Tips on Achieving Atrial Fibrillation Certification: Interview with Drs. William Nesbitt and Hoyt Frenzel

Texas Health Heart & Vascular Hospital Arlington, located on the campus of Texas Health Arlington Memorial Hospital, recently earned full Atrial Fibrillation Certification status from the Society of Cardiovascular Patient Care (SCPC). In this feature interview, EP Lab Digest® speaks with William “Bill” Nesbitt, MD, a cardiac electrophysiologist on the medical staff at Texas Health Heart & Vascular Hospital Arlington, and Hoyt Frenzel, MD, Medical Director of Texas Health Arlington Memorial’s emergency department (ED) and an emergency medicine physician on the hospital’s medical staff.

Tell us about the cardiac electrophysiology program at Texas Health Heart & Vascular Hospital Arlington. How many EP labs are there? How many EP lab staff members and electrophysiologists are there?

Nesbitt: There is one EP lab with four lab staff members for most complex cases. There are three electrophysiologists that staff the lab.

Approximately how many atrial fibrillation (AF) patients does the hospital see annually?

Nesbitt: We do approximately 150 AF cases per year.

Why did your facility choose to pursue AF certification from the SCPC? What was your goal in this earning this certification status?

Nesbitt: The goal from the outset during planning of Texas Health Heart & Vascular Hospital Arlington was to strive for achieving the best possible outcomes for patients. This certification was a logical step towards a unified guideline-based approach in the treatment of AF.

Frenzel: Our facility has been accredited as an Acute Heart Failure Center and Cycle IV Chest Pain Center with Angioplasty by the SCPC. We decided to seek AF certification because we wanted to continually provide the highest quality care to our patients. AF accreditation allows us to streamline care protocols and demonstrate through data that we are improving patient care. AF accreditation is also an external validation by a third party that we are providing the highest quality of care to our AF and EP patients.

How long did the certification process take? 

Nesbitt: The process took approximately six months.

What members of the staff and hospital were involved or in charge of the certification process? Was a subcommittee established to organize and enact plans for fulfilling the criteria needed for AF certification? How often did these staff members or subcommittee meet during the certification process?

Nesbitt: Dr. Frenzel was instrumental and took charge of the certification process. Through his leadership, a subcommittee was formed, which included Bobby Coxwell, RN with Texas Health Arlington Memorial’s cardiac cath lab, who acted as a point person and liaison.

Frenzel: Our Cardiovascular Com-
mittee is a collaborative committee between Texas Health Arlington Memorial Hospital and Texas Health Heart & Vascular Hospital. The committee was involved in all three accreditations. This is a multidisciplinary team that includes representation from the cath lab, EP lab, critical care unit, telemetry, pharmacy, radiology, emergency department, cardiologists, emergency medicine physicians, nursing, hospital administration, and emergency medical services (EMS). We meet monthly, and review data and processes for CHF, AMI, and AF. Project champions for this specific certification included Dr. Nesbitt, Bobby Coxwell, RN (EP lab manager), and myself.

What was the process for applying for certification? Discuss the Key Elements that a facility must effectively demonstrate to qualify for certification. How were these addressed? 

Frenzel: When applying for certification, the key stakeholders conducted a gap analysis of our current processes and the Key Elements of performance. We went through all key elements, collecting data and materials to support each element. Our multidisciplinary team met monthly and mapped out processes, approved protocols, and collected data for the project. The team compiled the data for the AF application and submitted it for SCPC review. The SCPC verified the items and after a detailed review process, approved the application. 

The Key Elements for the project were:

1. 1. Emergency department integration with EMS;

1. Risk stratification of the AF patient;
2. Treatment for patients presenting to the ED in AF;
3. Discharge criteria from the ED, observation services, or inpatient status;
4. AF patient education in the ED, observation services, and inpatient unit;
5. Personnel, competencies and training;
6. Process improvement;
7. Organizational structure and commitment; and
8. AF community outreach.

How has your facility’s approach to AF treatment and management changed since earning AF certification? 

Nesbitt: I think the biggest impact has been awareness of AF ablation as well as emphasis on risk scoring and anticoagulation for AF. 

Frenzel: We have streamlined our approach to the management of patients with AF and have enhanced our overall care. We have tools for risk stratification of bleeding risks for patients needing anticoagulation and for risks stratifying a patient’s risk for stroke from AF. We flow-charted all processes for the care of patients with AF. We then shared the new process and protocols with hospital employees and physicians on the medical staff. Risk stratification and flowcharts are based on current evidence-based medicine. 

Has the certification resulted in cost savings for the hospital? 

Frenzel: By providing evidence-based, high-quality care and by streamlining processes and protocols, this improves patient care. It also helps to decrease a patient’s length of stay and lessens the possibility of readmissions. These all decrease costs and improve care. 

What tips do you have for other labs considering or currently going through the certification process?

Nesbitt: The best approach would be to identify a leader and then create a small group to work on individual requirements and formulate final submission documents.

Frenzel: I strongly recommend that every EP lab consider AF accreditation. It was a very positive experience and allowed us to take patient care to the next level. 

What does achieving AF certification mean for the staff at Texas Health Heart & Vascular Hospital Arlington? 

Nesbitt: Achieving AF certification raises awareness and motivates all of us to raise our efforts to provide the best possible care to our community.

Frenzel:We are very proud of achieving AF accreditation, and it was truly a group collaboration. We sought AF accreditation to provide our patients with the highest quality of care. AF is the number one cause of stroke, and with our institution already being named an Accredited Primary Stroke Center, seeking AF accreditation was a natural progression. 

Disclosures: The authors have no conflicts of interest to report regarding the content herein.