Building the New TriStar Centennial Heart & Vascular Center EP Lab

In February 2012, Centennial Medical Center opened its new heart and vascular center. This article provides an overview of the 200,000 square foot center.

Background

TriStar Centennial Medical Center is the flagship hospital of Hospital Corporation of America (HCA). TriStar Centennial has 657 beds and is a large tertiary care referral center, seeing approximately 150,000 outpatients and admitting 24,000 patients on average annually. As HCA’s flagship facility, we have the privilege and responsibility of providing compassionate and outstanding care to our patients and their families.

The EP program at Centennial was started in 1994. The modernized facility, included in the new Centennial Heart & Vascular Center, held its grand opening on February 14, 2012. Dr. R. Christopher Jones, chairman of cardiovascular medicine at Centennial Heart and Vascular Center and director of electrophysiology research at the Sarah Cannon Research Institute, describes how the “vision for the Centennial Heart & Vascular Center was to create a center where our cardiac specialists are immediately accessible to one another, where patients and healthcare providers at other hospitals could receive real-time support from our center’s experts, and most importantly, where the doctor-patient-family connection is at the forefront of the care provided.”

New EP Lab Technology

The EP portion of the center includes two dedicated EP rooms, a cath/EP hybrid, and a hybrid OR. The original plans for the Centennial Heart & Vascular Center were drawn up in 2008. The new facility includes larger rooms that allow for more efficiency by increasing work flow and increased in-room storage for necessary equipment. Also, an added control room in each lab helps to decrease radiation exposure to members of the lab that are not scrubbed in. EP Lab 1 is connected via the tele-presence technology of SystemsOne to the Medtronic headquarters in Minneapolis, strengthening our ability to obtain access to the newest technologies as soon as they become available. We anticipate replicating this model with other industry partners to facilitate our role as a proving ground for the latest techniques and technologies.

The Heart & Vascular Center is located on a single floor in the hospital, thus enabling improved communication and consultation for faster patient treatment among the heart specialties. Physicians and staff benefit from a workplace that is centered on flow and the most effective use of technology as well as the location of the lab, CVOR, and support services all being on one floor. Creating a spacious and efficient lab has facilitated a safer working environment for the staff, physicians, and patients. Physicians and staff were greatly involved in the design process.

The benefits of the new facility to the patients are also numerous. One example is ease of access, which begins with having a dedicated entrance to the heart center with complimentary valet parking. Another benefit is continuity of care; having the same nurse caring for patients before and after procedures improves safety and builds trust.

The EP staff includes manager Lindsay Stergar, RN, BSN, MBAH, Jennifer Baxter, RT(R), Vicki Braun, RN, Mica Brown, RN, Jeff Deimel, RT(R)(MR), Paul Euren, RCIS, Charity Helson, RN, Mandy Keller, RN, Susie Forczek, RN, Carol Thompson, CVT, and Alicia Zepeda, RN. The lab has a combined total experience of more than 150 years in the medical field and 80 years in the cardiovascular specialty. Our physicians include Gregory Bashian, MD, Christopher Conley, MD, R. Christopher Jones, MD, and Thomas J. Killian, MD.

EP staff member Carol Thompson, CVT, adds, “The biggest change seen in our lab, other than volume, is the tremendous amount of new technology available for performing EP cases. At one time afib or VT ablations would take hours with long radiation exposure for the patients and staff. New technology is now allowing procedures to be performed with 10–20 minutes of fluoro time. Other technology that is in place is remote monitoring for both EP cases and device implants. In my career, I never imagined performing cases here in Nashville, with the technician supporting the procedure being located in California or Minnesota.”

EP Procedures and Growth

In 2011, Centennial EP lab completed more than 1,200 procedures (Figure 2). Our newer, expanded facilities will allow an even greater number of patients to be accommodated with improved care due to new technologies and higher facility efficiencies.

The two EP labs operate with the GE Innova and Philips Integris Allura fluoroscopy systems. The CardioLab (GE Healthcare) and Bloom stimulator are used for our stimulation protocols. The mapping systems utilized are St. Jude Medical’s EnSite Velocity and Biosense Webster’s Carto 3. The updated EnSite Velocity system brings the technology of OneMap, which allows for the gathering of various cardiac mapping data and geometry at one time, increasing clinical speed and flow of procedures. The advanced Carto 3 system is upgraded from the previous XP model with advanced catheter location technology and the Fast Anatomical Mapping (FAM) capability. Also, the restructured Patient Interface Unit (PIU) allows for quick connection of the catheter extension cables, increasing the speed of setup over the previous use of individual pin connectors. All of these technologies were also used in our previous labs, with the added technology of a remote ablation setup.

The implementation of SystemsOne was another vital addition to our lab. SystemsOne allows for all of the data and imaging modalities used during cases to be simultaneously displayed through a simple cable connection on one quad-HD monitor (Figure 3). The physician can easily view on one screen all of the electrograms, fluoroscopy and ultrasound images, the pacemaker programmer screen, mapping systems, anesthesia vitals, nContact ablation data, and the images from the surgical endoscope. The system also has a camera and microphone that allow for remote login and communication. A remotely linked SystemsOne display is currently being installed in the clinic offices of Centennial Heart; this will allow physicians to review cases in the EP lab from a remote location and provide valuable feedback in real time.

One of the advanced procedures we have added in the new facility is the convergent procedure, which utilizes a novel, laparoscopically placed epicardial ablation catheter from nContact. It allows both the cardiothoracic surgeon and electrophysiologist to provide better outcomes for patients with longstanding persistent atrial fibrillation or severely enlarged left atria. These patients have typically been undertreated or had lower success rates with traditional endocardial radiofrequency ablation. To date we have performed three ablations, with several more scheduled. These procedures were not performed in the previous facility due to lack of space.

We are also placing an emphasis on developing the atrial fibrillation ablation program. Dr. Gregory Bashian states that Centennial Medical Center is doing this for a number of reasons; in addition to the anticipated growth of this field due to the increasing prevalence of this dysrhythmia, this is also the area of electrophysiology with the most exciting technologic and therapeutic advances.

At TriStar Centennial, our quest to improve vendor relations has led to many new and exciting endeavors. One of these is implementing technology from the Medtronic Hospital of the Future, which melds strategic customer partnerships with cutting-edge technology to improve quality of care, increase efficiencies, and drive cost savings. Through integrated healthcare solutions, such as automated inventory management, interactive educational materials, and remote consulting via high-definition videoconferencing, the Hospital of the Future technologies will improve quality and the efficiency of patient care.

Summary

The future for the EP lab at TriStar Centennial Heart & Vascular Center is strong and exciting. EP technology is advancing at an amazing rate. At Centennial, we believe that if we can lead the way in advancing this technology, we can deliver world-class care not just to the people of Tennessee, but to the entire southeast region.