specialties to promote collaboration and communication across the health system and to standardize evidence-based best practices.


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Among the more recent groups to have formed, the Cardiac Catheterization Lab and the Dialysis affinity groups implemented enhanced and streamlined system-wide changes in clinical practice with support from members through communication and problem-solving with peers throughout Cleveland Clinic’s many sites.

Among the benefits cited by both groups so far are:

  • Standardization of policies across the health system
  • Reduction in the number of redundant policies
  • Improvement in some standard clinical procedures
  • Reduced costs on some equipment and supplies
  • Enhanced overall feeling of support and camaraderie among nurses colleagues working at multiple sites

Cardiac Cath Lab affinity group cultivates a unified team spirit

The Cardiac Cath Lab Affinity Group first came together in late 2015 so that nurses in cath labs across the health system could get to know each other, find commonalities and differences, and break down barriers, says Deborah Brosovich, MA, RN, NE-BC, CCRN, Assistant Director, Nursing, Sydell & Arnold Miller Family Heart & Vascular Institute.

Group members spent much time visiting each other’s locations, building a rapport with each other, and learning each other’s histories and procedures.

“We needed to standardize procedures, so we noted what was different among the various labs and what we had in common,” Brosovich says. “I was surprised at how swiftly the group came together and how accepting we were of our differences. We all agreed upon the procedures for routine care in the labs.”

One of the group’s major accomplishments in standardizing procedures was to combine several different policies for the removal of arterial sheaths into one streamlined policy.

“Just talking with each other has been beneficial,” says Traci Sustersic, BSN, RN, RCES, CCDS, Nurse Manager, Invasive Cardiovascular Services, Cleveland Clinic Fairview Hospital. “We have gained tips on efficiency and best practices for tracking on-time starts, room turnover times and utilization.”


She adds that breaking down communication barriers helped nurses at multiple sites feel more like they were working together. “I feel like we are one team now,” Sustersic says.

The group’s upcoming plans include work on tracking metrics and data and standardizing nursing job descriptions in cath labs across the health system. Changes will make it easier for nurses to transfer or float to other hospitals when necessary. The group is also looking at how to maximize pricing leverage on supplies and other expenses by making purchases together.

“Catheterization labs of each hospital are physically isolated,” Brosovich explains, “We’ve been accomplishing the same things in different ways for a long time. It has been important for us to take the time to sit down and talk through things together. This group has really stepped up to engage each other, be open to changes and commonalities, and begin implementing standardized best practices.”

Dialysis affinity group shares information for improved patient safety

The Dialysis Affinity Group was first created to enhance purchasing power and promote shared resources among dialysis sites within Cleveland Clinic. However, nurses in the Glickman Urological & Kidney Institute reestablished the group in early 2015 to shift the group’s focus toward clinical issues, specifically, standardizing dialysis delivery practices. The predominant goals were to better accommodate an escalating number of patients by encouraging consistent communication among dialysis department sites (that work independently of each other) and to facilitate consistent interpretation of regulations from the Centers for Medicare & Medicaid Services (CMS) and The Joint Commission.

The group quickly recognized there were over 150 policies for different aspects of dialysis care across the system. The group began with a goal to consolidate these policies to about 50. The team looks at policy redundancies and wording to learn what needs to be changed at different sites, explains Margie Hubman, MSN, RN, NEA-BC, Clinical Nursing Director, Glickman Urological & Kidney Institute.

“Some of the work involves making sure we’re all following the most current practices within the policies,” she says.

As an example of the group’s accomplishments, they standardized how each dialysis site takes water samples and reads water cultures.


“We’re now making sure we’re all drawing the same number of water samples for testing and following the most up-to-date Association for the Advancement of Medical Instrumentation and CMS guidelines,” says Jennifer Tramte, RN, Assistant Nurse Manager, Cleveland Clinic’s East Region Dialysis Group.

“The affinity group has been a remarkable aid for all of us,” Tramte says. “You always have a friend somewhere else and a network of help. It’s really good support.”

Affinity group team brainstorming resulted in health system consistency in using Phoenix meters to ensure that dialysate is within optimal parameters. Tramte says nursing staff were trained or retrained on using the meters to ensure quality control at each dialysis location.

Another affinity group best practice that is now followed came about after members shared information about potential incidents: use of safety clips on patients in continuous renal replacement therapy in the ICU. Safety clips prevent patients from being able to disconnect their lines due to movement. “When nurses cannot visualize the patient’s line 100 percent of the time, these clips are an important safety measure,” Hubman says.

Most dialysis locations are now saving money on hepatitis screenings due to the suggestion of a member of the affinity group. In the past, labs were drawn for a panel that included more than was needed for hepatitis screening. Now, Cleveland Clinic labs only draw the amount of blood needed for antigen and antibody screening, thus saving money.

“We have benefited in so many ways from the affinity group,” Hubman says. “From increased patient safety to sharing best practices to standardizing policies and saving money. Having this network of support is invaluable and will continue to help us all going forward.”

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