Building a State-of-the-Art EP Lab: Considerations and Technology: Interview with Sean Tierney, MD

When did the new electrophysiology (EP) lab open? How long did it take to build?

The new lab opened up on August 14, 2006. It took approximately 2 years, from conception to completion. The first year involved meeting with architects and vendors and budget setting. However, once the new air ducts were installed, the project was completed in roughly 9 months. Our old lab was a Trex system that was unreliable and had to be put out of service for staff and patient safety.

Describe the heart program there. Is the new EP lab located within and connected to the rest of the cardiology services?

The heart program is one of great tradition at St. Francis Hospital and Health Center in Blue Island. It was one of the first community hospitals to perform bypass surgery 35 years ago, and that tradition has continued over the years. The hospital provides cutting-edge services such as endovascular abdominal and thoracic aorta aneurysm repair, carotid artery stenting, and atrial fibrillation ablations. It is one of Solucient's 100 Top Cardiovascular Hospitals six years in a row and the recipient of the Malcolm Baldrige National Quality Award. The new lab was part of a greater expansion, which now includes a 15-bed Cardiac Recovery Unit where EP and cardiac cath patients are seen pre and post procedure. There are three dedicated cardiac catheterization labs, a new Special Procedures room where interventional radiology and peripheral interventions can be done, and the dedicated new EP lab. I am part of a large group of 29 Cardiologists with three Electrophysiologists. There are also three independent Electrophysiologists that come to St. Francis along with four dedicated Cardiovascular surgeons. We were doing our cases in one of the three cardiac cath labs adjacent to the recovery rooms in the first floor. The new lab is in the basement of the hospital with a six-bed holding area that we share with MRI and the new Special Procedures room.

What prompted the need for this new EP lab? Has your patient volume or EP procedures grown considerably in the last few years?

The hospital recognized that EP was one of the fastest-growing sections of Cardiology. This was proven by the first Electrophysiologist the group hired, Dr. Chuck Kinder, former Medical Director, who tripled the volume of the EP lab in his first year at St. Francis. Furthermore, the old EP room was antiquated and not ready for newer procedures like complex ablations.

How many staff members do you currently have in the EP lab? What is the range of credentials?

We have 1 x-ray tech who is also the EP lab supervisor; she has been doing EP for 10 years and is a master of connectology. In addition, there are 3 full-time RNs and 2 part-time RNs who are dedicated to staffing the new EP lab. There is also cross-training with the cath lab staff, especially for vacation coverage and for coverage of emergent call cases that are staffed by the cath lab team on call. There is no separate EP call team.

What considerations or special features were included when building the new lab?

We originally wanted biplane, but due to cost containment, we went for single plane, which allowed us to get a state-of-the-art recording system. We also needed new ventilation for the device cases, as well as gases from the ceiling for anesthesia if needed. However, the main consideration was space, and we now have a large room that can accommodate a lot of staff and equipment.

How many EP procedures does the EP department perform annually? What is the percentage of ICD implants?

The lab currently performs over 1200 procedures per year. This does not include cardioversions or tilt table testing, which are done in a different area. About 70% of the procedures are device implants, of which about 60% of the devices are ICDs including cardiac resynchronization devices. We have seen a mild slowing of the ICD implant population but growth of the pacemaker implants with the aging population, so these numbers are in flux. The other 30% include EP studies and catheter ablations.

How large is the new lab? How many rooms are there? Do you have a floor plan that you can provide?

The EP lab square footage is as follows: EP lab: 720 square feet EP Equipment: 94 square feet EP Control & Scrub: 256 square feet EP Holding: 837 square feet EP Patient Toilet: 54 square feet I have been in a lot of EP labs, and it's one of the biggest I have ever seen. The main room includes the fluoro, table and the recording equipment. There is a back equipment room for storage and access to the fluoro generator. The control room has two computers and the master controls of the fluoro system. Off the main procedure room there is a six-bed holding bay; patients stay here for the post-procedure rundown and talk with the family. They are then sent to recover upstairs in our Cardiac Recovery Unit. This Unit has 15 rooms, six of which are licensed by the state for overnight use. These are all private rooms, staffed by nurses familiar with the usual post-operative issues that can occur.

Does the lab also include new equipment and/or technology? Please describe.

The fluoro system is the GE Inova 2000, which provides pulsed digital fluoro and greatly reduces our x-ray exposure from the old intensified beam machine. We obtained the CardioLab IT recording system with a GE Micropace 4-channel stimulator. A big improvement was switching to DVD-based recording from optical disks. The new CardioLab has a fairly decent report generator. We use a Stockert RF generator, but also have an older EPT generator. Our 3D mapping system is CARTO from Biosense Webster with the CARTO Merge software and a THERMOCOOL pump for the irrigated tip catheter. We have a 64-slice cardiac CT in one of our offices, and the pictures of the left atrium in 3-D reconstruction are amazing. The problem is getting insurers to pay for the scan pre-ablation. We have also used cardiac MRI images, which are quite good. We have a tabletop Acuson Cypress machine for intracardiac echo, along with TZ Medical's Booker Box for intracardiac cardioversions. Lastly, regarding equipment and technology in the lab, I have to mention our Black & Decker Home Cafe Coffee Pod System in the break room, which makes individual cups of coffee all hours of the day key to staff morale!

What do you think is the best feature of this new lab?

The best feature of the new lab is the combination of a great space with a new fluoro system that provides crystal-clear visualization of catheters and leads, combined with a dedicated caring staff that provide tremendous care for each patient. If I needed something done, I would want this staff handling my conscious sedation and care. In short, one can build a state-of-the-art EP room with new equipment, but it is absolutely worthless without competent and caring staff, and I am lucky to be surrounded by excellent nurses and techs.

Is there anything else you'd like to add?

We are the only community hospital in the south Chicago area and south suburbs performing atrial fibrillation ablations. We also have quality control measures in place that keep our complication rate below 1% and infection rate below 0.5%. In addition, we actively participate in research trials and are an enrolling center in the MADIT-CRT trial and the RAPID RF trial studying wireless devices.

For more information, please visit:

www.heartcc.com

www.stfrancisblueisland.com/internet/home/stfrancisblueisland.nsf