Spotlight Interview: WakeMed Heart Center

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

The electrophysiology (EP) lab is a part of the Invasive Cardiology Department, located within the WakeMed Heart Center at WakeMed Health & Hospitals. The lab consists of three procedure rooms and an inventory supply room.

The Invasive Cardiology Department at WakeMed Health & Hospitals consists of eight cardiac catheterization procedure rooms (three of which are both coronary and peripheral functional) and three electrophysiology rooms.

The staff within our department consists of nine registered nurses (RNs), two radiation technologists (RTs), one paramedic, and two registered cardiovascular invasive specialists (RCISs). In addition, two of our staff have obtained their RCES in addition to their primary certification.

When was the EP lab started at your institution?

The EP lab at WakeMed officially started in late 1990. At that time, our lab had one dedicated physician. Our EP lab has been in its current location inside the heart center for approximately ten years.

What types of procedures are performed at your facility?

The EP department performs all procedures including implants of permanent pacemakers (PPM), implantable cardioverter-defibrillators (ICD), and biventricular implants (CRT-P and CRT-D) as well as tilt table tests (TTT), cardioversions (CV), EP studies, and complex ablations for SVT, atrial fibrillation, and ventricular tachycardia. 

We started our complex ablation program in February 2009 and presently have Biosense Webster’s Carto 3D mapping system and St. Jude Medical’s EnSite 3D mapping system. 

Who manages your EP lab?

The Invasive Cardiology management team consists of our manager, Kim Wooten, BSN, RN, RCIS, our EP lab supervisor, Jeannine Volles, BSN, RN, RCIS, and three Invasive Cardiology supervisors: Mike Turner, RT(R), Hollie Boswell, RCIS, and Kristy Whitley, BSN, RN, RCIS.

Are employees cross trained between cath and EP?

Currently, our department has several employees who are cross trained to perform both EP and cath lab procedures. These employees assist in both areas when volumes fluctuate. Our goal is to have all of our employees be cross trained between the two departments. 

Do you have cross training inside the EP lab? 

Our staff is cross trained to perform four roles (scrub, monitor, circulate, and support staff) in the lab. Our staff consists of mostly RNs. However, as cardiovascular specialists, we can perform all roles. 

Who handles your procedure scheduling? Do they use particular software? 

The Invasive Cardiology department has one dedicated scheduler. This scheduler utilizes the Epic (Cupid) software system to schedule all EP and cardiac cath procedures. Each physician’s orderset contains an electronic case request to schedule their procedure. 

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

Our department utilizes several quality assurance measures. The first measure involves infection control. The Infection Control department within the hospital completes environmental rounds in the lab on a monthly basis. All EP patients are tracked post procedure for infection. Our infection control nurse specialist collaborates with our performance improvement committee in the department to ensure that we maintain our quality outcomes. 

The department supervisors and educators perform weekly internal audits for the procedure rooms and staff (e.g., hand washing, procedure pause for the cause, and patient identifiers). WakeMed also has support teams that monitor all heart failure patients while inpatients and after discharge.

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

Inventory within the department is managed by our strategic sourcing department using the EPIC and Lawson computer software systems. The inventory specialist performs daily audits; however, our inventory is maintained through a perpetual ordering system. During a procedure, products utilized are barcoded into the Epic (Cupid) system. Once a product inventory level drops below a pre-set par level, a product replacement order is automatically generated. 

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

We have had three dedicated EP labs since 2009, and are currently assisting OR staff with laser lead extractions in our hybrid procedure room. Our complex procedure volume has grown by 50% over the past two years. 

We average 15 to 20 complex procedures a week, in addition to our implant volume. We just finished renovating a cath lab room, transitioning it into a universal procedure room. This universal procedure room will have full EP capabilities to handle our EP caseload overflow. 

Have you developed a referral base?

The WakeMed Health & Hospital system has a large referral base from the Wake County area and from the eastern North Carolina region.

What measures has your EP lab implemented in order to cut or contain costs? In addition, in what ways have you improved efficiencies in patient throughput?

Our hospital has a contract with a third-party vendor for reprocessing of single-use diagnostic EP and ultrasound catheters by Stryker; our sterile trays are sterilized by Synergy Health. We have reduced the cost of those catheters and the amount of medical waste sent to landfills.

We also started a Lean initiative in which we meet biweekly with other modalities such as anesthesia, the pre/post procedure area, and advanced practice providers, in order to decrease downtime, improve communication, and increase throughput for our complex procedures. We have developed a PI project that tracks patient prep times, anesthesia times, and turnover times.

How are new employees oriented and trained at your facility?

All new employees entering into the WakeMed system are required to complete a day-long system-wide orientation and clinical orientation. 

New employees are assigned a department educator and preceptor upon arrival to the EP department. The new employee will work one-on-one with the preceptor throughout their clinical orientation period. All new staff members follow a detailed orientation manual and are trained in one role at a time: scrub, circulate, and monitor. Once the employee has completed the initial assigned role, he or she is required to work independently in that role for approximately two weeks prior to evaluating their competency in that role. Once they are competent in the role, he or she advances to the next role. 

On average, the department orientation lasts from four to six months depending on the prior experience of the employee. They are also required to complete continuing education courses within the first year of employment which include, but are not limited to, hemodynamic monitoring, Intensive Care Unit (ICU) drips management, ventilator management, and basic and advanced arrhythmias.

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

Employees are provided with continuing education opportunities within the WakeMed system and are presented monthly in-services within the department. The equipment vendors for implants and ablations also provide educational opportunities for the staff.

WakeMed also offers employees tuition reimbursement, an on-site RN-to-BSN program through Winston-Salem State University (WSSU), Pfeiffer University’s Master of Health Administration and Master of Business Administration programs, WakeMed Leadership Academy, and several WakeMed Foundation grant and scholarship programs for skills development.

As a department, we try to send a small group of staff each year to the South Atlantic Society of Electrophysiology for Allied Professionals (SASEAP) conference in South Carolina.

How is staff competency evaluated?

Staff competency is evaluated throughout the orientation process at 30 days, 60 days, and 90 days by our department supervisor, educator, and preceptor. The department staff also performs a yearly procedure competency blitz and performance evaluation.

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

At WakeMed’s EP lab, we work hard to prevent staff burnout by rotating staff through three positions in the lab for each case. We have a shared governance committee in the lab that works through staff concerns with management support. WakeMed celebrates staff recognition and Cardiovascular Professionals week. In addition, we have holiday parties and celebrations for the staff throughout the year through our social committee. 

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

Staff members participate in department and hospital-wide committees. We have a department shared governance committee with EP staff representation. The subcommittees consist of quality/safety, scheduling/staff retention, policy/procedures, and fiscal responsibility. Our EP staff schedule is maintained by our staff representatives, in collaboration with the department supervisor.

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

At WakeMed’s EP lab, we consider vendors to be an extension of our patient care team. We currently use the REPTRAX system to verify vendor credentials, that their vaccinations are up to date, and to maintain the hospital-required competencies and privacy policies. Cardiac rhythm representatives participate in the implant procedures by programming the devices. They also follow up on device programming on inpatients and are on call at the hospital and Emergency Department for emergency situations.

How does your lab handle call time for staff members? 

Our staff is assigned late evening coverage one night per week. We have an on-call team for low-volume days surrounding the holidays. If there is an urgent/emergent case on the weekend, we ask for volunteers to assist. We also have cath lab staff in-house on nights and weekends to assist. 

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

All staff and physicians have assigned lead aprons and lead glasses that are required for all procedures. This personal protective equipment (PPE) is tagged and uploaded in a software system, and checked for holes and cracks annually. We also utilize the RADPAD (Worldwide Innovations & Technologies, Inc.) to reduce scatter radiation exposure during procedures. We also have movable lead shields to help protect EP and anesthesia staff during cases.

What are some of the dominant trends you see emerging in the practice of electrophysiology? How is your lab preparing for these future changes?

We have seen an increase in the amount of complex ablations, especially atrial fibrillation ablations. We have two electrophysiologists that perform these complex ablations at WakeMed. 

When was your last inspection by the Joint Commission? 

We were last inspected by The Joint Commission in the fall of 2015.

Give an example of a difficult problem or challenge your lab has faced. How it was addressed?

Our most recent challenge has been our increasing number of complex ablations and working with anesthesia as they care for our patients in these cases. The room setup, procedure prep, post-procedure care and room turnover is more complex and time consuming. We have addressed this by meeting twice a month with anesthesia and our Pre/Post Heart Center staff to improve efficiency and communication. 

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

Currently our lab averages in the top two in volume on the East Coast. We see a large number of patients and our patient satisfaction scores have maintained at 97%. Our staff is a dedicated, cross trained group of professionals who consistently put the patient and their family’s care and needs first. 

About WakeMed Health & Hospitals

The largest health system in Wake County, North Carolina, WakeMed Health & Hospitals exists to improve the health and well-being of our community by providing outstanding, compassionate, patient- and family-centered care to all. 

The 919-bed system comprises a network of facilities throughout the Research Triangle area, delivering health and wellness services that bring added value to the communities we serve. WakeMed is a leader in cardiac and vascular care, women’s and children’s services, emergency medicine and trauma care, physical rehabilitation, orthopedics and neurosciences. Specialty facilities include the WakeMed Heart Center, Children’s Hospital, Women’s Pavilion & Birthplace, Women’s Hospital at WakeMed North, Rehabilitation Hospital, Adult and Children’s Emergency Departments, and a Level 1 Trauma Center. 

WakeMed’s team of more than 8,200 employees, 1,500 volunteers, 1,200 affiliated physicians, and the more than 255 physicians employed by WakeMed Physician Practices use the most advanced technologies along with the best minds and the biggest hearts to ensure the finest quality in health care and community health.

WakeMed is one of the state’s largest providers of comprehensive cardiothoracic and vascular services. The hub of cardiac services at WakeMed Raleigh Campus is the WakeMed Heart Center. This facility, which is physically connected to the main hospital, first opened in 1998 and underwent expansion and renovation in 2005. The layout of the WakeMed Heart Center allows patients to register, see their cardiologist, and have non-invasive cardiovascular tests, invasive cardiac catheterization procedures and electrophysiology procedures performed, all under one roof. If an overnight stay is required prior to or following a specific procedure or test, patients and their families have the option of spending the night in the full-service hotel located on the top floor of the WakeMed Heart Center.

Other services unique to WakeMed that bring added value to the communities we serve include: 

• Primary Stroke Center Certification by The Joint Commission. 
• Chest Pain Center Accreditation by The Society of Cardiovascular Patient Care.
• Heart Failure Accreditation by The Society of Cardiovascular Patient Care.
• American College of Cardiology Navigator Program. 
• The WakeMed Heart Center Conference Center, which is a 5,000-square foot facility with meeting rooms for conferences and symposia. It has state-of-the-art capabilities for streaming video directly from the cardiac catheterizations labs and operating rooms to the conference center. WakeMed physicians frequently present findings from research, as well as host experts in cardiovascular disease treatment and management for local physicians and health care professionals.
• On-site twenty-four/seven cath lab staff to expedite all emergent procedures.
• Wake County’s only Level I Trauma Center as designated by the North Carolina Office of Emergency Medical Services.

WakeMed Awards & Accolades

• American College of Cardiology’s NCDR ACTION Registry - GWTG Platinum Performance Achievement Award for 2015.
• American Heart Association’s Mission: Lifeline Receiving Center - SILVER Plus Level Recognition Quality Achievement Award. 
• American Heart Association’s Get With The Guidelines 2015 Heart Failure Gold Plus Quality Achievement Award.
• Cardiothoracic Surgery Top International Rating - WakeMed is among the 12 to 15 percent of the 1,100 international hospitals involved in the Society of Thoracic Surgeons (STS) National Database™ to receive a “3-star” rating for quality of coronary artery bypass graft (CABG) surgery, the highest rating a hospital can achieve.
• Magnet Designated Organization Recognized by the American Nurses Credentialing Center.
• Professional Research Consultants Excellence in Healthcare Award for WakeMed Heart & Vascular Physicians Cary and Clayton offices.
• Recognized as #6 in the Raleigh-Durham metro area and #16 in North Carolina by the U.S. News & World Report Best Hospitals for “High Performing in Heart Bypass Surgery and Heart Failure” and “High Performing for Heart Failure”.