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Spotlight Interview: Northern Westchester Hospital
Northern Westchester Hospital (NWH), part of Northwell Health, provides quality, patient-centered care that is close to home through a unique combination of medical expertise, leading-edge technology, and a commitment to humanity. With state-of-the-art technology, over 700 highly skilled physicians, and a professional staff of caregivers, we are committed to offering the highest quality care and building clinical programs that provide those who live and work in this region access to comprehensive services, including the cardiac catheterization and electrophysiology (EP) labs at the Seema Boesky Heart Center; the Yablon Cancer Health and Wellness Program at the Northwell Health Cancer Institute; a Center of Excellence in Robotic Surgery; and a Maternal Child Health Center with a Level 3 Neonatal Intensive Care Unit. NWH has established extensive internal quality measurements and standards to help ensure that the treatment patients receive is among the best in the nation. The team is proud to be recognized and accredited by many national organizations, including Magnet recognition for nursing excellence by the American Nurses Credentialing Center, Planetree Distinction Award for Leadership and Innovation in Person-Centered Care, and recognition as a top regional hospital in Westchester County by U.S. News and World Report’s Best Hospital rankings.
When was the EP program started at your institution, and by whom?
The EP program was started in January 2021 as part of the Seema Boesky Heart Center at NWH, shortly after the opening of the cath lab. It was started by Dr Subbarao Choudry, the director of the EP lab. Soon afterward, he was joined by Dr Mark Abrams, associate director. Our previous nursing manager, Patricia Soriano, has extensive experience in opening new labs and was instrumental in starting our program.
What is the size of your EP lab facility? Where is the EP lab in relation to the catheterization department?
Our EP lab facility consists of 2 procedure rooms that are shared with the interventional cardiology department. One room is predominantly used for EP procedures and the other is predominantly used for cardiac catheterizations.
Are employees cross-trained?
Both the EP and cath labs are part of the Seema Boesky Heart Center at NWH. We operate collaboratively and share lab space. Some of the nurses and technologists are cross-trained in both cath and EP, and we are working to cross-train the entire staff. There are didactic and peer-led trainings to ensure a standard of knowledge and competency in EP.
What is the number of staff members? What is the mix of credentials at your lab? Describe your lab staffing and structure.
We have approximately 15-20 staff members present each day to help the lab run smoothly. We currently do not have fellows or trainees. Registered nurses (RNs) and allied cardiac professionals (ACPs), including physician assistants and nurse practitioners, manage the preprocedural and postprocedural patients. RNs and radiation technologists assist with procedures. In addition to clinical staff, we have a patient care director who oversees operations and administrative staff who help with scheduling and coordination of care.
Who manages your EP lab?
Our EP lab is managed by Dr Choudry, director, and Dr Abrams, associate director, in addition to Felicia Gill, patient care manager.
What types of procedures are performed at your facility? What types of complex ablations are performed?
We currently perform a full range of device implant procedures as well as EP studies and right-sided supraventricular ablations. Our program is an extension of the award-winning cardiology program at Lenox Hill Hospital in New York City, which is consistently recognized by Healthgrades as one of America’s 100 best heart programs. Our complex ablations are currently performed there, since cardiac surgery is not onsite at our institution. We are working toward being able to provide more comprehensive ablation services at NWH.
What types of EP equipment are most commonly used in the lab?
The rooms are complete with state-of-the-art fluoroscopy and mapping equipment. We use the EnSite Precision system (Abbott) for mapping and ablation.
What would you consider to be the most frequent procedures performed or the most common arrhythmias seen?
The most frequent procedures that we perform in our lab are permanent pacemaker (PPM) implants, pacemaker and implantable cardioverter-defibrillator (ICD) generator changes, and ablations for atrial flutter and atrioventricular nodal reentry tachycardia. We are excited to be able to provide these services to our catchment area, which previously had limited options for EP services.
Approximately how many catheter ablations (for all arrhythmias), device implants, lead extractions, and left atrial appendage (LAA) closures are performed each month?
We perform an average of around 20 device implants (PPM or ICD) each month, in addition to 5 EP studies and ablations, 5-10 loop recorder implants, and 5 cardioversions. We do not yet perform left-sided ablation procedures due to state regulations; those procedures are currently done in the EP lab at Lenox Hill Hospital.
What type of hospital is your EP program a part of?
NWH is a community hospital that functions at the cutting edge of cardiac care. We are uniquely situated as an extension of the cardiology program at Lenox Hill Hospital and are a part of the Northwell Health system.
What are the best features of your EP lab’s layout or design?
In line with the hospital’s mission to have state-of-the-art technology to provide world-class patient care, where it can be easily accessed by so many in the community, the labs have been built with growth in mind. They are spacious and beautifully designed with the latest EP mapping equipment in a fully renovated part of the hospital to provide patients with a positive and comforting experience.
Tell us about your patient volume and possibility for lab expansion.
Since we began accepting patients in January 2021, our patient volume has continued to grow. We are proud to be able to provide EP care to a region of the Hudson Valley that was previously underserved. With the growth in both EP and cath volume, we have already recognized the need to expand. We are planning to build an additional fully equipped procedure room in addition to new preprocedural and postprocedural areas to accommodate this growing volume.
How is shift coverage managed (typical hours)? How does your lab handle call?
Coverage/call for our EP lab is divided by days of the week between our EP group. We share weekend coverage with our sister team at Lenox Hill Hospital. During the week, each electrophysiologist is assigned a day to provide coverage for add-on cases and emergencies. Nurses and ACPs typically work 12-hour weekday shifts (eg, 7 AM-7 PM or 10 AM-10 PM) as well as Saturday mornings to care for postprocedural patients from Friday’s cases.
What type of quality control measures are practiced in your EP lab? How are new employees oriented and trained, and what types of continuing education opportunities are provided to staff?
As we grow and continue to add new staff members, maintaining a high quality of care is of utmost importance. We have a rigorous orientation to the lab for new staff members, and we also have scheduled trainings, simulations, and peer-led education initiatives to ensure quality control. As part of the Northwell Health network, we also take advantage of a system-wide EP education lecture series. Alba Padin, our nurse educator, oversees these quality control efforts by providing group and individual education initiatives for the staff.
Does your EP lab compete for patients? Has your institution formed an alliance with others in the area?
While the catchment area for our EP lab is broad with relatively few EP labs in the immediate area, we are located in close proximity to New York City. NWH has an esteemed reputation in the community that has been built over time, which the EP lab benefits from and strives to live up to. As part of Northwell Health, our hospital draws patients from the local community and surrounding areas. We also receive patients who are transferred from other local hospitals. Many of our patients are referred by CareMount Medical, a large multisite, multispecialty outpatient-based group in the area.
Describe a particularly memorable case from your EP lab and how it was addressed.
As a new EP lab, one particularly memorable case was our first leadless pacemaker implant. A patient who is an active member of our community and long-time volunteer firefighter needed a pacemaker implant, and after discussion, we decided a leadless pacemaker would be appropriate. Although this is not a new procedure in the EP field, it was new to our staff and to the hospital. As such, we coordinated education and training for the ACPs, RNs, and technologists who had never previously done this procedure. The procedure went well and the patient was very appreciative. While not a particularly challenging case from an EP perspective, it brought our new team together and got them excited as they saw firsthand how we can provide new technologies to members of our community.
What approaches has your lab taken to reduce fluoroscopy time? What percentage of cases are done without fluoroscopy? What types of radiation protective shielding and technology are used?
We are conscious about fluoroscopy time and radiation exposure. While our EP mapping equipment allows us to minimize fluoroscopy time, we are continuing to explore optimization of radiation settings and shielding to further reduce exposure. We have portable radiation shields that allow us to do femoral access procedures without wearing lead. Almost half of our EP studies and ablations are performed without any fluoroscopy.
What are some of the dominant trends you see emerging in the practice of electrophysiology?
The growing need for EP services has accelerated the need for community-based EP care. As technological advancements continue to make our procedures safer and more effective, many of the EP procedures that were previously performed only at large academic medical centers can now be offered locally at community hospitals such as ours. This allows our patients to have easier access to the advanced care they need. As part of Northwell Health—the largest hospital system in New York State—we can provide much of the needed care on a local level and also leverage our affiliation with larger hospitals in the network when more advanced care is needed.
Please tell our readers what you consider special about your EP lab and staff.
As a brand-new EP program, our staff is comprised of a broad mix of people who have previously worked in a variety of other roles and settings. While this has required additional training to familiarize everyone with the operation of the EP and cath lab, it is refreshing to hear the fresh perspectives that our staff brings to everything they do as they draw on the breadth of their prior experiences.
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