Atrial Fibrillation with EPS Accreditation: Experience at Tallahassee Memorial HealthCare

Interview by Jodie Elrod

In this feature interview, EP Lab Digest speaks with Farhat Khairallah, MD, FACC, FHRS, Medical Director of the Electrophysiology Program at Tallahassee Memorial HealthCare (TMH) about recently receiving the American College of Cardiology’s (ACC) Atrial Fibrillation with EPS accreditation.

Tell us about the EP program at Tallahassee Memorial HealthCare. 

The EP program at TMH is composed of two electrophysiology labs, with a third lab in the planning phase. We have four electrophysiologists who provide highly advanced treatment options to our community. The lab is managed by our electrophysiology program nurse manager, and is currently staffed with eight techs and five RNs. Our EP program serves patients well beyond the borders of Tallahassee — we serve patients across a 17-county region in North Florida, South Georgia, and beyond. Our labs are equipped with the CARTO (Biosense Webster, Inc., a Johnson & Johnson company), EnSite (Abbott), and Rhythmia (Boston Scientific) Mapping Systems, allowing us the flexibility to create a personalized treatment plan for each patient. TMH was one of the first hospitals in the country to commercially offer the WATCHMAN procedure (Boston Scientific) for those patients who require left atrial appendage closure. In addition, we also offer the Micra Transcatheter Pacing System (Medtronic) for those patients who would benefit from exclusive RV pacing; only 75 physicians across the U.S. were initially selected to train with this leadless pacemaker, and all four of our electrophysiologists were included. Annually, we see approximately 1600 atrial fibrillation (AF) patients.

When did Tallahassee Memorial HealthCare achieve the ACC’s Atrial Fibrillation with EPS accreditation?  

TMH received the ACC’s Atrial Fibrillation with EPS accreditation in August 2017. We are the only hospital in Florida and only one of two hospitals in the country to hold two of the highest designations from the ACC: the Chest Pain Center with PCI and Resuscitation accreditation, and the Atrial Fibrillation Program with EPS accreditation. We were also the first in the country to achieve a successful accreditation survey for two separate ACC accreditations in the same day. 

Was the process for achieving accreditation a multidisciplinary effort? What members of the staff were involved in the AF accreditation process?  

Yes, many people contributed to this multidisciplinary effort. Our nurse manager, whose focus is accreditations, worked closely with our improvement advisor and cardiovascular educator. Our AF navigator and the director of the cardiovascular lab also contributed, as did nurse managers and staff members from our emergency center, the EP lab, and inpatient units. In addition, we worked closely with members of our EMS and first responder teams to improve care. We had support from our administration and physicians in many areas. 

What can you tell us about the process for achieving Atrial Fibrillation Accreditation?  

It was a year-long process that took many hours of preparation and culminated in an onsite review from a representative of the ACC Accreditation Services. Numerous processes and documents were reviewed, updated, amended, and then submitted electronically to the ACC ahead of the site survey. Our nurse manager worked closely with the ACC accreditation review specialists for a year prior to the survey. 

Why were you interested in pursuing this accreditation? 

Accreditation supports improvement in clinical processes for the early identification, assessment, diagnosis, and treatment of patients with AF. This leads to improvement in clinical outcomes, cost, and patient satisfaction. Accreditation may support increases in patient self-referral and provider referral, leading to improved clinical outcomes. Through the accreditation process, we were also able to identify gaps in practice and revise processes, helping us improve in the application of evidence-based interventions to achieve timely and accurate diagnosis and treatment. Finally, achieving accreditation gave us the opportunity to demonstrate to our community our commitment and dedication to provide exceptional cardiac care.

Give us an example of how your approach to AF management has changed since earning this accreditation.  

Risk stratification of our AF patients occurs more consistently — separating them into high risk, low risk, and rising risk. This has helped us identify those in need of early intervention. 

Has the certification yet resulted in cost savings for the hospital?  

Since we received these accreditations in August 2017, we haven’t yet had enough time or data to analyze our cost savings. However, one of our goals in pursuing the accreditation was to improve clinical processes for early assessment, diagnosis, and treatment of patients with AF. These improvements support cost reductions in the AF population related to earlier treatment and reduction in adverse outcomes, such as stroke. 

What tips do you have for other labs considering this accreditation process? 

It truly takes a team that works well together and is dedicated and motivated to accomplish accreditation. With a strong team foundation, the evaluation process is manageable and achieving the accreditation is possible. 

What does achieving AF accreditation mean for the staff at Tallahassee Memorial HealthCare? 

It has been very rewarding. Our colleagues worked very hard to help obtain accreditation, which was a big goal for all of us here at Tallahassee Memorial HealthCare. We are very happy and honored to receive this accreditation. 

Is there anything else you’d like to add? 

It was a pleasure working with everyone involved in this effort. Our team at Tallahassee Memorial HealthCare looks forward to utilizing the tools we developed during this process to continue providing exceptional AF care for our patients.