Spotlight InterviewMercy Heart Institute, Mercy General Hospital

We have recently participated in device studies for biventricular pacemakers/defibrillators with Medtronic, Guidant and St. Jude for heart failure, a drug study to evaluate new drug therapy for SVT, and catheter studies for VT ablation and AF using linear ablation techniques. Advanced technology and highly trained physicians are important elements of Mercy s heart program, but the most important ingredient in the success of our program is the teamwork and skills of those providing the patient care. Mercy s electrophysiologists, cardiac nurses, and specially trained technicians work together to deliver high quality care that emphasizes the personal needs of the patient and their family members. What is the size of your EP lab facility and number of staff members? What is the mix of credentials at your lab? We currently have 2 labs located at Mercy General Hospital one for electrophysiology, and one for implanting devices. In the spring of 2003, we will be opening two new EP labs at our current site, in addition to our present Pacer Lab. The new labs will provide us the opportunity to perform EP and implants in the same room, therefore, improving service to our patients. Our staff consists of 4 electrophysiologists, eight RNs, one EP tech, two CV techs and 1 Rad tech. We are currently recruiting RNs and technicians for our expansion. On-site training is available RNs must have ICU experience with a focus of cardiovascular care; technicians must have cardiovascular knowledge as well as computer skills. When was the EP lab started at your institution? Our EP Lab opened in 1988. What types of procedures are performed at your facility? Approximately how many are performed each week? We are a full service EP lab performing diagnostic procedures, interventional procedures, and implantable devices (EP studies, ablations, tilt table testing, pacemaker, biventricular pacemakers, and ICD implants). In 2001, we performed over 900 procedures. Current trends, January through September 2002: EP lab procedures: 564 [Tilt studies, 11; EP studies, 146; ablations, 407 (A tach, SVT, HIS, VT, atrial flutter; atrial fibrillation)]. Pacer lab procedures: 402: [Pacers, ICDs; Biventricular pacers/defibrillators]. What complications do you find during these procedures? As far as infection and vascular damage, there was none reported. In addition, there was a very low incidence of complete heart block and tamponade. How is your EP lab managed, and by whom? Our Medical Director is Gearoid O Neill; the Director Cardiovascular Services is Sue Kelman, RN; Manager of EP, Pacer, and Cath Labs is Steve Rowell; Clinical Nurse Specialist is Nancy Beck, RN; Charge Nurse for EP and Pacer Lab is Wilma Caluag, RN; and the Lead EP tech is James Vargo. Is the EP lab separate from the Cath lab? How long has this been? Are employees cross-trained? Our EP Program has always been a separate entity there is no cross training with the Cath Lab staff. Do you have cross-training inside the EP lab? Within the EP and Pacer Labs, the staff are cross-trained within their job classification. In addition, the RNs are being cross-trained to scrub for the surgical procedures. What are some of the new equipment, devices and products introduced at your lab lately? How has this changed the way you perform those procedures? With our EP expansion, we are upgrading our GE Cardio Lab monitoring system. Our lab also utilizes the Endocardial Solutions Ensite Mapping System. Combined with our GE mapping system, this has allowed us the flexibility to utilize the most appropriate equipment in order to provide a high success rate for ablation. Mercy will continue to explore all new technologies with the intent of providing the best clinical outcomes for our patients. Is your EP lab filmless, or does it plan to become filmless in the foreseeable future? We are a filmless lab. Who handles your procedure scheduling? Do you use a particular software? How do you handle physician timeliness? Scheduling of EP and Pacer cases is handled by the Charge Nurse via a voicemail/pager system. Physician timeliness is enhanced by telephone verification. MDs receive a call 30-45 minutes prior to scheduled procedure time to confirm patient pick-up time; a second call is made when patient is prepped and draped. How is inventory managed at your EP lab? Who handles the purchasing of equipment and supplies? The Materials Management Coordinator manages the inventory, and in cooperation with the manager and director, is responsible for purchases in the EP and Pacer labs. Has your EP lab recently expanded in size and patient volume, or will it be in the near future? Yes, we are continuing to expand our program. In June 2001, our staff consisted of 1 full-time RN and 1 EP tech, one part-time RN and one tech. The Clinical Nurse Specialist position was added at this time. In October 2001, we opened a new lab for insertion of pacemakers and ICDs. Like the EP Lab, the operational hours are day shifts Monday through Friday. We are currently averaging 40-50 cases per month in the Pacer lab; cases are performed primarily utilizing procedural sedation. We are currently in the final construction phase of two new EP labs which will be completed in February 2002. This will expand our services to 2 EP labs and a Pacer lab. In the new EP labs, we will be able to perform EP procedures as well as surgical implantable devices. Staff recruitment and training is currently underway. How has managed care affected your EP lab and the care it provides patients? At Mercy Heart Institute, we have not changed our commitment to excellence despite the penetration of managed care and changes in revenue. Our EP Program located at Mercy General Hospital continues to be one of the largest in the country, listed in the top 5% for volume. We will continue to bring new technology and quality regardless of diminishing reimbursement. What measures has your EP lab implemented in order to cut or contain costs and improve efficiencies in patient through-put? The recruitment of our Material Management Coordinator, David Yamasaki, to evaluate usage/cost of supplies and help with vendors negotiations, enables us to offer the best technology at the best price. Our active involvement in research allows us to be familiar with the technology before the actual availability of the product, physician involvement is essential. Recruitment of a Clinical Nurse Specialist, Nancy Beck, who has responsibility for many aspects within the cardiovascular programs. Evaluation/update of coding and billing to meet the new 2002 CPT Coding changes. Implementation of policy and procedure to improve the accuracy of procedure billing and staff training. Efficiency has been enhanced through the development of pre-op checklists, pre-printed admit and discharge orders. This allows smoother transition for patients throughout the process. Our current expansion will provide a greater opportunity to meet the growing need for electrophysiology and implantable device therapies, while providing the care in the most effective manner possible. Does your EP lab compete for patients? Has your institution formed an alliance with others in the area? Mercy General Hospital, located in the Sacramento area, competes with two other healthcare organizations who have EP programs. However, we do have an exclusive contract with Kaiser Foundation for all Cardiovascular Services, and also market to outlying areas. Does your lab have an outpatient program? Many of our procedures are performed as outpatient. How are new employees oriented and trained at your facility? Orientation and training is individualized to match the employees experience level. We require RNs to have ICU experience and techs to have cardiovascular knowledge. Each employee is paired with a preceptor; the orientation checklist guides the process with follow-up from the Clinical Nurse Specialist. Our approach is very hands-on, providing the orientee the opportunity to see one, do one and teach one. The electrophysiologists play an active role by providing learning experiences, explanations, and feedback. What type of continuing education opportunities are provided to staff members? Annual Cardiovascular Conferences are presented by the Mercy Heart Institute for physicians, nurses and technical staff. These conferences bring nationally renowned speakers to the Sacramento area. Staff also attend conferences such as Order and Disorder, NASPE and other EP conferences around the nation; their attendance is sponsored by Mercy Heart Institute. In addition, in-services and workshops are promoted during work hours in cooperation with various companies. Our electrophysiologists provide case presentations to enhance the staff knowledge. How is staff competency evaluated? Staff competency and learning needs are evaluated continually by the Manager and Clinical Nurse Specialist, as supported by the quality assurance measures in place. In-services for new technologies, devices and supplies are monitored for 100% attendance. Annual competency consists of general competency and department-specific competency such as procedural sedation, radiation safety and equipment operation. Does your lab utilize any alternative therapies? At this time, we do not utilize any alternative therapies. Have you had any interesting or bizarre cases come through your EP lab? Most recently, a young man with intractable sustained ventricular tachycardia (of many years), who had unsuccessful ablations in the past at another medical facility, and failed pharmaceutical therapy was recently referred for services. During a short procedure, the VT source was identified and successfully ablated. The patient was discharged with normal sinus rhythm. How does your lab handle call time for staff members? How often is each staff member on call? How frequently do they have to come in, on average? Do they still maintain a full schedule the next day if they had to come in the night before? Our EP and Pacer labs operated Monday through Friday, daytime hours, with no call. Generally, the cases are elective, but when needed, the staff have been willing to adjust the schedule and hours to provide the patient services required. We are currently exploring the expansion of hours. What type of quality control/quality assurance measures are practiced in your EP lab? Quarterly procedural sedation audits; Tracking of case volume, case length, turnover time; Implementation of audit process for billing accuracy. What trends do you see emerging in the practice of invasive cardiology? Some of the trends we see are the advancements of mapping and catheter technology, the increase in ablations, biventricular pacing and ICD implants. Does your lab undergo any sort of inspection? How often does this occur? We have the JCAHO inspection every 2 years. Does your lab provide any educational or support programs for patients who may have additional questions or those who may be interested in support groups? Mercy Heart Institute sponsors a support group for patients who have had an ICD implanted. The meetings are held every other month and include a Christmas celebration and a summer Picnic. Patients and their families are encouraged to attend the events which include education as well as support from an EP staff RN, physician office RN, social worker, and physicians. If there a problem or challenge your lab has faced? How it was addressed? Active participation by the Cardiovascular Director, Medical Director, Manager and Clinical Nurse specialist enhances our ability to address challenges quickly and effectively. Open communication with all team members assists in prompt problem identification and resolution. Please tell our readers what you consider unique or innovate about your EP lab and its staff. Our facility offers comprehensive, high-quality cardiovascular care that includes surgical and interventional programs, as well as an active Research Department. We have dedicated EP staff, supportive electrophysiologists, and the administrative support that gives us access to the best modalities of treatment for our EP patients. We stay actively involved in the cutting edge technologies through participation in research trials for pharmaceuticals, catheters, and implantable devices.