Modular EP Lab Installation: Experience From Flagstaff Medical Center

In this interview, we learn more about the installation of a modular EP lab at Northern Arizona Healthcare’s Flagstaff Medical Center in Flagstaff, Arizona. John B. Crane, III, RN, BSN, is the System Clinical Manager, Invasive Cardiology, at Flagstaff Medical Center and Verde Valley Medical Center.

Tell us about your EP program at Flagstaff Medical Center. What were the reasons for needing to install the modular EP lab?

The EP program at Flagstaff Medical Center has been in place for 2 and a half years. We have a total of 6 RNs and 6 radiologic technologists. Although currently we do not have dedicated staff assigned to the EP lab, 2 nurses and 3 radiologic technologists primarily cover EP. We also have one electrophysiologist, Dr. Lynn Otto, at the Heart and Vascular Center of Northern Arizona at Flagstaff Medical Center. She performs all of the EP work here, including EP studies, ablations, and a majority of our device implants. 

Our EP lab is made up of one suite. However, since the x-ray equipment in this EP lab is currently being replaced, we decided to consider installation of a modular lab. 

Why was a modular EP lab considered over a mobile EP lab? What considerations needed to be taken in regards to the lab? 

Having been a cath lab nurse myself, I previously had the opportunity to work in a mobile (tractor trailer-based) cath lab. From my experience and from talking with others, that particular mobile lab felt too cramped and tight for both staff and patients; therefore, the size of the lab was the number one factor driving us to look at a different solution. Another issue I worried about was whether a lift system would be needed. We wanted the lab to be at floor level, without having to build an elaborate covered walkway, which you’ll often find with a tractor trailer-based mobile lab. 

Our x-ray equipment vendor, GE Healthcare, suggested that I contact Modular Devices, Inc. (www.modulardevices.com). After speaking with them, Dr. Otto and I discovered there was a modular-based lab at Yavapai Regional Medical Center in Prescott Valley coming out of use. Going to see that particular model, which measured about 14’x48’, made it clear to us that we would be able to use this in the EP realm. That modular lab had a large control room as well as considerable width and length to the room that accommodated all of the x-ray, anesthesia, and EP equipment at the same time, along with the patient and staff. 

After further discussion with Modular Devices, Inc., we chose a modular lab design with pop-out side extensions (Figure 10). It’s quite a large room. 

When was the modular EP lab installed, and how long did it take? Where is the modular lab located? 

The modular EP lab was put into place on May 17, 2015. It was installed in a covered, enclosed area and is essentially an extension of the building, so patients never have to go outside. If you’ve ever been to Flagstaff or know of Flagstaff, we’re at a 7,000-foot elevation, so we can get a fair amount of snow in the winter as well as rain during monsoon season in June. Because of these weather elements, we built an extension off the building that marries up, floor level to floor level, so we can drive stretchers and patient beds from inside the building and into the modular. 

Is the modular lab used primarily for EP? 

The modular is currently shared with the cath staff, so cath procedures are also performed in there. In fact, last week was the first time that we did a STEMI in both rooms at the same time. Everything has worked out really well so far, and the x-ray equipment takes great pictures. However, although there is plenty of cabinetry space in the modular room, there are some things you can’t fit in two places at the same time. Therefore, we’ve amended our staffing a little bit. For a typical procedure, we have a nurse, radiologic technologist, and one other staff member in the modular, as well as a nurse, radiologic technologist, and 2 other staff members in the other room. With this setup, one person acts

as a monitor, one is a runner, and there is still a nurse in the room attending to the patient. 

What services or procedures are provided in the modular EP lab? 

First and foremost, all EP cases and device implants are done in the modular lab. In the past, about 35-40 percent of our total cases were done in the second suite, of which the modular is now our second suite. As mentioned previously, heart caths and peripheral work are also performed in the modular as well. 

Do you plan to make any further updates or upgrades to the modular lab?

Since most EP cases require anesthesia service, we worked with Modular Devices, Inc. to install ceiling-mounted gas systems and a power supply for the anesthesia cart near the head of the patient bed. We ran oxygen, suction, anesthetic gas waste, power, and data through the head of the bed, so our anesthesia staff members have all the equipment they need. 

We also determined we needed to install an intercom. Since the modular is essentially an extension of the building, we were having some difficulty hearing when intercom calls came through overhead for a code or emergency call. Therefore, we installed a speaker system into the modular to be able to hear intercom calls more clearly. 

We also had to do a little bit of wiring up through the floor and into the ceiling overhead for the Biosense Webster system in order to allow connectivity between that system and other cart-mounted systems. 

Has workflow changed since opening the modular EP lab? 

The biggest workflow change was adding a fourth person to be a runner. In addition to the electrophysiologist and anesthesia providers, our EP team typically consists of a nurse and 2 radiologic technologists. This is typically enough for EP cases, which tend to have less expeditious needs in terms of emergency, so there is not as much of a need for that extra EP team member. However, when we’re doing cath or emergency procedures, it’s helpful to have that fourth person as a runner. 

How has the modular lab helped with caseload? 

One of the things that we were very cognizant of and tried to avoid was a hiatus of our EP services during the installation of the modular lab. Maintaining full service of all our EP, cath, and peripheral procedures was the biggest drive for getting the modular system. During the transfer from our existing EP room to the modular, we shut down EP starting at 10 am on a Monday, and by Wednesday at 3 pm, we had EP services back up. Therefore, our downtime was quite short. It was important for us not to suspend EP services; Flagstaff Medical Center is the only EP lab in the northern part of 

Arizona, and we’re servicing a very large territory — essentially the northern third of the state of Arizona. 

How long will you be using the modular lab?

We expect we will have the modular in use for EP procedures until about April or May 2016, as part of the room 2 replacement project. After that, we’re looking at doing some additional work to our other existing room 1, so we may end up keeping the modular beyond the original expectation of through spring 2016.

Disclosure: The author has no conflicts of interest to report regarding the content herein.