Spotlight Interview: Holy Spirit Hospital

What is the size of your EP lab facility and number of staff members? What is the mix of credentials in your EP lab?

The Electrophysiology Department consists of two dedicated labs. We have a total of nine staff members (eight full-time employees and one part-time employee). Three are nurses, and six are technical staff members including RCIS, RCES and RT(R).

When was the EP lab started at your institution?

We opened The Ortenzio Heart Center at Holy Spirit Hospital in November 2003. Our EP lab is located in the Heart Center and also opened in November 2003.

What types of procedures are performed at your facility? Approximately how many are performed each week?

The EP lab performs diagnostic EP studies, radiofrequency (RF) and cryoablations, loop recorder, pacemaker, ICD, and biventricular ICD implantations, laser lead extractions, TEEs, cardioversions and LARIAT (SentreHEART, Inc.) procedures.

The lab performs an average of 30 ablations per month and 40 to 50 implants each month.

What is the primary goal of your program?

Our goal at Holy Spirit is to provide the highest and safest level of care and treatment of cardiovascular diseases. At this time, our focus has been to increase treatment of atrial fibrillation (A-Fib). With the creation of our A-Fib Clinic, our volumes have more than doubled.

Who manages your EP lab?

David Man, MD, FACC is the Director of Holy Spirit’s EP lab. Safwat Gassis, MD, FACC is the Director of the A-Fib Clinic. They were the first physicians to perform the LARIAT procedure in Pennsylvania. Deborah Thornberg, BSN, RN-BC is the Department Manager, Barbara Gutshall, BSN, RN, RCIS is the Assistant Manager, and Douglas Kline, RT(R), (CV) is the Lead Technologist.

Is the EP lab separate from the cath lab? How long has this been? Are employees cross-trained?

The Invasive Cardiology Department includes both the EP and cardiac catheterization labs. Some employees are cross-trained to work in either lab to scrub for device implants in EP or scrub and monitor for catheterization procedures in the cath lab. Both labs share a Central Processing Unit of 16 beds for pre- and post-care. 

Do you have cross-training inside the EP lab? What are the regulations in your state?

Our goal is to have all RNs and all technologists cross-trained in the near future for all roles of the department (only RNs can give conscious sedation/medication administration). We have adapted some of the roles in the lab to be in compliance with the hospital’s policy, as well as state regulations as they change.

What new equipment, devices and/or products have been introduced at your lab lately? How has this changed the way you perform these procedures?

The EP lab’s new equipment includes: Carrot Medical’s Image Viewing/Monitoring System, Bard EP’s MicroPace stimulator, Hansen Medical’s Sensei Robotic Catheter System, GE Healthcare’s Vivid ultrasound system, St. Jude Medical’s RF Cardiac Ablation Generator and Cool Point Irrigation Pump, and Baylis Medical’s RF Puncture Generator. This new equipment has enhanced our operational efficiency and allowed the staff to provide better service and safety for the patient.

Have you recently upgraded your imaging technology?

We have upgraded our imaging technology to GE Healthcare’s Innova biplane system.

What type of quality control and assurance measures are practiced in your EP lab?

We participate in the ICD Registry^™ and keep an implant log that is maintained by lab personnel to keep track of purchase order numbers, serial numbers, and lot numbers of devices for review. We have a Quality Control Department that reviews data for every device implanted for criteria, post-procedure meds, etc.

How is inventory managed at your EP lab? Who handles purchasing of equipment/supplies?

The EP lab shares an Inventory Control staff member with the cath lab to ensure that an adequate level of disposables is maintained at a consistent level, but not to excess. The purchase of major equipment and supplies is done by the Nurse Manager and the EP Lead Technologist, along with the Inventory Control staff member.

Has your EP lab recently expanded in size and patient volume, or will it be in the near future? 

The Ortenzio Heart Center has two EP labs, three cath labs, a Cardiovascular Unit, a Cardiovascular ICU, Cardiac Rehabilitation, Cardiovascular OR, Echo, and Pacer Clinic.

The second EP lab opened in April 2013. This new lab was opened to accommodate higher patient volume. The increase in volume is attributed to ablations. We have had approximately a 200% increase in the last two years.

Have you developed a referral base?

There are local hospitals and physician groups that refer to our EP program. Our A-Fib Clinic also provides information and community events to patients who receive services from what our EP program provides.

What measures has your EP lab implemented in order to cut or contain costs?

We participate in the reprocessing/recycling program from Stryker Sustainability Solutions, as well as EPreward. We buy supplies in bulk. We use the GE Healthcare Centricity management system to track inventory. We communicate with our physicians to determine what supplies are needed before the procedure begins, and only open supplies as needed.

How are new employees oriented and trained at your facility?

New employees are placed with a preceptor for a 12-week orientation period. During this phase, they are introduced to scrubbing/sterile techniques, monitoring, and circulating roles. The orientation process is tailored to the individual’s needs, so this can be shortened or lengthened per employee. After demonstrating competency, the employee is put into the daily rotation of roles in the lab.

What types of continuing education opportunities are provided to staff members?

Holy Spirit Hospital provides in-house training regarding new products and services. We also participate in outside conferences to retain our certification/licensure. 

How is staff competency evaluated?

We have to meet hospital-wide competencies each year. We also have to fulfill mandatory departmental competencies.

Do you encourage your clinical staff members to take the registry exam for Registered Cardiac Electrophysiology Specialist (RCES)? How many members of your lab have taken the exam?

It is encouraged, but not required, to take the RCES exam. Currently, two team members have their RCES certification.

How do you prevent staff burnout? In addition, do your practice any team-building exercises?

To prevent burnout, we have a “late day” sign-up log in which each team member is required to sign-up to stay two late days per week as needed. This allows everyone to rotate working long days.

The Invasive Cardiology Department has a monthly meeting to keep everyone informed about the department and any issues/problems that might arise.

What committees, if any, are staff members asked to serve on in your lab?

Each staff member is part of a unit-based committee aligned with the hospital-based shared governance committees. These include Education/Evidence-Based Practice/
Research, Relationship Management, Image and Work Life, and Technology/CITC Committee. The Lead Technologist and Nurse Manager actively participate on the EP Subcommittee.

How do you handle vendor visits to the department? Do you contract with vendors?

Vendors introducing new products are managed by the Nurse Manager and Lead Technologist of the EP lab. The Nurse Manager presents the new product to the Value Analysis Committee, which evaluates all information including cost, product, and latest technology to determine if the product fits the values and needs of the hospital and our patients. If the new product is approved, an in-service is scheduled to present the new product to the EP staff. At the current time, we have contracts with CRM vendors at a 50/50 split. 

Does your lab utilize any alternative therapies in the EP lab?

Our patients have the opportunity to listen to their choice of music during a procedure. The EP Department also uses an iPad as a learning tool to present guided imagery, giving patients a better understanding of their condition and the EP procedure they are about to have done.

How does your lab handle call time?

EP lab staff members do not take call. The lab operates five days a week with no weekends or holiday schedules. If a temporary pacemaker is needed when the EP lab is not operating, the cath lab staff is called in. In the rare instance that a device needs to be placed after hours, the main hospital OR would perform the implant.

Approximately what percentage of your ablation procedures are done with cryo? RF?

Approximately 70 percent of our patients receive cryoablation procedures, while 30 percent have RF ablation procedures.

Do you perform only adult EP procedures or do you also perform pediatric cases? 

The EP lab only performs procedures on adult patients aged 17 and above. 

What measures has your lab taken to minimize radiation exposure to physicians and staff?

As we all should know, time, distance, and shielding are basic ways to reduce exposure. Each physician and staff member is supplied with a lead apron and thyroid collar to minimize exposure to radiation. By using some of the newest and advanced technology such as Biosense Webster’s CartoSound and GE Healthcare’s Vivid i Ultrasound, we also reduce radiation to physicians, staff, and patients. In the new lab, we use the GE Healthcare’s Innova Dose Reports service, which sends email alerts to those specified in the reporting system. 

Is your EP lab currently involved in any clinical research studies?

Yes, we are currently involved in several studies involving devices and ablations.

Please tell our readers what you consider unique or innovative about your EP lab and staff.

Holy Spirit Hospital is a faith-based organization focused on patient-centered care while providing the latest technology. We are fortunate to work in a facility where everyone from administration to the staff members strive to provide our patients with state-of-the-art care for the diagnosis and treatment of cardiac disease.