Spotlight Interview: King`s Daughters Medical Center

What is the size of your EP lab facility and number of staff members? What is the mix of credentials at your lab? We have five cardiac catheterization labs, one of which functions as an electrophysiology lab. Our lab is staffed with registered nurses, radiology techs, and emergency medical technicians. Out of a staff of 36 people, five are core electrophysiology personnel. When was the EP lab started at your institution? Our EP program started in the spring of 1999. What types of procedures are performed at your facility? We currently perform EP studies and ablations for AVNRT, AVRT, atrial tachycardia, atrial flutter, ventricular arrhythmias, PVC ablations, and pulmonary vein isolations. We implant pacemakers, ICDs, and biventricular devices. Our EP lab also functions as a cardiac catheterization lab when no EP cases are scheduled. Approximately how many are performed each week? What complications do you find during these procedures? Approximately 18 cases a week are performed in the EP lab; this number fluctuates from week to week depending on our census in the hospital. Who manages your EP lab? The Cardiac Cath Lab Manager, Kim Grooms, manages our EP lab. Is the EP lab separate from the cath lab? How long has this been? Are employees cross-trained? The EP lab is part of the cardiac cath lab. This has been the arrangement since the EP program was started. Do you have cross training inside the EP lab? What are the regulations in your state? Our registered nurses and radiology technicians are all cross trained. We take turns scrubbing, circulating, and recording. All staff is ACLS-certified. Registered nurses give all medications that do not fall under ACLS guidelines. 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? We recently upgraded our EP MedSystems dos-based system with the EP MedSystems windows-based system, and purchased the EP MedSystems ViewMate ® (EP MedSystems, Inc., West Berlin, NJ) intracardiac echocardiogram. This equipment has allowed us better visualization of the heart during transseptal approaches and ablation procedures. The lab also utilizes the CARTO (Biosense Webster, Inc., a Johnson and Johnson company, Diamond Bar, CA) 3D mapping system integrated with the EP Med system. Who handles your procedure scheduling? Do you use a particular software? How do you handle physician timeliness? Our EP cases are scheduled through the cath lab secretary. Out patients are called a day before by the cath lab scheduler to confirm the appointment and to answer any questions the patient might have about the procedure. We have two physicians that perform electrophysiology procedures. Scheduling is performed on a first-come, first-serve basis; if there is a conflict, the physicians are notified and a compromise is made. What type of quality control/quality assurance measures are practiced in your EP lab? Our institution currently has quality and control personnel that will respond to complaints or concerns that the staff may have involving procedures. Cardiac cath lab personnel continuously monitor quality and control on a case-by-case basis. How is inventory managed at your EP lab? Who handles the purchasing of equipment and supplies? Inventory in the lab is monitored by the electrophysiology staff. The electrophysiology personnel under the direction of the cath lab director perform the purchasing of materials for the lab; however, we have hired an inventory control specialist who will be trained to manage day-to-day supplies and inventory needed. Has your EP lab recently expanded in size and patient volume, or will it be in the near future? Our electrophysiology caseload has remained about the same over the last couple of years, while device implantation has increased significantly. Our institution is currently building a new Heart and Vascular Center, where we will increase our number of labs with the potential to add a second EP lab. How has managed care affected your EP lab and the care it provides patients? Our patients that come in for elective electrophysiology procedures are pre-certified with the insurance companies prior to admission to the hospital. What measures has your EP lab implemented in order to cut or contain costs? In addition, in what ways have you improved efficiencies in patient throughput? In order to contain costs in the electrophysiology lab, we limit the number of vendors servicing the lab. This allows us to keep a smaller inventory of supplies on hand while providing the physicians with the equipment necessary to perform the procedures. We currently use St. Jude Medical and Biosense Webster equipment. EP vendor selection is based primarily on quality of service. Our purchasing department and physicians meet once a year with device companies to negotiate contracts regarding pricing. We only carry two device companies. The contracts are awarded based on pricing and the quality of the devices. We currently use Medtronic and St. Jude Medical. Does your EP lab compete for patients? Has your institution formed an alliance with others in the area? In our geographic area, we compete with one area hospital about 20 miles away that also performs EP procedures. We currently have no alliance with any institution in our area. What procedures do you perform on an outpatient basis? We currently perform ICD and pacemaker generator changes, EP studies and ablations, and tilt-table testing on an outpatient basis. If the patient requires transseptal approach or new device lead implantation, the patient will stay overnight. How are new employees oriented and trained at your facility? Our new employees start their orientation in the cardiac catheterization lab. Our lab has an orientation program that pairs the new employee with an experienced preceptor. Orientation usually lasts approximately three to six months, depending on the experience of the new employee. If the person expresses interest in electrophysiology, then they are allowed to orient in the EP lab. Orientation to the EP lab is through a preceptorship and on-the-job training. Our institution will also send new personnel through various EP training seminars located throughout the country. What types of continuing education opportunities are provided to staff members? The hospital offers continuing education courses throughout the year. Sometimes we invite EP clinical specialists from outside the hospital to talk about electrophysiology procedures. The lab will also send staff to HRS and other symposiums throughout the year. Annually, KDMC has a Heart and Vascular Conference that is free to all employees. How is staff competency evaluated? Staff competency is evaluated through physician and staff input along with an orientation/validation packet. Also, we have annual competency for all staff. How do you handle vendor visits to your department? Vendor visits are scheduled in advance prior to them coming in to the lab. All vendors are required to wear an identification badge and check in with security upon arrival to the hospital. Does your lab utilize any alternative therapies? We do not utilize any alternative therapies. Please describe one of the more interesting or bizarre cases that have come through your EP lab. During a recent biventricular implant, one of our physicians implanted a coronary stent in the coronary sinus to facilitate placement of the LV lead. 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? Is there a particular mix of credentials needed for each call team? Our lab call schedule operates as follows: on call one day a week and every fifth weekend. The EP staff performs coronary procedures when there are no EP procedures on the schedule. Therefore, the EP staff takes call with the core coronary personnel. We try to keep one EP person on each of the five call teams in case an EP case would arise after hours. There are always four staff members on call at any given time: two RTs and two RNs, or one RT and three RNs. Does your lab use a third party for reprocessing? The EP lab does not use a third party for reprocessing procedures. All the materials used are new out of the box. Approximately what percentage of your ablation procedures are done with cryo? What percentage is done with radiofrequency? We currently do not have a cryoablation system. We use radiofrequency on all of our cases. Do you perform only adult EP procedures or do you also do pediatric cases? Is there cross training for pediatric cases? All of our EP procedures are performed on adult or adolescent patients. The decision to perform an EP on an adolescent is based on the physician and body surface area of the patient. What trends do you see emerging in the practice of electrophysiology? The trends we are seeing in the EP lab tend to be a significant increase in device implantation. We have also seen an improvement in the catheters and sheaths used in EP cases, especially those used for pulmonary vein isolations. Is your EP lab currently involved in any clinical trials or special projects? A formal in-house research team was initiated in 2004. We have participated in several data collection projects, including the first retrospective analysis with Angiomax (The Medicines Company, Parsippany, NJ) in transseptal catheterization. We have been using Angiomax routinely since 2002. Does your lab undergo a JCAHO inspection? Yes, Our last inspection was in December 2004. 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? We have educational literature available, and the physician and office staff educates the patient prior to the procedure. The hospital has worked with the EP physicians for a support group called Zap, for patients with AICDs. Give an example of a difficult problem or challenge your lab has faced. How it was addressed? Some of the challenges that we have faced in the last year were the tremendous growth of our EP and coronary volume, as well as hiring new staff and getting them trained. Another challenge was keeping track of inventory used in cases and proper billing of procedures. We have three full-time employees that work continuously coding procedures and maintaining inventory. These employees once worked within the cath lab, and have a good understanding of the procedures performed in the lab. Describe your city or general regional area. How does it differ from the rest of the U.S.? We are in a geographical area known for a significant amount of heart disease. We receive patients from all over eastern Kentucky, southern Ohio and southwestern West Virginia. Our facility performs heart catheterizations, angioplasty, electrophysiology procedures, ablations, device implantation, and open-heart surgery. According to the Centers for Disease Control, Kentucky's death rate from cardiovascular disease is 10 percent higher than that of the general U.S. population, and the fourth highest rate in the nation. Please tell our readers what you consider unique or innovative about your EP lab and its staff? What I think is unique about our EP lab is that we can perform any procedure that can be performed in a cardiac catheterization lab. We will do heart caths, angioplasty, electrophysiology procedures, pericardiocentesis procedures, device implants, and sometimes peripheral procedures. Both of our EP physicians are interventional cardiologists; therefore, we must be versatile to accommodate them. We also cross train. You could look into our lab and you would not be able to tell the RNs from the RTs. This flexibility allows us to be able to respond to any emergency that might arise during a procedure.