Spotlight Interview: Baptist Health

What is the size of your EP lab facility and number of staff members? What is the mix of credentials at your lab? We have a one-room EP lab with four dedicated staff: two radiologic technologists, 1 RN, and 1 EP doctor. Both RTs are credentialed with their cardiovascular interventional registry both are licensed by the state of Arkansas. Our RN has CVOR and CVICU experience. When was the EP lab started at your institution? This facility opened with two cath labs in 1999. It wasn t until 2000 that an EP lab was established. What types of procedures are performed at your facility? We do tilt studies, EP studies, ablations, transeptal ablations, permanent pacemakers, ICD implants, biventricular pacers and ICDs, loop recorders and ICD checks, as well as cardiac catheterizations and interventional procedures. Approximately how many are performed each week? What complications do you find during these procedures? We probably average 10 cases a week for EP studies and related procedures. We average around 15 caths and interventional procedures weekly. We really don t have any complications during these procedures. Most complications occur during our cardiac intervention procedures. We ve had some pretty intense moments when doing transeptals. We sometimes have problems with patients who are very large and have sleep apnea. These cases are done with anesthesia. If any complications arise, our OR is located right around the corner. We have a great surgical department here. Who manages your EP lab? The two radiological technologists manage the workflow, supplies, and any equipment problems that should arise. Our cath lab manager, Teresa Dodson, covers day-to-day operations in both the EP and cath labs. Is the EP lab separate from the cath lab? Are employees cross-trained? We have a combination lab that can do both EP and cardiac caths. Our staff in EP are cross-trained to do both EP and cardiac procedures. Our Special Procedures Lab is affiliated with the cath lab. We help with overflow cases when a room is available. The other RTs assist with procedures if one of us is off or absent, under direct supervision of one of the trained staff. The nurses in the cath lab come over and fill in when necessary with limited supervision. How is inventory managed at your EP lab? Who handles the purchasing of equipment and supplies? The two RTs order supplies for EP. Any capital equipment or special requests are handled by our department manager. Inventory par levels are kept to a minimum. We order as needed to try and keep cost down. Inventory is checked frequently. Has your EP lab recently expanded in size and patient volume, or will it be in the near future? Our lab is average in size. Our patient volume is steadily increasing and we hope that we will be doing more once we get started doing atrial fibrillation (AF) ablations. Last year we did 228 procedures. There is talk of getting another EP doctor; if so, volume will definitely increase. Since Medicare has decided to pay for ICD implants without having to meet criteria, we have seen a slight volume increase. How has managed care affected your EP lab and the care it provides patients? We really haven t seen managed care have that much impact on our lab or the care we provide. We strive to give our patients the most up-to-date treatment options. What measures has your EP lab implemented in order to cut or contain costs? In addition, in what ways have you improved efficiencies in patient through-put? We are always trying to keep our costs down. We resterilize our EP and ablation catheters. We buy in bulk when possible. We are a little bias, but we feel we are very efficient. Our patient satisfaction has been 100%. Does your EP lab compete for patients? Has your institution formed an alliance with others in the area? We are the only EP lab in North Little Rock. We rely on our patients from physician referrals. I am not aware of any alliance. What procedures do you perform on an outpatient basis? Any of our procedures can be done on an outpatient basis. Implants and ablations require an overnight stay. How are new employees oriented and trained at your facility? New employees have a mandatory employee orientation for the hospital. Each new employee is assigned a preceptor who is responsible for their orientation and training. They must meet certain criteria before they are considered to go solo. Do you have cross training inside the EP lab? What are the regulations in your state? The EP lab staff is crosstrained. Our state has a licensure that regulates the operation of the x-ray equipment. Nurses do not scrub nor do they operate the x-ray equipment during procedures. They are responsible for giving IV conscious sedation and patient assessment. They must have a current registration. All of our staff are BCLS- and ACLS-certified. Both EP techs have taken the cardiovascular intervention registry offered by ARRT. We hope to take the NASPExAM next year. 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? A little over a year ago, we installed a Siemens Axiom Artis imaging system. It is a single-plane x-ray unit. It is set up so we can do cardiac catheterizations. When the EP lab first opened, it was in an old x-ray unit and we avoided doing cardiac caths. This allows us to use lab time more efficiently by offering other time slots to other cardiologists. We had a Chilli ® ablation system (Boston Scientific) that was a separate unit, but Boston Scientific has developed a system that adapts to our EPT-1000 XP generator. It has made set up must faster and easier. We have budgeted for an Acuson ultrasound device that will assist with the treatment of AF. We do not do AF ablations at this time however, we hope to be offering this treatment in the near future. In addition, we have access to the Biosense Webster CARTO 3D mapping system that we use for some of our more complex procedures. Who handles your procedure scheduling? Do you use particular software? How do you handle physician timeliness? We have one EP doctor; Dr. Jeffrey Neuhauser is a board-certified electrophysiologist. His nurse calls to schedule his procedures. They have given him blocked times to do his EP cases. Lab times are shared with other staff cardiologists. Physicians are given 30 minutes to arrive to do their procedure. If they are not there and ready to start after 30 minutes of the scheduled time, their patient is taken off the table and the patient will be done at the end of the day or when time allows. This encourages timeliness. What types of quality assurance measures are practiced in your EP lab? Our equipment is inspected periodically and our inventory is checked monthly for expiration dates. Dr. Neuhauser informs us of any complications such as hematomas or infections. Each case that is done in the EP lab is entered into our Witt system and any complications during the procedure are documented there. What types of continuing education opportunities are provided to staff members? We try to attend the annual Heart Rhythm Society meeting. It has become more and more difficult to get the funds to attend, though. Our vendors offer inservices that help us get our CEUs. How is staff competency evaluated? By observation; their preceptors monitor their training. We have annual competency testing. How do you handle vendor visits to your department? Vendors must call and schedule a time to come. Only 1 vendor is allowed per day. They must check in with our central supply area and have a vendor badge that identifies them. Does your lab utilize any alternative therapies? No. Please describe one of the more interesting or bizarre cases that have come through your EP lab. A 19-year-old came in with SVT with a normal resting ECG and echo. During the EP study, she had a wide QRS-induced tachycardia that was terminated with adenosine. Following administration of the adenosine, she had pre-excitation and the pattern was identical to the tachycardia. After mapping, she was found to have a right posterior accessory pathway and an adenosine-sensitive ventricular tachycardia in the region around the ventricular insertion of the accessory pathway. We ablated both the pathway and the VT. How does your lab handle call time for staff members? The EP lab staff are dedicated staff. We do not take call. We are obligated to cover one holiday a year. The holidays are rotated. If cases run late, we stay and finish. Anything over eight hours is considered overtime. How often is each staff member on call? We only take 1 holiday a year. Cath lab staff have a scheduled rotation. For the RTs, it is usually every third day and every third weekend. Nurses have 1 day a week and every fourth weekend. They also rotate holidays. The schedule is very flexible. Some people like to take call more than others do. How frequently do they have to come in, on average? It is hard to say. These things are so unpredictable. One week you will not have anything, and the next week we will get called in two or three times. Our hours of operation are 7 am to 5:30 pm, Monday through Friday. We generally manage to get all scheduled cases done by 5:30. Is there a particular mix of credentials for each call team? Cath lab call team is comprised of 1 RN and 2 RTs. Does your lab use a third party for reprocessing? Yes; we use Alliance Medical Corporation. Approximately what percentage of your ablation procedures are done with cryo? What percentage is done with radiofrequency? None of our ablations are done with cryo. All of our ablations are done using radiofrequency. Do you perform only adult EP procedures, or do you also do pediatric cases? Is there cross training for pediatric cases? We only do adult cases. Pediatric cases are done at the Arkansas Children s Hospital, where they specialize in pediatrics. What trends do you see emerging in the practice of electrophysiology? There are always new things emerging. We are especially looking forward to doing atrial fibrillation ablations. Is your EP lab currently involved in any clinical trials or special projects? Dr. Neuhauser recently went to train to use the new steerable pacemaker lead. Does your lab undergo a JCAHO inspection? Yes, annually. Does your lab provide any educational or support programs for patients who may have additional questions or for those who may be interested in support groups? Dr. Neuhauser s nurse provides patients undergoing procedures with teaching and brochures that explain what we are going to be doing. There are no support groups at this time. Describe your city or general regional area. How does it differ from the rest of the U.S.? North Little Rock is small compared to some of the larger cities like Dallas or Houston. We really have a nice city, with area attractions like the Clinton Library and Altell arena. Arkansas is a beautiful state with places for boating, fishing, hiking, camping and hunting. Please tell our readers what you consider unique or innovative about your EP lab and its staff. We have a dedicated staff and 1 EP physician. We also feel we take an academic approach to treating each patient. It s not about getting them in and out. We tailor to the needs of the patient. We were the first lab to introduce resynchronization therapy. We also were the first in the area to use the irrigated lead (Chilli tip) for ablation therapy.