Spotlight Interview: Einstein Heart Institute

What is the size of your EP lab facility and number of staff members? What is the mix of credentials at your lab?

The Electrophysiology Lab at Einstein Heart Institute has one dedicated electrophysiology lab and an AICD and pacemaker clinic. Our team consists of two electrophysiologists, four registered nurses and two secretaries.

When was the EP lab started at your institution?

Electrophysiology services began at Einstein in 1986.

What types of procedures are performed at your facility? Approximately how many are performed each week?

Electrophysiology services provided by Einstein include tilt table testing, cardioversions, diagnostic electrophysiology studies, ablations (including atrial fibrillation), AICD and pacemaker implants including bi-ventricular device implants for heart failure. We perform approximately 13 to 15 cases per week, as well as a 15 to 20 person-per-week device clinic.

How is your EP lab managed, and by whom?

Carol Irvine oversees Healthcare Services for Einstein Heart Institute. David Muller is the clinical nurse manager for Electrophysiology Services and manages our EP lab and clinic. There is also a manager for the cardiac cath labs.

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

Einstein Heart Institute s electrophysiology services are separate from the cardiac cath; however, we work together to provide optimal care to all of our patients.

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

Einstein's electrophysiology nurses are dedicated EP staff. Currently, cross training has not been a necessity, though it would be explored if necessary.

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?

Einstein dedicated a new lab for electrophysiology in Fall 2001. The lab is equipped with a Phillips CV-9 fluoroscopy system. In addition, we use CARTO (Biosense) for advanced mapping of complex arrhythmias.

Is your EP lab filmless?

Both our electrophysiology and cardiac cath labs are completely digital, and all images are stored on the Phillips Inturis archival system.

How is your procedure scheduling handled? Scheduling for electrophysiology is handled jointly by our secretarial staff and the electrophysiology nurses. The secretaries handle the upfront data collection, pre-admission test scheduling, and initial patient contact. After this process is complete, a nurse calls the patients to review medications, teach and provide our patients with a voice and contact so they have continuity and some familiarity prior to admission.

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

Inventory is managed by the clinical nurse manager and lab staff. Our inventory management system allows for easy documentation and reordering of supplies with minimal phone and documentation.

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

This year, our lab has increased its volume by 25 percent. The expansion of electrophysiology services can be attributed to the staff s development and implementation of new processes involving computer information systems, lab efficiencies and post-procedural patient management.

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

Managed care has not really affected the care of our patients, but has resulted in our becoming a more efficient lab.

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

With the addition of pass-through items, the billing process has been streamlined and computerized to make certain bills are processed as soon as a patient is discharged. These items are flagged in the system ahead of time to ensure efficient processing.

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

Einstein Heart Institute is located in North Philadelphia, an urban area that is heavily populated with both patients and hospitals. The Philadelphia area healthcare market is extremely competitive, with some of the best healthcare systems competing for patients in the same geographic area. We have become a member of the Jefferson Health System, which affords us better pricing and purchasing abilities with vendors.

Does your lab have an outpatient program?

Our lab does not have an outpatient program. We do see device patients in clinic to follow AICDs, pacemakers, and implantable loop recorders.

How are new employees oriented and trained at your facility?

Our new employees undergo a preceptorship training program. Our physicians and nurse manager evaluate the progress of new employees and determine areas in which additional training may be required. Our physicians are excellent educators and will take time to teach during or after cases. A review of the case and electrograms is usually done with staff at the end of ablations and EP studies. In addition, Einstein holds a two-day annual Electrophysiology Symposium, during which topics in basic and advanced EP are discussed.

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

Our staff attends conferences sponsored by the various companies. We are fortunate that organizations in the Philadelphia area offer numerous educational programs, including annual symposia such as the Horowitz Memorial Lecture. How is staff competency evaluated? Staff competencies are continually maintained and audited through inservices, article reviews at weekly journal club meetings, cardiology grand rounds, and individualized EP specific competencies within the department.

How does your lab handle call time for staff members?

Our Electrophysiology Lab requires no call schedule, as most of our patients are elective cases. Emergent cases are routed through the cardiac cath lab.

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

Our lab measures quality control, quality assurance, patient safety and patient satisfaction.

What trends do you see emerging in the practice of electrophysiology?

We are preparing for many of the trends on the horizon for EP. With the outcome of clinical trials changing the way we treat and manage our patients, we are projecting a large increase in AICD placements over the next five years. In addition, as technology and delivery systems improve, biventricular devices in heart failure also offer a lot of room for growth. With the advanced mapping systems and ability to focus on pulmonary vein potentials for atrial fibrillation ablations, growth in the field of electrophysiology is boundless. Also with the prevalence of heart disease and the increasing age of baby boomers, cardiology and electrophysiology will have to continue advancing the methods of treating heart disease.

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

Our lab is inspected by JCAHO every two 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?

Prior to any procedure in the EP lab, a phone call from one of our RNs is made to the patient. In addition, we mail information to each patient describing the procedure, giving instructions and a contact name and phone number in case the patient or family have any questions.

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

What I consider unique and innovative about our EP lab staff is that we all work together and flex to accommodate our patients. We have strong relationships with all of our patients and their families. I have never had the pleasure of working with a staff so dedicated to caring for patients, educating themselves and others, and working to accommodate the needs of our patient population. In closing, as the Clinical Nurse Manager of electrophysiology services at Einstein Heart Institute, I must say the nurses and staff deserve the highest recognition for their dedication to their education, their profession, and most of all to their patients.