Medical City Heart

The EP program at Medical City Heart has a dedicated crew. Their healthcare is recognized on local, national and international levels. In fact, they are the North Texas leader in cardiac resynchronization therapy, and they were one of the first EP labs to purchase a three-dimensional mapping system. Find out how this state-of-the-art lab stays so successful.

What is the size of your EP lab facility and number of staff members? What is the mix of credentials at your lab? Our staff s skills are mixed. We have one RCIS, one CVT, and two RNs. In 2002, we performed 730 procedures.

When was the lab started at your institution? The electrophysiology program at Medical City Heart was started in 1990.

What types of procedures are performed at your institution? We perform diagnostic EP studies, ablations assisted with three-dimensional mapping and Chilli technologies. ICD, pacemaker, and biventricular devices, as well as laser lead extractions, are performed in the OR. Our lab performs approximately 10 cases per week.

How is your EP lab managed, and by whom? Our EP lab is under the supervision of Angela Riley, RT, Manager of Invasive and Non-Invasive Cardiology. She has been at Medical City Heart since 1997.

Is the EP lab seperate from the cath lab? How long has this been? Are employees cross-trained? Our electrophysiology lab is a dedicated crew. It includes Kelly Taylor, RCIS (who has been there since 1997); Gail Metcalf, CIS (who has been there since 1980); and Sue Hamner, RN (who has been there since 2001). It is in the same area as the catheterization lab, and we also share a pre/post area. The cath lab staff fill in when someone is on vacation.

What are some of the new equipment, devices and products introduced at your lab lately? How has this chaned the way you perform procedures? We were one of the first EP labs to purchase the three-dimensional mapping system (Biosense Webster Inc., Diamond Bar, California). We use the Chilli technology (EP Technologies/Boston Scientific, Natick, Massachusetts) for some ablations. We also participate in clinical trials and research, and are currently participating in the EASYTRAK 3 Lead Trial.

Is your lab filmess? Yes, our lab is filmless.

Who handles your procedure scheduling? So you use a particular software? How do you handle physician timeliness? Scheduling of procedures is handled by the cath lab schedulers; they use hospital LAN and Meditech software. Physician timelines work well. We have three core EP physicians, and they try to work on certain days, around each other s schedule.

What type of quality control/quality assurance measures are practiced in your EP lab? We have a Cardiology Performance Improvement Committee that meets once a month. This is a multidisciplinary team of physicians, managers, and directors.

How does your lab handle hemostasis? We practice manual hemostasis in the EP lab, and our cath lab uses closure devices.

How is inventory managed at your EP lab? Who handles the purchasing of equipment and supplies? Our EP crew handles all of the routine ordering of supplies. The manager oversees the monthly supply cost, collaboration with physicians, the purchasing of new supplies and equipment.

Has your EP lab recently expanded in size and patient volume? Our EP lab is definitely expanding. We are looking at adding one more RN and another physician.

How has managed care affected your EP lab and the care it provides to patients? Managed care has had a small impact on our lab.

What measures has your EP lab implemented in order to cut or contain costs and improve efficiencies in patient through-put? We have implemented reprocessing of catheters and some bulk purchases. To improve patient through-put, each physician gets one full day in the EP lab.

Does your EP lab compete for patients? Has your institution formed an alliance with others in the area? There a lot of labs in the area; however, there is not much competition, because there are plenty of patients.

Does your lab have an outpatient program? Yes, we do both in-patient and outpatient procedures. We have a very nice setup for outpatients. When they arrive at the cath lab, they are directly admitted, then have their procedure, and are later discharged from the CCL holding area.

How are new employees oriented and trained at your facility? There is a house-wide orientation followed by a department specific orientation. Everyone has a preceptor assigned to him or her.

What type of continuing education opportunities are provided to your staff members? Many of our educational offerings for the EP lab are vendor-sponsored. In addition, we send one staff member to NASPE each year.

How is staff competency evaluated? Staff competencies are evaluated every year through skills assessments: verbal, written and high-risk low volume.

Have you had any interesting or bizarre cases come through your EP lab? Once we implemented the three-dimensional mapping system, we started to see a lot of interesting cases.

How does your lab handle call time for staff members? Do they still maintain a full schedule the next day if they had to come in the night before? Is there a particular mix of credentials needed for each call team? We have one EP staff member on call to handle any after hours scheduling. They do not take call for any emergency procedures after hours. The cath lab call team handles any emergency procedures after hours and on weekends.

What trends do you see emerging in the practice of electrophysiology? Some of the trends that we find are emerging are more devices that will help improve patients quality of life.

Does your lab undergo inspection? Our lab undergoes JCAHO inspection.

Does your lab provide any educational or support programs for patients who may have additional questions, or those who may be interested in support groups? Patient education support is done through the physician s office for the Electrophysiology Department. The hospital has a few support programs for cardiology. These include support groups for congestive heart failure, open-heart surgery, and heart transplant procedures.

Is there a challenge your lab has faced? It is very challenging to find bright people who love EP.

Please tell our readers what you consider unique or innovative about your EP lab and its staff. Our lab is unique because of our bright and dedicated team. Our goal is to have our team understand as much as we do, so they will be active participants in the procedures and be comfortable making suggestions. They do, and are frequently right and reliable. They are some of the best we have ever seen, and they are brighter than some of the EP fellows I've worked with!