Central Baptist Hospital

What is the size of your EP lab facility and number of staff members? What is the mix of credentials at your lab?

The electrophysiology lab at Central Baptist has 3 dedicated EP labs. There are 5 electrophysiologists that practice here. Our team consists of 9 RNs, 4 RTs, 1 EP manager, and 2 dedicated RNs from our research department. We are all ACLS certified. RNs are also certified in PALS and credentialed in conscious sedation. More than half of the staff has cath lab experience.

When was the EP lab started at your institution?

Dr. Michael Rukavina performed the first ablation in the fall of 1993. Dr. Gery Tomassoni came in August of 1999, and we became a dedicated EP lab. Dr. Peter Gallagher joined Dr. Tomassoni in 2001. After that time, volume has increased dramatically, and recently Dr. Aaron Hesselson joined the practice in August of 2004. Dr. Robert Brewer of Cardiology Associates, another large cardiology group that practices here, arrived in August of 2004 and performs some of his cases at Central Baptist Hospital.

What types of procedures are performed at your facility?

We perform a diverse variety of EP cases. As far as EP studies, we perform all diagnostic studies, ablations (SVT, VT and atrial fibrillation) including those requiring transseptal approach, ICDs, pacemakers, CRT, and lead extractions. We also do magnetic navigation in an investigational manner for all the above procedures. We perform NIPS procedures, as well as external and internal cardioversions.  

Approximately how many are performed each week? What complications do you find during these procedures?

We perform over 500 SVT ablations, 650 EP studies, 450 ICD, 180 pacemakers, 210 biventricular devices, and 110 pulmonary vein ablations a year. Complications rarely occur during procedure, and are lower than national published standards. All complications are closely monitored and assessed with physicians and staff.

Who manages your EP lab?

Dr. Peter Gallagher is the Medical Director of the EP lab, and Dr. Gery Tomassoni is Director of Research for the EP lab. Linda Miller, BSN, MBA is the director of Invasive Cardiology, and Nanette Richardson, RT(R) is EP lab manager. We collaboratively work together as a team.

Is the EP lab separate from the cath lab? Are employees cross-trained?

The EP lab is separate from the cath lab, but they are located in the same area. However, we work together to provide optimal care to all patients. Currently, we are not cross-trained with the cath lab, but we do help each other out. We have some cath lab RNs who are conscious sedation trained, and EP staff has helped with scrubbing device implants in the cath lab.

Do you have cross training inside the EP lab? What are the regulations in your state?

Nurses perform conscious sedation during procedures. Nurses and technologist scrub, circulate, monitor and run the computer equipment, including the Bloom Stimulator, Prucka, and CARTO mapping systems. This allows more options and flexibility, and ultimately a more manageable staffing schedule.

What are some of the new equipment, devices and products introduced at your lab lately? How has this changed the way you perform those procedures?

We had the first Niobe Artis Stereotaxis system installed in April 2003. We have the CARTO XP mapping system in all three labs, and recently installed CARTO Sync. Soon we expect to have a preliminary integrated Stereotaxis CARTO System. We recently purchased the Sequoia intracardiac ultrasound machine. We ve recently started using pre-procedural three-dimensional cardiac CT scanning and esophageal temperature monitoring for pulmonary vein ablations.

Who handles your procedure scheduling? Do you use a particular software? How do you handle physician timeliness?

Pathway Healthcare Scheduling is the software program we use to schedule patients. We have good relationships with our physician offices to take care of any scheduling changes that occur doing the course of the day. Physician timeliness is not a problem for us.

What types of quality assurance measures are practiced in your EP lab?

Our QA/QC measures include conscious sedation, complications and documentation review. Any medication given for sedation reversal is reported to patient safety. We also do equipment checks and monitor history and physical assessment, which is a JCAHO requirement.

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

We have an inventory specialist that maintains inventory and stock for both cath and EP labs. This is a huge task and it s done extremely well. Staff and the EP manager watch EP catheters, connectors and accessories needed for cases closely. For bigger purchases of equipment, the EP manager and director proceed thorough departmental request and capital budget.

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

We are now training staff on the Siemens Sensis EP monitoring system, which is installed in our third EP lab. We are fortunate to have an administration that has good foresight, has embraced technology, and understands that EP is technology driven. Administration is committed to keeping this program as a regional center of excellence.

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

Managed care has had only a minimal effect on what we do.

What measures has your EP lab implemented in order to cut or contain costs?

Quarterly costs are reassessed, and changes in volume are accounted for. We have a corporate committee that meets quarterly for to discuss Cardiac Rhythm Management. The EP lab manager watches EP catheters and supplies closely.

How are new employees oriented and trained at your facility?

New employees are trained slowly. We focus on tasks and expand when the person is ready. The orientation can last three to six months or longer, until the person is comfortable with each type of procedure. For the nurse, conscious sedation is a major role that is taken seriously and evaluated carefully.

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

We send several staff members to the Heart Rhythm Society meeting each year. We have departmental in-services, included with the cath lab, on topics of interest. We also send staff to training courses such as CARTO and Stereotaxis. We are fortunate that we work with physicians who also in-service staff and teach.

How is staff competency evaluated?

We have a competency checklist individualized for the EP staff. Conscious sedation is an important part of what we do; nurses are evaluated yearly for competency. We also perform annual departmental and JCAHO competencies.

Please describe one of the more interesting or bizarre cases that have come through your EP lab.

We ablated 5 different atrial arrhythmias in a patient with an orthotopic-transplanted heart. We also had a recent pulmonary vein isolation ablation case with possible congenital absence of the left inferior pulmonary vein. A recent interesting case involves the successful use of the Navistar irrigated tip ablation catheter for a difficult case of inappropriate sinus tachycardia. We also have a case series of 11 symptomatic VT ablated from the left main coronary cusp.

How does your lab handle call time for staff members?

We do not take call in the EP lab, but staff members stay until cases are finished for the day. This is a known requirement for anyone applying for a position in the EP lab.

Does your lab use a third party for reprocessing?

We do not use a third party for reprocessing, but the hospital has a committee that is researching the possibility of reprocessing in the future.

Approximately what percentage of your ablation procedures are done with cryo? What percentage is done with RF?

We use RF energy for all ablations.

What trends do you see emerging in the practice of electrophysiology?

As electrophysiology grows, so does the advancement of technology and techniques to optimize our outcomes. We believe that ablations, ICD and CRT volume will increase while pacemaker volume decreases. Our initial experience with Stereotaxis Magnetic Navigation would suggest that our ability to perform remote procedures without wearing lead looks promising.

Does your lab provide any educational or support programs for patients?

There is a regional support group for patients with biventricular devices. This was accomplished with the help of our two research nurses, Laura Martin and Lori Angel, and Guidant Corporation, Medtronic, Inc. and the University of Kentucky.

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

Central Baptist in Lexington is in the heart of the bluegrass in Central Kentucky. Our patients come from the entire state, with the majority from one center of the state.

Please tell our readers what you consider unique or innovative about your EP lab and its staff.

Our EP lab was the first to become involved in magnetic navigation. We have 32 active research protocols, and 75% of these are device-related. The rest are drug studies, catheter ablation and investigational protocols. Our staff is cross-trained in all areas of EP, which allows staffing flexibility. Because of this flexibility, the staff self schedule and work well as a team. Starting in January, we will begin the game Jeopardy. The staff will divide into teams, then Dr. Tomassoni will give the answer, and the staff will provide the questions related to electrophysiology. Not only is this a fun game, but it will also provide the staff with an educational learning experience. The winning team will receive a prize.