Spotlight Interview: EMH Regional Healthcare System

EMH Regional Healthcare System (formerly Elyria Memorial Hospital), which was founded in 1915, is a 438-bed, two-hospital system with campuses in Elyria and Amherst, Ohio. We have a full array of immediate diagnostic and therapeutic cardiac services, which include coronary bypass, open-heart surgery, coronary angioplasty and electrophysiology studies. EMH s motto is First Class Care, Close to Home. This motto for our cardiac services is backed up with awards such as: Ranked No. 1 in Ohio for cardiac services Ranked No. 1 in Ohio two consecutive years for interventional procedures Best rated in the region for cardiac services Rated in the top 5 percent nationwide for heart surgery and interventional procedures.

What is the mix of credentials at your lab?

Our Invasive Cardiology department implemented an electrophysiology service in 1992 with one electrophysiologist and two nurses. We have grown since then and now have three electrophysiologists, nine RNs and a cardiovascular technician. Two of our EP labs are dedicated only for electrophysiology procedures and a dual EP/HCL performs both EP and HCL procedures. The new dual EP/HCL was completed in 2000 to accommodate an increasing volume of cases. The Device Clinic, which was introduced in 1986, staffs two full-time and one part-time RN(s).

What types of procedures are performed at your facility? Approximately how many are performed each week?

The electrophysiology lab procedures include ablative therapies, device implants, cardioversions, diagnostic studies, and tilt table tests. We perform 3-4 ablative therapies and 12-15 implants per week.

How is your EP lab managed, and by whom?

The Invasive Cardiology Department has a director that oversees all operations of the department. There is also a supervisor for the EP and Pacing labs and another for the Heart Cath labs. The supervisors have hands-on opportunities as well as being in charge of management of staff and scheduling.

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

The EP RNs are dedicated to EP and Pacing but our dual lab has staff that is cross-trained for both EP and heart cath lab procedures. This increase in staff has helped to provide enough staff to perform procedures during vacations and personal days off.

Do you have cross-training inside the EP lab? What are some of the new equipment, devices and products introduced at your lab lately?

All of our staff are trained to operate all equipment, which includes the stimulator and monitoring system, mapping system, ablative therapy generator, analyzer, and device manufacturer programmers. This past year, we have been using the CARTO mapping system (Biosense Webster, Inc., Diamond Bar, California) for ablative procedures. Our implants now include device therapies for atrial fibrillation and heart failure. A manufacturer representative is involved in all of our internal defibrillator implants, but staff analyzes and programs pacemakers for implants.

Who handles your procedure scheduling? How do you handle physician timeliness?

The EP schedule is initiated in the Cardiology office. This schedule is sent to the Invasive Cardiology office, where the daily charge nurse reviews it. The charge nurse will then notify the device manufacturer representative if they are needed for an implant and to designate procedures to a particular lab. Our electrophysiologists are very timely because they are dedicated to lab procedures. The non-invasive cardiologists and nurse practitioners attend to daily in-patient concerns.

How does your lab handle hemostasis (i.e., manual or vascular closure devices, where do patients go, who is responsible?)

Venous and arterial hemostasis is performed before the patient leaves the EP lab. Arterial hemostasis is performed with a vascular closure. Most patients are admitted as outpatient and go home the same day of the procedure. These patients recover from conscious sedation on a telemetry floor. In-patients are recovered in their designated in-patient room. All RNs in our institution are passed through a competency for conscious sedation and are able to recover any patient who has received these medications.

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

Inventory is monitored by an inventory specialist using the Apollo Software Program (Lumdex, Seattle, Washington). All equipment is kept track of on a daily basis. Staff barcodes all equipment and procedures daily and the inventory specialist will order equipment as needed. We have found that having an inventory specialist and software program has helped to keep costs down and has increased accuracy of the number of procedures performed and equipment used.

What measures has your EP lab implemented in order to cut or contain costs and improve efficiencies in patient through-put?

Our Pacemaker Clinic follows over 2,000 patients. The EP lab and Device Clinic work very closely with staff and physicians on a daily basis. This helps to coordinate implant procedures and physicians that are accessible when device troubleshooting is needed. The Pacemaker Clinic has two procedure rooms and also performs transtelephonic monitoring. Our clinic has an open-door policy. This means that a patient who feels that they need to be seen for a device-related problem will come into the clinic for an unscheduled check. Cardiologists and nurse practitioners are then consulted immediately for any problems noted. After hours, patients with symptoms are instructed to place a call to the Cardiac Care Unit for TTM monitoring. How are new employees oriented and trained at your facility? New employees are given a 90-day or more orientation into the lab.

How is staff competency evaluated?

Competencies are maintained throughout the year and in-services are given for new procedures and equipment. Since every member of our staff has hands-on experience with all equipment, we do not have a problem maintaining competencies. These competencies are monitored on a daily basis, and staff is given feedback as needed. Our institution's training and development program provides BCLS/ACLS certification. Peer and customer service evaluations are requested before an employee is given an annual review. Annual goals are also given to employees to encourage growth and leadership in the EP arena. We have very little turnover in the labs as well as in our institution. The average employment time for staff in the Invasive Cardiology Department is 8-10 years.

How does your lab handle call time for staff members? How frequently do they have to come in, on average?

Call time for EP staff is 5 hours on a Saturday morning, if needed. Our staff also takes call for one out of every 12 weeks for the Device Clinic. The call person may be needed after hours to accommodate patients that come into the ER or go to the operating room.

What trends do you see emerging in the practice of invasive cardiology?

New advances in equipment for device and ablative therapies appear to be ever-changing. Frequent staff in-services are given to keep staff informed of these changes.

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

Our EP lab is unique in that we are very timely. We utilize a charge person to handle the daily changing schedule and keep the staff and physicians informed of changes and add-ons. All RNs rotate as a designated charge person. Our staff also chooses to transport patients to and from the lab even though our institution has a transportation system. With staff transporting, the turnaround time is very quick. Our electrophysiologists mainly attend to the EP patient and their families, while the non-invasive cardiologist attends to other cardiac patients. Our efficiency in turnover of patients not only benefits the patient and his/her family, but allows staff to have very little overtime. We have 8- and 10-hour shifts and begin our day promptly by 7:00 a.m. Our Device Clinic is unique for its educational services and its internal cardioverter defibrillator (ICD) support group. All patients are given an invitation to attend a quarterly small group session. At these meetings, an informative video is shown, followed by a question and answer session. In the fall we have an outdoor picnic at a local retreat center, which is attended by 100-150 patients and their families. We also have a Christmas program, which includes a educational speaker or entertainment, light refreshments, and door prizes. One of our patients, who has an ICD implant, generates a Support Group Newsletter that is published quarterly. There is also a committee of patients who have implants that meet on a regular basis to organize meetings and educational speakers.

For more information about EMH Regional Healthcare System, please check out their website at: www.emh-healthcare.org