Expanding Electrophysiology Services at the Heart Institute at AtlantiCare Regional Medical Center’s Mainland Campus

On February 16, the Cardiac Catheterization & Rhythm Center opened at the Heart Institute at AtlantiCare Regional Medical Center’s (ARMC) Mainland Campus located in Pomona, New Jersey. In this interview we speak with Mary E. Tiernan, RN, team leader, EP Lab, AtlantiCare Regional Medical Center, about the new facility. Tell us about the new Cardiac Catheterization & Rhythm Center. What new equipment or technology is included? What EP procedures are performed there? The Cardiac Catheterization & Rhythm Center features five laboratories — three catheterization labs, one dedicated to electrophysiology and one (swing lab) for catheterization or electrophysiology. We perform procedures including AF ablations, ICDs (single and dual chamber), along with BiVs, explants, lead revisions and ablations. Our goal is to also have a dedicated ablation room using advanced navigation systems. Currently we treat AVNRTs, SVTs, RVOT tachy-arrhythmias, WPW and atrial flutter. How large is the new addition? How many beds and/or patient rooms are now available with these additions? The Cardiac Catheterization & Rhythm Center is 20,000 square feet. It has 16 private patient bays in the holding area. Will further staff be added? Yes, we are in the process now of hiring for the EP and cath labs. We have already hired three additional RNs for EP. In the cath lab they have hired an additional four staff members as of now. We are growing as far as staff, and now that we are merging (previously EP was a separate entity that had its own holding area staff and lab staff), our holding area staff will be merging to receive both cath and EP. What prompted the need for these new additions and renovations? Has your patient volume or EP procedures grown in the last few years? How many EP procedures does the AtlantiCare Regional Medical Center perform annually? ARMC has expanded and enhanced its services to meet the growing needs of the community, including the most complex cardiac issues. It was substantial growth that prompted the facility to build up EP services. The EP lab here at ARMC is relatively new — it was started in 2002 — so when we first started out we were sharing one of the cath labs. We outgrew that rather quickly, so we then moved to the first floor of the hospital and shared a lab with the interventional radiology department. However, it then got to the point where we needed more time for procedures, so interventional radiology moved out in January 2008, and gave us the lab. Originally we were a closed lab with one EP physician; now we are up to three separate groups with a total of four EP physicians. Last year we did 964 cases, and this year we are already up to 130 cases! How long did renovation take? What was the total cost of the renovation? Renovation took approximately one year to complete. The total cost was $20 million. I see that staff and physicians participated in decisions about the design and decor of the unit and patient rooms. What special considerations were included to benefit your patients and staff in the new addition? Yes, we were included in assessing the blueprints and suggesting where we wanted things located as far as anesthesia, equipment and lines. We wanted everything set up in a way where everything was underground and nothing was visible. When I first started in EP, there were wires all over the place so we were always tripping. Now everything is run in conduits under the floor. Our anesthesia has separate lines; we have pure air for our vents, oxygen and nasal cannulas, extra suction and extra outlets, which are what we needed. The locations of all monitors were put as far as we wanted them and were also mobile so that we wouldn’t be walking into them. What do you think is the best feature of this new lab? The best feature is the open space and more patient bays. Patients are able to come in earlier, such as 6:30 a.m. as opposed to having to wait until 7:30 a.m. There are dedicated staff for the holding area, a separate designated staff for the procedure room (for tilts, cardioversions, ICD checks and TEEs), and separate lab staff. Therefore, our productivity has increased tremendously. There is also a staggered staff schedule, so staff in the holding area as well as the techs arrive, around 6 a.m. and patients are scheduled to arrive by 6:30 a.m. By 7:30 a.m. we have patients on the table and therefore gain an hour of productivity in that time frame. When the procedures are done, we take patients to the holding area and there is specific staff receiving the patients. Then we are able to return to the lab, turn it over and proceed with other patients. Is there anything else you’d like to add? We are doing advanced procedures including transseptals, intracardiac echo and using AcuNav. We are ramping up training in EP. We also have anesthesia coverage for our cases. For more information, please visit: www.atlanticare.org or call the AtlantiCare Access Center at 1-888-569-1000.