Spotlight Interview: Saint Vincent Health Center

Located in Erie, Pennsylvania, Saint Vincent Health Center is a 450-bed regional referral center recognized as a leader in a number of medical specialties, including cardiovascular disease. In 1990, the Saint Vincent Heart Center introduced the first comprehensive electrophysiology lab in the northwestern Pennsylvania region and has continued innovations in both diagnosis and treatment. The Saint Vincent Heart Center has three board-certified electrophysiologists, two dedicated EP Labs and an outpatient Pacemaker/Defibrillator Clinic. We have four full-time RNs, one part-time RN, a full-time RT and a full-time pacemaker specialist on our team.

What types of procedures are performed at your facility? Approximately how many are performed each week? What complications do you find during these procedures?

The EP lab performs comprehensive EP studies, radiofrequency ablations, pacemaker/defibrillator implants, non-invasive-programmed stimulation, and tilt studies, as well as organizing all cardioversions in the hospital. We average eight implants and four ablations a week. Our pacemaker clinic checks 15-20 outpatient and in-house devices a day. Our complication rates are lower than the national and local average.

How is your EP lab managed, and by whom?

Jeff Buetikofer, MD, is the Director of EP Services, and I am the EP lab supervisor. We work together on daily operations as well as on long-term goals for the EP service.

Is the EP lab separate from the cath lab? Are employees cross-trained?

The EP labs and cath labs are in the same area of the hospital, but EP procedures are separate from all cath procedures. The strength of our service is that the responsibilities of the nurses and techs are only to the EP lab and Pacer Clinic.The majority of us have cath lab/critical care experience and help out in those areas when needed.

Do you have cross-training inside the EP Lab? What are the regulations in your state?

The nurses in the lab are also cross-trained to work in the Pacemaker Clinic. In the lab, nurses and techs perform all the same duties, with the exception of conscious sedation and medication administration handled by the RNs.

What are some of the new equipment, devices and products introduced at your lab lately?

We have participated in the MADIT II, Companion and Rid AF studies. Currently, we are in Medtronic s Marquis study and Biosense s Navistar study, which uses an 8 mm tip catheter for atrial flutter ablations. We have the expertise of two certified Clinical Research Coordinators for the smooth operations of the clinical trials. Recently, we have also started implanting biventricular pacers using Medtronic s InSync device. Our labs are fitted with Prucka recording systems and Radionics stimulators. We utilize the Biosense CARTO Mapping System and Stockert RF generator with all of our ablations and have cut fluoro time considerably. For transseptal ablations, we use Acuson s intra-cardiac echo machine to visualize cardiac anatomy. We have a Trex pulse fluoro in one lab and a Ziehm mobile c-arm in the other.

Is your EP lab filmless?

Our labs are completely filmless.

Who handles your procedure scheduling? Do you use a particular software? How do you handle physician timeliness?

We work with the nurses in the cardiology offices, who set up the outpatient scheduling. The physicians contact us in the lab for all in-patient procedures. The IT department at Saint Vincent has developed an online scheduling system between the hospital and cardiology office for maximum efficiency.

What processes does your lab use for pulling sheaths post-diagnostic and interventional procedures: How does your lab handle hemostasis (ie, manual or vascular closure devices, where do patients go, who is responsible?)

Our sheaths are pulled immediately post-procedure by the RN or Tech in the room, while the patient is still on the table. Hemostasis is obtained by manual compression, and most patients are transported directly to their room post-op.

How is inventory managed at your EP lab? Who handles the purchasing of equipment and supplies?

Steve Stauffer, RT, manages the inventory and works with the purchasing department and our cardiology database to monitor the stock and decrease any waste. Item usage is tracked and bulk purchases are compiled to decrease costs. We have a business relationship with all of our vendors to maintain current technology at the best price. The physicians and staff research and test high-cost equipment before it is purchased.

Has your EP lab recently expanded in size and patient volume?

In the last fiscal year, EP volumes have increased by 26%, with ablation becoming a treatment for atrial fibrillation and biventricular pacing as a new treatment for congestive heart failure; our volumes should continue to rise.

How has managed care affected your EP lab and the care it provides patients?

Managed care has provided us with the challenge of providing a higher degree of care to our patients while at the same time reducing costs. Fortunately, in our area, we have been able to improve care, increase volumes and offer new services, despite changes in the reimbursement arena.

What measures has your EP lab implemented in order to cut or contain costs and improve efficiencies in patient through-put?

Our EP service has to be as efficient as possible operating two dedicated EP labs allows us to do more procedures and decrease hospital stay. We are able to schedule more outpatients and elective procedures and still take care of our inpatients in a timely manner.

Does your EP lab compete for patients? Has your institution formed an alliance with others in the area?

Saint Vincent Health Center draws its patients from a referral base of up to a 50-75 mile radius. Being located approximately 100 miles from the major metropoliton areas of Cleveland, Pittsburgh and Buffalo competition is considerable in those outlying regions. Saint Vincent has formed the Regional Heart Network, a collaborative business venture that links technology, training and expertise for a new standard of care throughout the region. There are currently 15 healthcare organizations in the Regional Heart Network dedicated to providing the best cardiac care in northwest Pennsylvania and western New York.

Does your lab have an outpatient program?

We do our tilt studies and pacer checks, as well as some diagnostic EP studies and non-invasive programmed stimulation as an outpatient procedure. Our tilt patients have pre-arranged time slots and report directly to the Heart Center labs. The patients are then taken back to the EP lab for their study. Once the test is complete, they are briefly placed in a supervised holding area, where the results of their study are discussed by the physician. Elective implants and ablations will stay overnight and be discharged in the morning.

How are new employees oriented and trained at your facility?

All of our new employees receive a general orientation to the Heart Center, where they are introduced to the flow of a typical day. New staff members to the EP lab will be teamed up with a preceptor to learn the specific duties expected of them. Weekly evaluations are performed for 3 months to identify areas of improvement and mutual goals for the next week. All candidates for positions in the EP lab must have previous cardiology experience.

What type of continuing education opportunities are provided to staff members?

Continuous education in EP is very important to us; we send a delegation from Saint Vincent to attend the annual NASPE seminar. We also have a Lunch & Learns weekly meeting to informally discuss the latest EP developments or just brush up on the basics. We operate and maintain all the equipment in the lab, so we have periodic meetings in services and training to keep up with the technology. Everyone on our team must be ACLS- and BCLS-certified.

How is staff competency evaluated?

Each employee has an annual competency evaluation, when job performance is assessed. If specific areas are not met, then a plan is agreed upon to improve the area of need.

Does your lab utilize any alternative therapies?

We do not utilize any specific alternative therapy, but I have found that a calm atmosphere and a smile can diverge a patient s pre-op anxiety.

How does your lab handle call time for staff members?

Our EP lab does not have a formal on-call team. If procedures run late, we take turns on who will stay. Our Pacemaker Clinic has a 24-hour call list to manage weekend and off-hour checks.

What type of quality control/quality assurance measures are practiced in your EP lab?

The Saint Vincent Heart Center has a cardiology database to track all outcomes. Areas such as length of stay, turnover time, physician response time and complications are trended and a quarterly report is generated. This report card is posted for everyone to identify areas of improvement.

What trends do you see emerging in the practice of invasive cardiology?

Our referral base is starting to recognize radiofrequency ablation as a safe and effective first-line treatment for supraventricular tachycardias. RF ablation in the treatment of atrial fibrillation will likely soon become a major part of the practice of EP, and we are well prepared for that as well. National statistics have also shown a rise in the congestive heart failure population and the importance biventricular pacing plays in their treatment.

Does your lab undergo any sort of inspection? How often does this occur?

We are formally inspected every three years by JCAHO and at least once a year by the Department of Health. The hospital conducts various safety and health inspections to the equipment and facility throughout the year.

Please tell our readers what you consider unique or innovate about your EP lab and its staff.

We are different from most EP labs because we are privately employed by the Cardiology Group. This close association between the hospital and cardiologists allows us to operate at maximum efficiency and maintain the highest quality. When not working, seven members from our Heart Center also participate on a hospital-sponsored ice hockey team. Our team is doing pretty well, but we have not quit our day jobs yet!

Is there a specific problem or challenge your lab has faced? How was it addressed?

Three years ago, when we acquired a second and then a third electrophysiologist, we only had one EP lab. Our volumes were increasing, we were doing more complex cases and the staff was working later and later. The solution was to convert an existing conference room next to our lab into a second EP lab. Hospital equipment from previous renovations were upgraded, along with the purchase of a new Prucka system, and a seamless installation was achieved. Now that the patients do not have to wait as long for their procedures and the staff does not have to work as much overtime, everyone is much happier. For more information about Saint Vincent Heart Center, please check out their website at: www.svhs.org\