Spotlight Interview: West Florida Hospital

West Florida Healthcare is proud to be the first hospital in Northwest Florida to offer all private rooms as well as the area’s first Accredited Chest Pain Center. The facility is also an Advanced Primary Stroke Center, the area’s first accredited Breast Imaging Center of Excellence, and the area’s only Certified Atrial Fibrillation program. The West Florida Healthcare campus includes the all-private room acute care hospital, the area’s only comprehensive physical rehabilitation hospital, a mental health facility, and a cancer center.

Affiliated with HCA, the nation’s leading provider of healthcare, West Florida Healthcare meets the community’s healthcare needs in major services such as oncology, orthopedics, cardiology, cardiovascular surgery, robotic-assisted surgery, critical care, neurology/neurosurgery, emergency care, urology, behavioral health, gastroenterology, obstetrics, pulmonary, and rehabilitative medicine. 

What is the size of your EP lab facility? 

We have a four-room integrated invasive cardiology suite comprised of two EP labs and two cath labs. 

When was the EP lab started at your institution? 

The EP lab and EP services began at our hospital in 1989 with the arrival of Dr. Marcelo Branco, our first cardiac electrophysiologist.

What is the number of staff members? What is the mix of credentials at your lab?

We have 18 staff members; there are two RNs in holding, a nursing supervisor, QI coordinator, equipment manager, and director. Credentials include eight RNs, three RTRs, and three RCISs.

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

We provide a comprehensive range of EP procedures, including complex ablations for atrial fibrillation (AF) and ventricular tachycardia (VT). We implant all types of devices including pacemakers, ICDs, biventricular devices and implantable loop recorders. Lead extractions are done in the OR by our EP physicians. 

We do 12-15 EP procedures each week, with a projected increase with the introduction of Dr. Farhat Mehmood, our second electrophysiologist. 

Who manages your EP lab? 

Our leadership team consists of Clyde Godwin, Director of Invasive Cardiovascular Labs, and Calvin Callahan, RN, Nurse Supervisor and board runner.

Do you have cross training inside the EP lab? 

Yes, every staff member is cross trained to perform all jobs including scrubbing, monitoring, documenting, and running x-ray equipment. Industry representatives provide support for mapping procedures. 

What types of EP equipment are most commonly used in the lab? 

Both our labs use St. Jude Medical’s EnSite Velocity System for mapping, and use their EnSite Array Catheter as well. We use the GE Prucka as our recording system. Our workhorse ablation catheter is Biosense Webster’s ThermoCool. Both rooms are equipped with CATHPAX Radiation Protection Cabins (Anthem Medical), which allow our doctors to perform ablation procedures without the need to wear lead aprons. A CIRCA S-CATH multisensor esophageal temperature probe is available in both rooms for use during AF ablations. 

How is shift coverage managed? What are typical hours (not including call time)?

The staff typically works an 8-hour shift. As with most labs, work volume and hours can vary greatly, but typically our employees work from 7 AM to 5 PM; however, it is not uncommon for procedures to go beyond 5 PM.

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

In addition to recently adding two CATHPAX Radiation Protection Cabins and two CIRCA S-CATH multisensory esophageal temperature probes, we’ve also added a C-View 52” monitoring system (Carrot Medical) and have the ability to use the Impella pump (ABIOMED, Inc.).

The CIRCA S-CATH esophageal temperature probe has 12 sensors that allow for more accurate and quicker detection of temperature rises within the esophagus, increasing the safety of our AF ablations. Carrot Medical’s C-View monitor has eight viewing screens so all visual information required for EP procedures is present for the physician to see. The CATHPAX Radiation Protection Cabin has significantly decreased radiation exposure to our physicians as well as eliminated the need for lead aprons. ABIOMED’s Impella pump provides excellent hemodynamic support during complex VT ablations.

Tell us what a typical day might be like in your EP lab. 

The patient arrives to our holding area where their information is loaded into our computer system, lab work is gathered and the pre-anesthesia workup is done. The patient is then moved to the EP suite, where the prep work begins and patches are applied. After the patient is under anesthesia, access is obtained and we start the mapping and ablation process. Depending on the procedure, either TEE or ICE is done to rule out LAA clot and to facilitate with the transseptal puncture. After the ablation is done, the patient is brought to the PACU unit for post-sedation care, and placed in the ICU unit overnight for observation.

What is your experience with MR conditional cardiac devices? 

We have reached out to the Medtronic pacing division for this type of device with very positive results. More than 50% of our dual-chamber pacemaker implants are now MR conditional.

Does your program utilize a picture archiving system (PACS)? 

Yes, we have a PACS system which greatly enhances our ability to review data in preparation for procedures. All EP-related information, including tracings, reports and map images are stored in the network.

Do you employ travel RNs, RT(R)s, or RCISs? 

As with most centers, we have on occasion relied on travelers. Although travelers can bring a different flavor to the lab, we consider maintaining a stable cadre of RNs, RTRs and RCISs essential to promoting an environment of harmony and consistency in the lab. Currently, our staff is comprised totally of full-time employees.

Who handles your procedure scheduling? 

We use the OR scheduler for procedure scheduling.

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

All documentation, charges and inventory are monitored within the lab using computer systems. We employ a full-time IT person in the lab to help with the process. Staff education is constantly being reviewed and renewed. A procedure or process is chosen each month by the staff for review and presentation.

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

We have an inventory system within the GE Mac-Lab. We employ an inventory analyst to help with ordering, rotating stock and price control. 

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

We just opened up our second EP lab and have added an additional EP doctor, which has led to a significant increase in volume. 

How has managed care affected your EP lab and the care it provides patients? 

Managed care has made us take a more focused look at every process in the lab, with the goal of reducing cost and maintaining excellent patient care and satisfaction.

How does your lab communicate necessary information to staff? 

The day typically begins with a team huddle, during which any pertinent issues are communicated to the staff and preparations are made for the workday.

How do you ensure timely case starts and patient turnover? 

When does an 8 o’clock case start? At 8 o’clock, of course. Our board runners and staff are challenged daily with getting the cases started on time. We monitor the turnaround times and are constantly thinking of ways to improve work flow.

Does your EP lab compete for patients? 

We are in a very competitive market, with three large hospitals with established EP programs. We consider our high level of patient care and satisfaction to be our best marketing strategy.

How are new employees oriented and trained at your facility? 

All new employees first receive an orientation to the hospital’s code of conduct and education. In the cath lab, we set them up with a preceptor to teach and mentor the new employee through a competency requirement and to make the employee feel more comfortable in their new position. It’s good to have someone you can turn to for any advice or information. 

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

The staff has an ongoing formal education program through HealthStream, which is evaluated and updated annually, as well as in-services by the vendors. The staff picks topics of interest for group discussion on a monthly basis.

How is staff competency evaluated? 

Along with their annual evaluation and education requirements, an annual competency is done to maintain the level of skills needed for the cath and EP labs.

Do you encourage your clinical staff members to take the registry exam for Registered Cardiac Electrophysiology Specialist (RCES)? Does staff receive an incentive bonus or raise upon passing the exam? 

We do encourage the staff to take the registry RCIS and RCES exams. Currently, there is no salary raise or bonus for taking the exam. 

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

Engagement is key in preventing staff burnout. The daily huddles with the nursing supervisor to discuss the plan for the day, the weekly meetings with the director to work out any frustrations and to facilitate the needs of the department, and the monthly leadership rounds by upper management, all help to maintain harmony and cohesiveness in the department. It emphasizes our goal to strive for the highest level of patient care and satisfaction.

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

The nurse supervisor attends the hospital Nursing Review Board. The director of the lab sits in many committees, including Cardiology Operations and SMAT.

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

The vendors all go through Reptrax, then meet with the equipment analyst to set up time for technical support and/or in-service opportunities. 

Does your lab utilize any alternative therapies to help patients in the EP lab? 

We ask the patients if they would like to hear music during the procedure and try to provide them with the music style of their choice. They have the option of using headphones. We also explain the procedure and answer any questions they may have. We treat them as we would a family member, and strive to provide them with the best experience possible. All patients receive a phone call within days of their procedure, and are asked about their experience and for any suggestions to improve the process.

How does your lab handle call time for staff members? 

The average call burden is eight to ten days per month, three days being a weekend. We have a four-person team comprised of two RNs and two RTR/RCISs. Depending on the work volume, the call team has an “early out” option for the day before call.

Does your lab use a third party for reprocessing or catheter recycling? How has it impacted your lab? 

We are constantly looking for ways to cost manage our EP procedures. We work closely with Stryker Sustainability Solutions for catheter recycling, and it has helped in controlling costs in the EP lab.

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

We do radiofrequency ablations only.

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

Currently, we only do EP procedures on adult and adolescent patients.

Tell us more about the measures your lab has taken to reduce fluoroscopy time and minimize radiation exposure to physicians and staff. 

Our two CATHPAX Radiation Protection Cabins enclose the physician in a radiation protection area, greatly decreasing exposure and obviating the need to wear a lead apron. We have affectionately named this cabin the “Pope Mobile”. We monitor the badges of the doctors and staff closely, and require annual education on radiation safety. We have set limits for quality, and do a monthly review of any cases exceeding the standard.

What are your methods for infection prevention?

We have reached out to the surgical department for in-servicing on proper sterile prepping techniques and procedures. We adhere to mask and gowns in the room when trays are open, and a proper handwashing technique. Depending on the patient’s risk for infection, AIGISRx^® Antibacterial Envelopes (TYRX, Inc.) may be used during device implants.

Do your nurses/techs participate in the follow-up of pacemakers and ICDs? 

No. The Northwest Florida Heart Group, which has partnered with the hospital, provides pacemaker and ICD follow-up at their Device Clinic.

Does your hospital offer a cardiac device support group for patients? 

The hospital has a support group that meets monthly for emotional support and advice. There is frequently a guest speaker to provide education.

Do you utilize the American College of Cardiology National Cardiovascular Data Registry (ACC-NCDR)? 

Yes, we collect data on device implants and cath/PCI procedures, and report to the ACC-NCDR database.

How do you use the NCDR Outcome Reports to drive QI initiatives at your facility? 

All NCDR Outcome Reports are reviewed at Cardiology Operations committee meetings with all the cardiologists present. The committee addresses shortfalls and focuses on ways to improve quality. 

What are your thoughts on electronic record systems? 

Our electronic record system has helped improve data accuracy and legibility. The order entry component has eliminated redundancy and minimized the risk of error. 

How does your lab handle device recalls? 

We work closely in conjunction with our vendor partners to ensure patients are contacted and given the opportunity to discuss their options with our clinical team.

How is outpatient cardiac monitoring managed?

All device follow-up is managed by our partners, the Northwest Florida Cardiology Group.

How is coding and coding education handled in your lab?

We are constantly trying to keep up with coding changes. We provide point of care charge entry so accuracy is essential. Our dedicated IT staff is very helpful in reprogramming and keeping the system updated to the latest coding requirements.

Describe your city or general regional area. How is it unique from the rest of the U.S.? 

Pensacola is a mid-sized city with a greater area population of almost 300,000. Its location along the Gulf Coast attracts a great number of tourists, snowbirds, and retirees. The city is host to a large naval base and is considered the “Cradle of Naval Aviation”. It is home to several famous athletes, including Dallas Cowboys running back Emmitt Smith, PGA players Boo Weekley and Bubba Watson, and heavyweight champion Roy Jones, Jr. The rising number of elderly patients in our area has also added to the many challenges we face in the delivery of health care.

Please tell our readers what you consider special about your EP lab and staff.

I am not sure that we consider ourselves special. We are a team composed of members with different skill sets, which work together to complement each other. Our goal is to provide our patients with the highest level of care possible. Our lab is small compared to many, but our level of care and expertise is second to none. We provide our patients access to the same technology, care and outcomes expected at renowned institutions.