Achieving Atrial Fibrillation Certification: Wheaton Franciscan Healthcare-St. Francis

Wheaton Franciscan Healthcare-St. Francis was recently the first hospital in the state of Wisconsin to achieve full Atrial Fibrillation (AF) Certification from the Society of Cardiovascular Patient Care (SCPC). In this interview, we speak with Dr. Charles Lanzarotti, Medical Director for Wheaton Franciscan Healthcare’s Department of Cardiac Electrophysiology and Medical Director of the Cardiac Electrophysiology Lab at Wheaton Franciscan Healthcare-St. Francis, about receiving this certification.

Tell us about the cardiac electrophysiology program at Wheaton Franciscan Healthcare-St. Francis. How many EP labs are there? How many EP lab staff members and electrophysiologists are there? Approximately how many AF cases does the hospital see annually?

The Wheaton system has six hospitals in southeast Wisconsin, four of which have EP labs. St. Francis is one of those six hospitals in the system, and we probably have the busiest EP program. We do roughly 500 EP cases a year and about 150 AF ablations. There are two EP labs at St. Francis, and both have Biosense Webster’s Carto mapping systems. We do our AF ablations with the Medtronic cryoablation system. We also have the Stereotaxis Odyssey to communicate between the two labs and to communicate with our other labs in the Wheaton system outside of St. Francis. All six Wheaton hospitals in Wisconsin have cardiac services, but at this time, only four have dedicated EP labs: Wheaton Franciscan - Wisconsin Heart Hospital Campus (two labs), St. Joseph Campus (one lab), and Wheaton Franciscan Healthcare - All Saints in Racine (one lab). As far as staff, there are four electrophysiologists currently in our group, and we’re hiring a fifth electrophysiologist who will be joining us in August. 

Why did your facility choose to pursue Atrial Fibrillation Certification from the SCPC? What was your goal in this earning this certification status?

At St. Francis, we have a very busy AF ablation program, and we wanted to showcase how we treat our patients with AF and also see if there was anything that we could be doing better, so we decided to go through the certification process. As director of the EP program for the Wheaton system, I’ve worked closely with the Emergency Department (ED) physicians throughout our Wheaton system, and part of the certification is to integrate with the ED to help them develop protocols as to how to risk stratify AF patients. This includes whether to admit the patients, put them on observation, or if they’re safe to be discharged (and if discharged, what the treatment protocol would be for discharge and what kind of follow-up they should have). We’ve already been doing a lot of this informally, and it has helped us be more organized in the certification process. Since part of this process was to integrate into the inpatient service as well, we also developed AF template protocols for admitting patients with AF. St. Francis has close to 50,000 ED visits each year, and about 10 percent of those are admitted. This is a high volume of patients, many of whom have AF, for one hospital. It’s important to have these protocols in place on how to treat AF patients in the ED, and know who to admit, how to admit them, and integrate that with our EP program, our consultation service, and our ablation program. 

What was the time frame for achieving certification, from start to finish? 

It was well over a year from when we first decided we would go forward with it, through to actually getting the certification. 

What members of the staff and hospital were involved in the certification process?

There was a wide range of representation from the ED, nursing representation from both the ED and the nursing floor, a nurse and nurse practitioner from the EP department, and representation from the VP of Medical Affairs and Hospital Administration. 

Discuss how you addressed the Key Elements needed to qualify for certification. 

I think the most important things were to be organized and to understand what was involved, including integrating very different groups such as the ED, EP, cardiology, and nursing. Achieving certification requires everyone, from the hospital administration down, to agree to work together, take the time necessary for meetings, and organize protocols in order to move forward. 

How has your facility’s approach to AF treatment and management changed or improved since earning Atrial Fibrillation Certification?

I think we now have a better handle on how we treat patients, particularly in the ED and for inpatients. We’re taking a better look at what we can do going forward to improve things further, in terms of their acute management from when they first reach the ED (rate control), to quickly coordinating between the ED physicians and electrophysiology/cardiology to establish a treatment plan for the patient. We also learned better ways to communicate and how to more rapidly get the patient into the proper treatment plan. 

Has the certification resulted in cost savings for the hospital?

It’s still too early to tell — we were just recently certified in June. 

What tips do you have for other labs considering or currently going through the certification process?

I would say that to move forward with this type of certification, you need to have: 1) a large volume of AF patients that you’re treating, and 2) a system where all involved — including administration, ED, cardiology and EP physicians, and the inpatient admitting physician hospitalists — are committed to going forward with this. It’s a group effort and it really does take a lot of involvement from all of these different specialties. Get organized early, and know you can’t go it alone — without everyone’s support, I don’t think it would have gone as easily as it went for us. Fortunately, everybody involved saw this as a goal that we really wanted to reach.

What does achieving Atrial Fibrillation Certification mean for the staff at Wheaton Franciscan Healthcare-St. Francis?

Again, it’s a way for us to showcase that we treat many patients with atrial fibrillation and that we’re dedicated to providing the best care for these patients. Some patients may need nothing more than to control their heart rate or anticoagulation, but we also offer specialized care including ablation. The entire hospital system is dedicated to going the extra effort to show our dedication in the treatment of patients with AF. 

Is there anything else you’d like to add?

It was a goal we wanted to achieve because we really wanted to showcase what we do. We have a great EP program in the entire Wheaton system, and particularly at our busiest AF ablation program here at St. Francis — our doctors strive to provide the best care.