Spotlight Interview: St. Joseph's Hospital Health 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 a one-room laboratory. The mix of staff is two electrophysiologists, three full-time RNs (one of which is a certified heart rhythm professional), one part-time RN, and one administrative assistant. We perform implants and extractions in our Operating Room, which includes separately trained staff. When was the EP lab started at your institution? We opened the electrophysiology laboratory in June of 1997. What types of procedures are performed at your facility? We perform EP studies and ablations for all types of arrhythmias, including atrial fibrillation ablations. We use retrograde and transeptal techniques, and have a three-dimensional (3D) mapping system. We insert permanent pacemakers and ICDs, including biventricular devices. One of our physicians is also credentialed to perform lead extractions. What is the primary goal of your program (AF ablations, lead extractions, BiVs, etc.)? Our primary goal is to provide a comprehensive, state-of-the-art EP service. Approximately how many are performed each week? What complications do you find during these procedures? We perform approximately 12 EP cases and 19 device cases a week. Over one year, we do approximately 540 cases in the laboratory. Devices are done in the Operating Room. Our complications are rare in occurrence. Who manages your EP lab? The laboratory is managed by our Medical Director and an RN-Manager. Is the electrophysiology lab separate from the cath lab? How long has this been? Are employees cross-trained? Our EP lab is separate from the cath lab. It has been this way since the lab opened. Employees are not cross-trained. Do you have cross training inside the EP lab? What are the regulations in your state? The RNs are cross-trained to scrub, circulate, sedate and map. Our state regulates that only RNs pass out medications. What new equipment, devices and/or products have been introduced at your lab lately? How has this changed the way you perform those procedures? We received our newest piece of equipment when we switched out our old Prucka system to the new GE CardioLab. We have had the EnSite mapping system for over five years. Who handles your procedure scheduling? Do you use particular software? Our administrative assistant handles all scheduling of the EP laboratory, and our Central Scheduling staff schedules in the Operating Room. They use the PHS system for scheduling. What type of quality control/quality assurance measures are practiced in your EP lab? We log every case. If complications do occur, they are sent to and reviewed by our hospital s Risk Management team. How is inventory managed at your EP lab? Who handles the purchasing of equipment and supplies? Our hospital uses a handheld system of managing our everyday medical supplies. Our catheters and specific EP supplies are ordered and managed by our nurse manager. Has your EP lab recently expanded in size and patient volume, or will it be in the near future? In the 10 years we have been open, we have seen a change in the mix of procedures, not necessarily a number increase. As with most institutions, our ICD volume is also up. What measures has your electrophysiology lab implemented in order to cut or contain costs? In addition, in what ways have you improved efficiencies in patient through-put? We have always been stringent on our cost per case. We use two major vendors for EP catheters, and get low pricing because we use two. Our turnover time and time per case is quite fast. What procedures do you perform on an outpatient basis? The vast majority of our cases in the EP lab and Operating Room are done as outpatients. Very few patients are done as inpatients they would fit into this category only if they were transferred in from an outlying hospital. How are new employees oriented and trained at your facility? We use a competency-based orientation. We often say we are constantly being trained, since we learn daily. What types of continuing education opportunities are provided to staff members? We have a Network Resource staff that helps us with continuing education. Some of it is provided online. There is also always hands-on education. How is staff competency evaluated? Competency is evaluated yearly. What committees, if any, are staff members asked to serve on in your lab? Some of the committees include Performance Improvement, Ethics, and Magnet, to name a few. How do you handle vendor visits to your department? Do you contract with vendors? Our vendors are to be scheduled to come to the lab. For the most part, pricing is discussed with our purchasing agent. Does your lab utilize any alternative therapies? We were one of the first labs to use Precedex ^® for sedation. Please describe one of the more interesting or bizarre cases that have come through your electrophysiology lab. Over the past 10 years there have been so many that it is difficult to pinpoint just one. How does your lab handle call time for staff members? We do not use an on-call system. Does your lab use a third party for reprocessing? We are single use but also recycle our catheter tips. Approximately what percentage of your ablation procedures are done with cryo? We do not use cryo. Do you perform only adult EP procedures, or do you also do pediatric cases? Our state regulates us as an adult lab. Do your nurses/techs participate in the follow up of pacemakers and ICDs? No. What are your thoughts about non-EPs implanting ICDs? Do you train such individuals? Our physicians do assist in training non-EPs to implant. What about device recalls? How has your lab handled these? Recalls are handled through the Operating Room and the private physician offices. Is your lab doing web-based/transtelephonic device follow-up? Our lab does not do follow-up, although our physicians are using Web-based follow-up programs in their offices. Is your EP lab currently involved in any clinical research studies or special projects? Yes. When was your last inspection by the Joint Commission? Our last inspection was in December 2007. Are you ACGME-approved for EP training? No. 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 started an ICD support group in 1998. Please tell our readers what you consider unique or innovative about your EP lab and staff. We pride ourselves on the personalized care we provide our patients and our efficiency. In addition, our Medical Director is unique; when he decided he wanted to start performing atrial fibrillation ablations, he traveled to Milan and worked with Dr. Pappone. When he returned, we all sat down and discussed how we were going to begin these cases. We discussed pre-, intra- and post-care, how many cases we were going to do per week, what type of staff needed to be present during these cases, etc. All of the staff were aware of their roles and expectations. When our very first atrial fibrillation ablation took place in April of 2003, the procedure time was nine hours and 30 minutes. Now we perform two atrial fibrillation ablations per week. Our procedure time now is approximately two hours and 30 minutes. For more information, please visit: www.sjhsyr.org/sjhhc/