Spotlight Interview: Marion General Hospital

What is the size of your EP lab facility and the number of staff members? What is the mix of credentials at your lab? Marion General Hospital is a 176 acute-bed hospital in a small community in northeast Indiana. The electrophysiology lab employs five registered nurses (all with critical care background), one registered radiology technologist, one cardiovascular technologist, and one secretary.  We have one dedicated Electrophysiologist. When was the EP lab started at your institution? We added EP services in 2001 to our existing cardiac catheterization lab after Dr. M. Nabi Sharif came to us. Dr. Sharif is board-certified in cardiology and internal medicine and did his electrophysiology fellowship at Kaiser Permanent LA Medical Center in Los Angeles, California, and at the University of Calgary in Alberta, Canada. What types of procedures are performed at your facility? We perform EP studies, NIPS, implanting of pacemakers, event recorders, ICDs, and CRT-Ds, as well as tilt table testing, SA ECGs, cardioversions and device programming. Who manages your EP lab? My name is Melo-Dee Perez, RN, MS, and I am the administrative director of the cardiovascular service line.  I lead the day-to-day operations of the combo lab, as well as carry out administrative duties for the cardiovascular and cardiac rehab departments. Is the EP lab separate from the Cath lab? Are employees cross-trained? No, currently we do EP in our cath lab. At times this has been a challenge, and we are in the process of expanding our services to include vascular procedures and adding a second lab.  We are all trained for cardiovascular and EP procedures.   Do you have cross-training inside the EP lab? What are the regulations in your state? All of our nurses are cross-trained to monitor, scrub and give conscious sedation.  Our technologists can monitor and scrub. What types of quality assurance measures are practiced in your EP lab? We do QA monitors for infection, hematoma formation, conscious sedation and patient satisfaction. How is inventory managed at your EP lab? Who handles the purchasing of equipment and supplies? We use the GE/Prucka Combo Lab which helps in tracking of everyday supplies.  We are used to keeping Par levels, as spaced is limited.  Capital equipment is approved by the administrative director with the input of the cardiologists and/or staff, depending on the purchase. Has your EP lab recently expanded in size and patient volume, or will it be in the near future? Our electrophysiology services have grown steadily each year. For a small hospital with many large competitors an hour away, we are proud of the services that we can offer to our community. How has managed care affected your EP lab and the care it provides patients? We have a unique situation at Marion General Hospital. Our electrophysiologist is very conscious of Medicare guidelines, reimbursement practices, etc. He works very well with us and patient accounts to make sure that we are doing what is best for the patient. By the same token, we are very comfortable in knowing that there are times when he knows what is best for the patient and we have to work hard on the back end to get coverage. We are so blessed to have a physician that partners so well with the hospital! What measures has your EP lab implemented in order to cut or contain costs? We are always re-evaluating our inventory to find better ways to cut waste.   We yearly update our custom packs, work with our vendors for better contracts, and use a reprocessing vendor on items that meet guidelines for re-use.   How are new employees oriented and trained at your facility? Employees new to our department complete at least a six-week orientation with a preceptor before they are allowed to perform independently. Each orientation is tailored to goals that are reviewed by the new team member and preceptor on a weekly basis.     What type of continuing education opportunities are provided to staff members? The hospital offers many opportunities for the staff in-house. These would include topics like cardiac medications, radiation safety, etc. As a department we participate in web-based seminars, send different members to conferences within the area, and always send at least one member to HRS each year. How is staff competency evaluated? We have certain competencies that our team feels are important to stay proficient in, and we update the list yearly. These competencies are performed with peer reviewers. How does your EP lab handle call time for staff members? At this time, our EP lab does not have a call team. Unfortunately, not unlike other EP labs, we have many late evening cases that require us to rotate staying over. Our team continues to graciously take turns covering these cases. Does your lab use a third party for reprocessing? We use Vanguard for reprocessing cables and expired items.  They provide us with containers that are picked up weekly.  We have been using this system for well over a year and are pleased with the cost-savings.   What trends do you see emerging in the practice of electrophysiology? I see a continual growth in the amount of ICD implants, especially with the expanded Medicare coverage guidelines.  Also, our CHF population is huge.  I m sure CRT device implants will continue to grow and implant times will continue to fall as we get more proficient and new LV lead placement supplies and techniques become available. Does your EP lab provide any educational or support programs for patients? We have started a yearly meeting for our ICD implants. This summer we hosted a luncheon at the country club in which Dr. Sharif spoke.  All of our team attended along with our electrophysiologist and his office nurse. We also had our implant vendors participate. We have a Congestive Heart Failure Support Group that meets monthly. Many of our device patients attend this meeting.   Describe your city or general regional area. How does it differ from the rest of the U.S.? We are about 45 minutes away from the nearest hospital. We are approximately one hour away from four heart centers.  Not unique to other small hospitals, we sometimes lose patients to the big city.   Please tell our readers what you consider unique or innovative about your EP lab and staff. We do what we call one-stop shopping for our patients.  They are given a pre-procedure phone call to obtain admission information, give them instructions, and answer questions.  They do not stop in admitting or get any pre-labs.  They come directly to the department where they are admitted to a very modern and comfortable holding area located just outside of the EP lab. At this time their history is completed, labs are drawn, X-rays are obtained, education is done and they are prepped all by the same team that will be doing the procedure! Post-procedure, they return to this area with the same team member that scrubbed the case to get dressing changes and/or hemostasis, receive post-instructions and get follow-up doctor appointments completed. For more information about Marion General Hospital, please visit: www.mgh.net/