Bringing the World’s Newest Technology to the Country’s Oldest City: Building an EP Program at Flagler Hospital

EP Lab Digest speaks with Donna Wagner, BSN, MS, RN, who serves as Administrator of Cardiovascular and Critical Care Services at Flagler Hospital in St. Augustine, Florida. In this interview, she describes the creation of a new EP lab and ablation program at Flagler Hospital.

Why was there a need for a new EP lab and ablation program? 

As the only hospital in our county, we were sending out a significant amount of patients for services. Therefore, Flagler Hospital decided to make the investment and enhance the service line. We have committed resources to build a 1000-square-foot, state-of-the-art hybrid EP lab to support the service line expansion.

When is it estimated to open? 

The new lab is still in the process of being constructed. We anticipate it opening in December 2018. However, we wanted to start offering EP services as soon as possible. We have been able to borrow time within one of our newly constructed interventional radiology (IR) suites to accommodate these procedures. Fortunately, ablation and mapping technology and equipment have become somewhat mobile, allowing us to roll the equipment in and out on the days we are performing ablations. We look forward to offering services 5 days a week once our dedicated EP lab is built. 

Where will the lab and program be located? 

It will be adjacent to cardiac services, and there will be a red line door for the OR. It will be built as a hybrid OR and EP suite, so that when we eventually add in a structural heart program, we’ll be able to have our cardiac surgeons come right through and still maintain the red line. 

What prompted the need for the new space? 

Flagler Hospital is located in St. Johns County, which is one of the fastest growing counties in the country. Not only do we have a population explosion happening here, but with the number of aging patients and cases with atrial fibrillation becoming more prevalent, we knew this would be an offering that would benefit the community. 

What special considerations or features are being included in construction and creation?

The goal is to create one of the most advanced EP laboratories in Northeast Florida (if not in the U.S.). We have invested in the latest iterations of technology. GE is our vendor for fluoroscopy. We have invested in the Discovery system, which allows for 360-degree around the table movement of the fluoroscopy system, along with out of the way robotic parking of the system when not in use. This feature was of particular interest to our surgeon, who may need to utilize the hybrid function of the lab. We also partnered with Abbott by investing in the latest iteration of their EnSite Precision 3D Cardiac Mapping System as well as the WorkMate Claris recording system. Finally, room design is focused on minimizing any ambient signal interference so that signal quality will be at the highest achievable quality. All equipment will be suspended on booms, and cabling will be individually insulated and isolated. 

What other aspects, such as staff training or workflow, have been taken into consideration with this project?

We currently have simulation training taking place in the IR suite — this includes staff from anesthesia, IT, Abbott, GE, and our biomedical department. This way, we can troubleshoot for any potential issues, including determining potential sources for signal interference. We have performed several multidisciplinary mock simulations, so that we may anticipate any hiccups along the way. We are fortunate to have hired staff that are already experienced in EP from working at other centers. Our director, in conjunction with industry representatives, has organized and will be implementing a formal educational series as well. One staff member is RCES certified. Our goal is to have all members become RCES certified.

What types of procedures will be performed in this new space?

We will be offering a full spectrum of electrophysiology services, including atrial fibrillation ablation with either radiofrequency or cryoballoon technology. Dr. Neil Sanghvi, Director of Electrophysiology Services at Flagler, is incredibly proficient with the cryoballoon, which has reduced table procedure time to as low as 45-55 minutes at times. We will be able to perform SVT, atrial flutter, and ventricular tachycardia ablations. We anticipate beginning a left atrial appendage closure program in the next year. 

What has this process been like? Who has been involved? 

I think what is unique about this project is how quickly we went from our start date to being able to do our first procedure. Because of the demand to have the service become available, what was scheduled to be an 18-month project wound up being 5 months! As you can imagine, our team has been instrumental in getting this done. Dr. Sanghvi has been amazing in helping us with direction and by guiding us through the process. Enzo Pistritto, our project manager, holds multiple weekly meetings so that all of the involved parties can collaborate. In addition, our IT services have been crucial in building all the documentation, order sets, and connections. Our engineering department has drawn up plans, ran cables, and taught me everything I could imagine about building a lab. Biomedical engineering has also been involved with getting everything electrically tested and putting safety equipment in place. Our chief nursing officer has given me a tremendous amount of support. Gina Mangus, our VP of Marketing and Strategic Planning, initially ran all the numbers for us and wrote up the initial charter when we were looking at all this. I’m now working very closely with her and her team on a marketing plan to inform our community about the project. Finally, I would be remiss not to mention our CEO, Jason Barrett, since none of this would have succeeded without his support. He truly committed the resources to get this done. Our whole team really pulled together, and one by one, we have been able to tackle any barriers. 

What does this new space mean for the staff at Flagler Hospital?

The staff is very excited about this expansion. They previously had to send patient after patient to get EP services done at another facility located >40 miles away. I actually had to send my own sister to another hospital in the area to have her ablation performed, which as you can imagine, was very difficult. Dr. Sanghvi will soon start offering an educational series on EP services for anyone on the hospital staff. Although much of our staff has up to 20+ years’ experience in EP, they’ve never actually launched a program before, so this project has much meaning for them!