Spotlighted Labs: Where are They Now?

November/December 2002: Mercy Heart Institute, Sacramento, California Update provided by: Nancy L. Diehl, RN, MSN, Clinical Nurse Specialist: Mercy General Hospital has one of the largest EP programs in the nation. The two new EP labs, which opened in April 2003, are equipped with the latest, state-of-the-art technology available for accurate diagnosis and treatment of heart rhythm abnormalities including upgraded 3-D mapping systems. The EP lab stays active with cutting-edge technology and participates in a wide range of research studies designed to improve the treatment options for patients, including ablation systems, new pacemaker technology, alternative drugs for VT, and new indications for bi-ventricular pacing. Since October 2002, our procedures have increased by 36%, from 900 to over 1,400 annually. To date for 2005, we have performed 263 EP/tilts, 434 ablations, and 738 pacers/ICDs. Our staffing eight RNs, three EP techs, and one CVT tech has remained stable. The implementation of 12-hour shifts has enabled the EP lab to handle the increased volume while improving satisfaction for the staff. We are currently adding call hours for additional coverage for implants on Friday evenings and Saturdays. Our commitment to education and extensive orientation for those who are changing specialties has helped us secure some outstanding individuals for our team. In October 2006, we will offer an EP Training Program for anyone looking to branch into this exciting field. For more information contact Nancy.diehl@chw.edu. Join our team! We are actively recruiting experienced staff: Manager, Electrophysiology and Cardiac Catheterization Labs, Registered Nurses, and Electrophysiology Technicians. For more information contact Janine.woodworth@chw.edu. July/August 2003: UMass Memorial Health Care, Worcester, Massachusetts Update provided by: Lawrence Rosenthal, MD, PhD, Director, Cardiac Pacing and Electrophysiology: A lot has happened at UMass Memorial Medical Center since our spotlight article in July 2003. First, we have new EP lab space in our state-of-the-art cath lab suite area. Currently we work out of a Siemens Biplane lab with both CARTO and ESI mapping technologies. There are plans to convert another cath lab to a single-plane GE EP lab, and this work should be completed by February 2006. We have gone from a nursing staff of three to a nursing staff of seven. We have also added a radiation technologist and are looking for additional lab staff. We also have assistance from the cath lab staff and recovery areas. This has greatly facilitated our ability to improve patient flow and increase our procedural volume. We have added a second nurse practitioner to help with clinic patients and the inpatient service. Clearly the administration has come to realize the potential of an active EP service. October 2004: Massachusetts General Hospital, Boston, Massachusetts Update provided by: Cris Bethune, RN, EP Lab Nurse Manager: The Massachusetts General Cardiac Arrhythmia Service continues to pioneer innovative treatments for cardiac arrhythmias including atrial fibrillation and ventricular tachycardia as well as device therapy for congestive heart failure. The Arrhythmia Service recently opened a new dedicated CRT Clinic. This multidisciplinary, integrated program involves the electrophysiologist and heart failure specialist in collaboration with the cardiac ultrasound laboratory in the same physical space. This service provides the patient with coordinated, integrated care and maximizes the effectiveness of cardiac resynchronization therapy for CHF while facilitating prospective outcomes research in the CRT population. In addition, in a collaborative project with Biosense Webster and Stereotaxis, we have initiated clinical research on the newest state-of-the-art RMT mapping system, which allows for automated mapping of the left atrium and high resolution ventricular mapping of scar-related VT using the Stereotaxis remote magnetic catheter guidance system. Finally, with near completion of CryoStop AF cryoballoon AF ablation feasibility trial, we look forward to participation in a trial involving the Watchman Left Atrial Appendage Filter. This device is designed to prevent embolization of thrombi that may form in the left atrial appendage in patients with non-valvular atrial fibrillation. The MGH EP Lab continues to offer our patients the most advanced and effective diagnostic and therapeutic options available for the treatment of cardiac arrhythmias. November 2004: Lancaster General Hospital, Lancaster, Pennsylvania Update provided by: Lisha Esbenshade-Smith, RCIS and Susan Deck, BS, RN: Lancaster General Hospital was spotlighted in the November 2004 issue of EP Lab Digest. In the ensuing year, our EP department has continued to grow and change as we continue to improve patient care and outcomes. Our second bi-plane lab is under construction and is scheduled to open in January 2006; a new single-plane lab will follow later in the year. We are now able to import CT scans into our 3-D mapping system for PVIs, and we are investigating both the Stereotaxis and Hansen navigation systems. The new labs and new technologies will help us better serve our patients as technology improves and our caseload continues to increase. To staff our new labs, we have graduated four EP technologists from our EP Internship program, and have another tech in training, bringing the total number of dedicated EP techs to 13. The EP tech clinical ladder has been revised and encourages techs to achieve and maintain an advanced level of practice. Three new sedation RNs are in the midst of orientation, and we have also welcomed another EP physician to the department, bringing the total to six. The EP department has also hired a physician assistant to facilitate patient admissions and discharges. One of our biggest problem areas has been case delays or cancellations due to incomplete or out-of-range labs, H&Ps, orders, etc. We recently implemented a Day Before clinic for outpatients undergoing complex procedures like biventricular implants or pulmonary vein isolations. A nurse meets with the patient and makes sure all pertinent labs/procedures are done and that results are within acceptable limits. In addition, the nurse completes all the required paperwork and makes sure that all pre-procedure teaching is completed and patients' questions are answered. It is hoped that the clinic will prevent delays and improve lab throughput. If it is successful, we plan to expand it to include all clients undergoing outpatient procedures. Much has changed in EP during the past year, and more change is certainly in the future. The electrophysiology department at LGH is committed to continued growth and improvement as we strive to provide first class care for the community we serve.