Resurrection Medical Center’s Biplane — A Treasure for EP Physicians

In this article, the author discusses the opening of a multispecialty biplane lab at Resurrection Medical Center in Chicago. After nearly 10 months of meticulous planning and construction, December marked the opening of Resurrection Medical Center’s (RMC) Neurointerventional Suite. Equipped with high-tech biplane angiography, the suite was initially developed as an integral part of Resurrection Health Care’s systemwide neuroscience service line. However, in the infancy stages of planning, electrophysiology (EP) and cardiac implications were brought to the forefront. Through numerous discussions, the Neurointerventional Suite transformed from a single-use room to a multi-specialty room where neuro, cardiac, and EP procedures take place. The Beginning Given that space is at a premium at most hospitals, Resurrection Medical Center is no exception, and staff had the challenge of finding the most appropriate location where the biplane could be housed without compromising patient care or safety. The decision was made to convert the Cardiac Catheterization department’s third lab into the Neurointerventional Suite for three main reasons: 1) Proximity to the operating room; 2) Multi-specialty use in a central location; and 3) Ability to cross-train staff to cover the various medically-related procedures. A multidisciplinary team was charged with the daunting task of selecting the capital equipment, facility and operations planning for the Neurointerventional Suite as well as policies and protocols for intra-system patient transfers for emergency neuro-related biplane procedures, such as stroke rescue procedures. To start, bi-weekly construction and operations meetings began, which included the facility director, general contractor/architect, electricians, cath lab manager, and administration with Anita Halvorsen, FACHE, MBA, MS, CCC-SLP, System Director of Neurosciences, as the facilitator. From early on, Resurrection Health Care along with Halvorsen knew that the biplane was a staple for any Neurointerventional Suite and worked with a $2+ million capital budget to chart the course of the suite to completion. Biplane Angiography Halvorsen says that since Resurrection Medical Center has the highest volume of stroke cases, it only made sense to house the biplane at RMC. Designing a specialty services room, sharing capital equipment and technical staff, only supports the trend of multi-use medical space in healthcare. Biplane angiography allows for a detailed multi-dimensional, simultaneous view of the body resulting in less contrast material and radiation exposure to the patient. The tiniest vessels can be seen in 3-D, allowing for greater ease when completing complex procedures. “The outstanding imaging quality produced by the biplane significantly reduces fluoroscopy time, thus decreasing radiation exposure and absorption for the patient,” says Erica Engelstein, MD, RMC electrophysiologist, who thus far has logged the most time using the biplane fluoroscopy for EP procedures. Dr. Engelstein was initially consulted during the development of the neuro-interventional suite for her guidance on how to integrate EP modalities into the space. For Dr. Engelstein, who has seen the volume of EP procedures at RMC quadruple since 2005, her major concern was to have the physical space and biplane imaging to perform complex catheter ablations of arrhythmias. These procedures often require additional equipment. “We didn’t have much space to move around in our previous EP lab considering the equipment required — EP recording equipment, 3-dimensional electroanatomic mapping equipment, intracardial ultrasound, and radiofrequency generators — not to mention a staff of six, at a minimum,” says Dr. Engelstein. “Now with our neuro suite, we have more space to have a bit more breathing room, making the staff, me, and most importantly, the patient, more comfortable in his or her surroundings. The biplane imaging has significantly decreased the fluoroscopy time for these often lengthy procedures.” Construction & Implementation Converting a cath lab room to a neuro suite required extensive architectural planning and engineering. As the idea of a multi-specialty neuro suite came to fruition, so did several unexpected challenges. Because Resurrection Medical Center was built in the early 1950s, there were some unknowns that were uncovered while the space was being gutted. A wall had to be moved, a soffit removed and more than 10 main pipes had to be re-routed. An even greater challenge was making sure the biplane fit in the allocated space given the girth of the equipment and the size of the room. Ideally, the team would have liked to have more space to work with given that the room had to be used for three disciplines — neuroendovascular services, cardiology and electrophysiology. “Some of the EP and cardiology procedure supplies had to be stored in a separate area to keep all neuro supplies accessible in the suite,” says Lead Technician Ed Jonathas, RT(R), a hospital veteran who helped to coordinate cross-training staff and utilization of supplies. “We have to make sure that our supplies reflect the procedures taking place in the suite that day. It is a bit more work but very manageable.” In November, when construction was completed, Illinois Department of Public Health surveyors inspected the suite. It passed on the first inspection for two main reasons: 1) Knowledgeable staff, and 2) Research. Throughout the development of the neuro suite, various levels of team members who either worked or consulted on the project brought such vast knowledge and experience to the project. It allowed the team to make the best choices given the available options. Secondly, the amount of research that went into the project enabled positive outcomes. Members of the planning team went on three site visits to hospitals with a neuro-focused vascular suite before developing the RMC plans. This first-hand knowledge sharing added a secondary perspective to reference — even though no two circumstances are exactly alike. Staffing While all the pieces of the neuro suite puzzle were falling into place, one major issue that still had to be addressed was staffing. Remembering that the neuro suite was designed primarily for stroke rescues, a neuro call team had to be developed and trained. Two nurses and two technicians were hired to help with neuro suite staffing. Cardiac cath nurses and techs were also cross trained to assist with neuro procedures with tight on-call windows. Call teams are rotated in order to promote work/life balance. “When you are on-call, it is pretty restrictive,” says Jonathas. “Even though you aren’t technically working, you can’t go too far from your home or the hospital. What helps is when you have a team of nurses and techs who have worked together for a while, so if you really have to be somewhere one weekend, you can count on a team member to help you out.” Make Way for EP As with any new service line, growth is incremental. The multi-specialty use of the neuro suite has been a huge benefit for cardiologists and electrophysiologists, as it has allowed them the opportunity to use the biplane while the neurosciences program is growing. “Multi-specialty labs are efficient and allow for growth,” says Dr. Engelstein. “Everyone can use it and the return on the investment is higher because you are not waiting for neuro cases to generate revenue. We are already doing it.” The suite follows a block schedule where there are certain days and times when EP and cardiology have preferential use of the biplane room. In cases of emergency, neuro procedures always take precedence. Thus far, three months since the suite has opened, there haven’t been any major issues with bumping/rescheduling patients, especially since not all EP procedures require use of the biplane. “We have two labs that we can use to accommodate our patients,” Dr. Engelstein noted. “More patients can be accommodated through staggered or simultaneous scheduling between the two rooms. The key to success is flexibility and cross-training of the staff.” Overall Biplane Benefits What it all boils down to is biplane imaging for EP procedures reduces the time patients are on the table, reducing their x-ray exposure and anesthesia time. The image quality is said to be almost “breathtaking” for diagnostic aficionados who truly appreciate its value. While the biplane is an outstanding tool for physicians, patients also reap the rewards. Dr. Engelstein estimates that for the most complex ablations, biplane imaging can reduce the procedure time by an hour and cut the radiation exposure in nearly half. At Resurrection Medical Center, its mission is to provide affordable, quality healthcare to all who come through its doors. The major capital investment into the state-of-the-art, multifunctional interventional suite has allowed the hospital to stay true to that mission. It’s part of the reason why Resurrection Health Care was recently named one of the Top 20 Best Places to Work in Healthcare by Modern Healthcare magazine. A great work environment leads to satisfied employees and physicians, and that means a better experience for its patients. For more information, please visit: www.reshealth.org/