Inside Scripps Health’s New Heart Hospital

Ten years in the planning, Scripps Health in San Diego recently opened Prebys Cardiovascular Institute (PCI) on February 26, 2015. It is now the most advanced center dedicated to heart care on the West Coast. The $456 million institute is on the campus of Scripps Memorial Hospital La Jolla and will serve as the high-tech hub for cardiovascular services at Scripps Health. The 383,000-square-foot tower of glass, brick and steel rising seven stories above Genesee Avenue is named for Conrad Prebys, a real estate developer, philanthropist and generous Scripps donor whose $45 million gift helped create an institution that will save lives and foster medical breakthroughs for decades to come.

The Prebys Cardiovascular Institute combines highly respected cardiovascular programs throughout the Scripps system and Kaiser Permanente, San Diego. In a unique affiliation with Kaiser, Scripps provides all of the advanced cardiac services, partnering with Kaiser cardiologists and electrophysiologists. Scripps is not only the largest heart care provider in San Diego County, but also the largest in California. With 166 cardiologists, Scripps performed more than 10,000 heart catheterizations and nearly 4,000 electrophysiology procedures in 2013. Scripps was recognized as No. 18 in the nation in heart care by U.S. News & World Report in 2014. Internationally recognized cardiologists who practice at Scripps include Prebys Cardiovascular Institute Medical Director Paul Teirstein, MD, Matthew Price, MD, Richard Fortuna, MD, Jeffrey Cavendish, MD, Richard Schatz, MD, and Eric Topol, MD. During the recent American College of Cardiology Scientific Sessions in San Diego, Dr. Topol welcomed a group of ACC attendees for a reception and tour of the institute.

Electrophysiology Program

Known as a pioneer in electrophysiology, Scripps Memorial Hospital La Jolla has had the largest EP program in San Diego County for decades. Prominent electrophysiologists include Director Steven Higgins, MD, Douglas Gibson, MD, Andrea Natale, MD, John Rogers, MD, and many others. Presently, there are 15 electrophysiologists who practice at Prebys Cardiovascular Institute. Recognized “firsts” for the Scripps EP program include:

• First in the United States to implant a dual chamber defibrillator;
• First in San Diego to do catheter ablation and arrhythmia surgery;
• First in the western U.S. to utilize new radiation reduction ablation imaging (Biosense Webster’s CartoUnivu);
• Second in the world to do a transvenous biventricular defibrillator;
• First, and only, in San Diego to offer an investigational leadless pacemaker (actually two, St. Jude Medical’s Nanostim and Medtronic’s Micra);
• First in California and one of the largest enrolling sites for the WATCHMAN Left Atrial Appendage Closure Device (Boston Scientific);
• Pivotal role and executive committee for all MADIT studies, MADIT-CRT, CONTAK-CD and others;
• First program in the western U.S. to have four dedicated electrophysiology labs;
• First in the nation to implant a miniaturized wireless heart monitor (Medtronic’s Reveal LINQ^™ Insertable Cardiac Monitor).

Currently, there are four electrophysiology labs at Prebys Cardiovascular Institute. One is presently used for device surgery only, but the other three include state-of-the-art mapping systems in each room (Biosense Webster’s Carto 3 with Univu, and St. Jude Medical’s EnSite) and low-radiation GE Innova fluoroscopy systems, some with rotational angiography capability. The program also has two EP robotic systems, manufactured by Catheter Robotics (Amigo Remote Catheter System) and Hansen Medical. There are plans to open a fifth EP lab next May with further expansion to seven EP labs in the institute. The labs are equipped with the new Stereotaxis Odyssey Cinema Systems, which allow physicians and staff to view all activities in the lab in real time or recorded.

With this busy EP program, Scripps has struggled with recruitment of trained electrophysiology staff. Recently, we have developed an educational program led by the Scripps Center for Learning and Innovation. This program is designed both to improve competencies of current EP staff and to educate nurses, CV technologists and radiology technologists who have an interest in working in the EP labs. We utilize our own educators with the Odyssey Cinema display as well as instructional support from industry for an eight-week educational program.

Although patient focused, the Prebys Cardiovascular Institute EP program has been a leading clinical research center in cardiac electrophysiology. Currently, Scripps EP is a leading implanter in both investigational leadless pacemaker systems, the St. Jude Medical Nanostim and Medtronic Micra. Other areas of clinical trial study include complex ablation and cardiac resynchronization therapy.

New Design and Facilities

Prebys Cardiovascular Institute rooms provide state-of-the-art private accommodations for cardiac patients, with 108 inpatient beds and 59 intensive care beds, all with large windows that feature magnificent views of La Jolla. There are six cardiac operating rooms, including two hybrid rooms utilized for laser lead extraction, robotic cardiac surgery, left atrial appendage occlusions and other procedures requiring collaboration between cardiologists, electrophysiologists and cardiac surgeons. Scripps performed more than 1,100 cardiac surgeries last year.

With five labs in place, there are plans to open up to eight catheterization labs by July 2016 when the adjacent Anderson Medical Pavilion is slated to open. At that time, the Scripps Clinic Division of Cardiology will move fully to Prebys Cardiovascular Institute. The Anderson Medical Pavilion, a 175,000-square-foot facility, will house medical offices for Scripps Clinic physicians as well as four outpatient catheterization labs, immediately adjacent to the institute, directly connected by elevated enclosed walkways.

The design of the Prebys Cardiovascular Institute was driven by evidence-based principles and shaped by more than 200 individuals — including doctors, nurses, hospital administration, architects and support staff — who provided guidance on the best practices for cardiac patients. Some of the hospital’s notable features include: 

• Decentralized nurse stations to closely monitor patients and communicate with family members.
• A three-tiered wireless infrastructure dedicated to enterprise, medical and consumer use that maintains maximum security and capabilities for clinicians.
• 17 negative pressure isolation rooms.
• Patient rooms and hallways bathed in natural light from floor-to-ceiling windows.
• Safety features incorporated in every room include offset sink drains, easy access private bathrooms and lift systems.
• A subdued color palette proven to increase patients’ sense of well-being and to boost the healing process.
• Private patient rooms equipped with LCD televisions that can display clinical images, such as angiograms and pullout couches so family members can stay comfortably overnight.

Other Scripps Programs

Scripps cardiovascular programs offer patients a comprehensive range of screening tests, diagnostic exams and treatment options. While Prebys Cardiovascular Institute serves as the hub for advanced cardiac procedures and research in San Diego, Scripps continues to provide excellence in cardiovascular care in the communities served by the other Scripps hospital campuses in downtown San Diego, Chula Vista, and Encinitas. 

The new Barbey Family Emergency and Trauma Center, a 52-bed, state-of-the-art emergency department and observation unit being constructed on the ground floor of Prebys Cardiovascular Institute, is scheduled to be completed in the summer of 2016. 

Scripps also partners with the Scripps Translational Science Institute (STSI) and The Scripps Research Institute to discover tomorrow’s heart treatments and therapies, using genomics, wireless technology and minimally invasive procedures. Under the guidance of Eric Topol, MD, STSI has launched a number of studies looking at innovative wireless sensors that can track ECG, brain waves, and a host of vital signs in people with heart problems, post-traumatic stress disorder, and other medical conditions, using apps and smartphones. 

Future Plans

The Prebys Cardiovascular Institute is the cornerstone of a 25-year master plan unveiled in November 2010 that is transforming the Scripps Memorial Hospital La Jolla campus. Future plans call for a second tower similar to Prebys Cardiovascular Institute to comply with California earthquake safety mandates, a new central energy plant, and additional medical office and parking structures.