Spotlight Interview: Mercy Hospital

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EP LAB DIGEST. 2023;23(7):1,11-12.

When was the cardiac electrophysiology (EP) and conduction system program started at your institution?

Dr Stanley Wiggins started the EP program in 1988. The conduction system pacing (CSP) program was started by Dr Indrajeet Mahata in January 2023.

What is the size of your EP lab facility? What is the number of staff members?

Mercy Hospital is a multistate, community-based hospital system. We serve the entire Southwest Missouri region. The EP lab consists of 3 electrophysiologists, 6 nurses, and 8 technicians. We have 2 dedicated EP labs, and a third hybrid lab is used for EP procedures on an as-needed basis. We are also interviewing for a fourth electrophysiologist partner.

What types of procedures are performed at your facility?

We are a full-service EP lab. We perform all types of device implants, including pacemakers, defibrillators, cardiac resynchronization therapy (CRT) systems, leadless pacemakers, and subcutaneous implantable cardioverter-defibrillators. We also perform lead extractions. In addition, we perform all types of ablations for various atrial and ventricular arrhythmias, including radiofrequency and cryoablation for AF.

What are some of the new products recently introduced at your lab?

In October 2022, the United States Food and Drug Administration (FDA) approved left bundle branch area pacing (LBBAP). Our CSP program was started in January 2023. In collaboration with Medtronic, we were able to bring a program offering these capabilities to our community. Since the 3830 SelectSecure (Medtronic) became available, pacemakers can now be placed in the LB area, which is a more natural way to place right ventricular (RV) leads. It has been demonstrated that this new device will be able to help reduce heart failure admissions and all-cause mortality in the future.

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

At Mercy, our day starts at 7:00 AM. Staff assignments are made the night before to fulfill designated roles and responsibilities. More experienced staff members are assigned to managing the stimulator under the supervision of a physician. There is a dedicated pre- and postprocedural area where patients are taken care of by our lab staff. For ablations, patients are brought into the lab for sedation by the anesthesia team; the sedation nurse assists with this for device cases. Both labs operate from 7 AM to 5 PM on weekdays, and the hybrid third lab is staffed based on need.

Can you describe the extent and use of vascular closure devices in your lab?

Most of our left-sided procedures are closed with figure-of-8 sutures and/or the Vascade MVP system (Haemonetics). If no heparin was used during the procedures or the patient had a right-sided procedure, then we close with manual pressure.

How do you ensure timely case starts and patient turnover?

We have strict start times, and we try to have a start/stick time by 8 or 8:15 AM. This enables us to perform and optimize lab time. Getting our labs (sometimes transesophageal echocardiograms) on the day prior to procedures helps streamline the process.

What quality control measures are practiced in your lab?

All staff members attend monthly EP educational conferences given by EP attending physicians, and there are regular in-services regarding new and old equipment for the teams.

Several staff members serve on hospital committees such as the lab committee, equipment procuring committee, and safety committee.

Designated staff members are responsible for certain parts of the procedure. Our staff have all received board certifications.

We have regular morbidity and mortality conferences to improve our outcomes.

There is a preprocedural huddle where roles are defined and a dry run of the procedure is carried out, so any possible issues can be worked on.

What works well for your lab for onboarding new team members? What are the quality metrics in your lab and how do you ensure quality?

We focus on having a strong foundation. We want our new team members in the lab to feel comfortable assisting with procedures, be knowledgeable about safe and successful procedures, and ask questions. We ensure quality by holding each other accountable, praising good work, and offering instruction where needed.

What continuing education opportunities are provided for staff members?

The lab offers educational hours once a month in the hospital. We review ablation protocols, devices, and any other questions the staff may have. We like to incorporate all topics of interest for the staff.

Describe a particularly memorable case from your EP lab.

We had a patient with an ejection fraction of 50% and Mobitz II (expected RV pacing was unclear). Based on current guidelines, he did not qualify for a CRT system. Dr Mahata ultimately performed LBBAP in this patient. We are the first lab to perform this type of pacing in Springfield and Southwest Missouri.

What are some of the dominant trends you see emerging in the practice of EP?

We feel there is a genuine push toward pulsed field ablation. This seems to be the direction where AF ablation is headed. We are eagerly awaiting FDA approval of this technology. We are committed to bringing the latest and safest technologies to our community.

How do you use digital health and wearable technologies in your treatment strategies? What challenges or benefits do you associate with that?

In the current era, we must embrace the advent of wearable technologies. There will a deluge of data that we as clinicians have to sift through and determine if it is actionable or not. These technologies can be a good starting point for investigation, but cannot yet be completely relied on or replace traditional cardiac monitoring systems.

Describe your city or general regional area. How is it unique?

Southwest Missouri has a unique combination of citizens. There are 7 colleges in the area, and it is also a hub for retired people as well as outdoorsmen (the home of Bass Pro Shops is located here). The region offers beautiful scenery in the Ozark mountains, hiking trails, and lake life. There is vibrant nightlife, with plenty of live music venues. The people are warm and friendly. Southwest Missouri certainly has a hometown feel.

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

We are a full-service EP lab. We have dedicated staff and cardiac anesthesia teams for our EP cases. There is minimal cross training from the cardiac catheterization lab.

However, the most important thing about our lab is our people and relationships. We sometimes spend more time in the lab than at home, so this place becomes a second home for us. Each one of us cares for the other and treats each other like family.