Spotlight Interview: Northeast Georgia Medical Center

What is the size of your EP lab facility and number of staff members? What is the mix of credentials at your lab? We currently have one EP Stereotaxis lab and one implant room. We presently have six dedicated staff members (one radiology tech, one respiratory therapist, three RNs, and one RCIS), as well as two full-time cardiac electrophysiologists. When was the EP lab started at your institution? Our EP program was started in April 2004. EP procedures were initially performed in one of the cardiac cath labs using mobile equipment, until our EP Stereotaxis lab was completed in January 2005. What types of procedures are performed at your facility? We perform procedures such as catheter ablation including ablation for AF and VT, device implantation including implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy (CRT), and laser lead extraction. We are the first EP program in Georgia to offer cryoablation for adults, and are the first and only lab performing ablation with the Stereotaxis Magnetic Navigation System. What is the primary goal of your program? The goal of our program is to provide comprehensive electrophysiology services to our region. We have a particular interest in catheter ablation and magnetic navigation. Approximately how many procedures are performed each week? We perform approximately 10-15 procedures per week. Complications are evaluated through a pre-specified Quality Review process. Who manages your EP lab? Rick Smith, RT (R) is our EP lab coordinator, and Daniel Tarte, RN is the manager of the cardiac labs, which includes EP and cath. Is the EP lab separate from the cath lab? How long has this been? Are employees cross-trained? Currently, the EP staff is a dedicated group within the cardiac cath labs. Cross training is not a requirement, although most EP staff have cath lab experience. In addition, cath lab staff often assist with procedures in our implant lab. Do you have cross training inside the EP lab? What are the regulations in your state? All techs and nurses are trained to scrub for EP studies and implants. Most of our techs and nurses are trained to use Carto, Stereotaxis, the Bloom Stimulator, and the CardioLab recording system. Our goal is to have one person become a designated super-user of each piece of equipment. This will enable them to train other staff members and be responsible for troubleshooting and implementing upgrades. Cross training is the goal. What new equipment, devices and/or products have been introduced at your lab lately? How has this changed the way you perform those procedures? We are currently in the process of installing the Odyssey system with Stereotaxis. Odyssey consolidates the variety of monitors used in a magnetic navigation lab into a large central monitor, and further integrates 3D mapping, catheter navigation, and fluoroscopy in the control room. In addition, real-time collaboration with other EP labs will be enabled for research, teaching, and potentially direct patient care. What type of quality control/quality assurance measures are practiced in your EP lab? A specific Quality Review policy is followed. All complications and variances trigger a process leading to a detailed case review by the EP/cath lab manager and physician medical directors. Outcomes are trended and specific cases are discussed at a quarterly meeting. How is inventory managed at your EP lab? Who handles the purchasing of equipment and supplies? The EP coordinator manages all inventory and supplies with collaboration from the cardiac cath lab inventory manager. Has your EP lab recently expanded in size and patient volume, or will it be in the near future? As a new program, we have experienced steady growth in procedural volume. We are currently expanding the number of dedicated EP staff and planning for additional lab space. Have you developed a referral base? We are the referral hospital for northeastern Georgia, but receive ablation referrals from outside this region as well. How are new employees oriented and trained at your facility? New staff members have a two-day hospital orientation. Our cardiac cath lab clinical educator organizes a one-day EP and cath lab orientation. Nurses are required to attend a one-hour class on conscious sedation and spend a six-week rotation through the cath lab. Once in the EP lab, training is under the guide of the EP coordinator and a preceptor. What types of continuing education opportunities are provided to staff members? Case review and didactic topics are discussed monthly by Drs. Ahn and Ramaswamy. In addition, vendor-sponsored programs are attended, and one to two lab staff attend national and regional EP meetings yearly. How is staff competency evaluated? We have yearly competency skills testing. How do you prevent staff burnout? With a relatively small staff and increasing procedural volumes, late days have become more common. We recently decided to limit electives on Fridays, and additional staff will be added over the coming year. Do you contract with vendors? How do you handle vendor visits to your department? Yes. Device vendors schedule appointments in the EP lab through the EP coordinator. Please describe one of the more interesting or bizarre cases that have come through your EP lab. We have been particularly excited about the Stereotaxis Magnetic Navigation System. Since the release of the NaviStar RMT magnetic catheter, we have expanded the use of the system. Currently, all ablation is performed with Stereotaxis Magnetic Navigation unless cryoablation or irrigated RF is required. We have found magnetic navigation advantageous for both straightforward and complex cases. Approximately what percentage of your ablation procedures are done with cryo? What percentage is done with radiofrequency? Approximately 30-40% of ablation was performed with cryo in 2005. Since the NaviStar RMT magnetic catheter became available in 2006, cryoablation is used for approximately 10-15% of ablation cases. Do you perform only adult EP procedures or do you also do pediatric cases? We only perform adult EP procedures. Do your nurses/techs participate in the follow up of pacemakers and ICDs? If so, how many device visits per week do they handle? Do you use any particular software for follow up? How many of your ICD/ pacemaker patients require a doctor for their visits? Patients with devices are followed at a dedicated Device Clinic located at the Northeast Georgia Heart Center. Some patients are seen by the electrophysiologist in a separate Arrhythmia Clinic. We use an electronic medical record system and are planning to incorporate device clinic records as well. What trends do you see emerging in the practice of electrophysiology? How is your lab preparing for these future changes? We see greater integration of technologies in the EP lab as being an important means of improving workflow in the EP lab. In addition, the ability to network with other labs will also improve patient care and research collaboration. What are your thoughts about non-EPs implanting ICDs? Do you train such individuals? We endorse the guidelines published by the Heart Rhythm Society, the American College of Cardiology and the American Heart Association. At our institution, ICD and CRT devices are implanted by CCEPs. Is your lab doing web-based/transtelephonic device follow-up? The Device Clinic performs remote monitoring of devices. Transtelephonic checks are not performed. Is your EP lab currently involved in any clinical research studies or special projects? Which ones? Our EP lab participated in Stereotaxis HEART trial, a prospective, randomized evaluation of magnetic navigation versus manual catheter manipulation for catheter ablation of SVT. In addition, we look forward to participating in an international, prospective evaluation of an MRI-compatible pacemaker (Medtronic EnRhythm). Drs. Ramaswamy and Ahn will be presenting their experience using Stereotaxis Magnetic Navigation in patients with SVT at the December 2007 World Congress of Pacing and Electrophysiology. Are you ACGME-approved for EP training? What do you think about two-year EP programs? Dr. Ahn and Dr. Ramaswamy completed two-year fellowships. We support the published guidelines for maintenance of competence for all electrophysiologists. 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? The medical center has a cardiac support group (Mended Hearts) that is active in providing support for patients with ICDs. Describe your city or general regional area. How does it differ from the rest of the U.S.? Gainesville is located approximately 45 minutes northeast of Atlanta on Lake Lanier. Please tell our readers what you consider unique or innovative about your EP lab and staff. Despite being a young program, the EP lab at Northeast Georgia Medical Center has distinguished itself as a leader in catheter ablation with magnetic navigation. The strength of our program is our team approach in striving for clinical excellence. The Northeast Georgia Medical Center was recently ranked the #1 hospital in Georgia for cardiac care for the third consecutive year by the Health-Grades Hospital Quality Study. For more information, please visit: www.nghs.com/