From Start to Finish: How to Build an EP Lab into an Established Cardiology Program

Munroe Regional Medical Center is a locally owned, not-for-profit community hospital in Marion County. Their full-service medical center, which has been serving patients for 111 years, has 421 licensed beds, 2,500 associates, 450 physicians and 1,700 volunteers. They recently built an electrophysiology lab into their cardiovascular program, Munroe Heart. This article outlines the smooth transition, from the beginning to the completion of the project. History Munroe Regional is nationally recognized as one of the nation’s top heart and vascular hospitals. Munroe Regional is the only community hospital in the nation to be named one of the 100 Top Hospitals® for cardiovascular care ten times by Thomson Reuters and is recognized by HealthGrades® as the best heart center in Florida for coronary intervention procedures two years in a row (2008 & 2009). HealthGrades also recognizes Munroe Regional as being in the top 5% of hospitals in the nation for overall cardiac services (2009). In February 2008, Munroe Regional announced an exclusive partnership with four of the nation’s top cardiothoracic surgeons and five cardiac anesthesiologists, who joined Munroe Regional’s existing interventional cardiologists to form Munroe Heart. Munroe Heart, an autonomous specialty unit within Munroe Regional Medical Center, combines a 20-year history of top quality cardiovascular care with a nationally recognized, state-of-the-art medical practice. Completing the Munroe Heart Program In the past, patients who needed cardiac electrophysiology services other than cardiac rhythm device implants had to travel outside the county to receive care. In an effort to expand Munroe Heart’s award-winning heart program and care for the needs of its patients, Munroe Regional Medical Center committed in March 2008 to adding a new electrophysiology (EP) service to its Munroe Heart program. "We want to make certain we meet the needs of all of our patients," said Pam Michell, vice president of heart and vascular services at Munroe. “Munroe Heart is recognized nationally for its cardiovascular excellence, but without the EP lab, we have been like a clock without an 11. The addition of Munroe Heart’s EP lab now gives Munroe a complete, comprehensive heart program.” Munroe Regional’s state-of-the-art EP lab will serve patients with complex cardiac rhythm disturbances or complex pacemakers. The EP program is scheduled to open on January 4, 2010. Staffing Munroe Heart conducted a comprehensive search to find a cardiac electrophysiologist to lead them into this new venture. In December 2009, Munroe Heart announced the addition of cardiac electrophysiologist Celso Acevedo, MD to its team. Dr. Acevedo joins Munroe Heart from Cardiology Associates of Fort Lauderdale. “I am eager to join the Munroe Heart team,” said Dr. Celso Acevedo. “Munroe’s reputation for cardiovascular care speaks for itself and the opportunity to launch an innovative EP program is exciting.” To prepare for the opening of Munroe Heart’s EP lab, one Munroe RN and one CVT-RCIS enrolled in a yearlong EP technician program through a regional community college. These two individuals will be the basis for our EP lab staffing. “The EP training had just been implemented at a regional community college, so it paved the way for us to utilize two individuals, with years of cath lab experience, in the new EP program,” said Carol Floyd, RN, MHA, director of cardiovascular services at Munroe. “Not only did it solve the immediate problem of finding experienced staff, it allowed us to provide a new opportunity for staff growth and satisfaction.” As part of the preparation for the lab opening, Munroe Heart arranged for their EP-trained RN and CVT to spend one week in Ft. Lauderdale working alongside Dr. Acevedo at his previous hospital. This allowed the EP staff the opportunity to function as a team prior to the lab’s opening. The Lab While electrophysiology may be the fastest growing of all the cardiovascular disciplines, it is often characterized by crowded and cluttered labs. Tedious procedures are made even longer by repositioning equipment, walking to the control room and working with dissimilar systems. To ease the functionality and enhance the capabilities of the EP lab, Munroe will be using innovative technology. Munroe Heart’s EP lab will be equipped with the Philips EP cockpit (Philips Healthcare, Andover, MA). The EP cockpit creates a comfortable working environment by integrating data management throughout the heart rhythm care cycles, and enables new complex therapies. The EP cockpit also organizes all our equipment on one movable ceiling-mounted rack to reduce clutter; this allows Munroe’s electrophysiologist to operate all equipment in the EP lab from a single location, which increases efficiency and enhances quality care. In addition, instead of having to navigate through several monitors, the EP cockpit is equipped with one 56-inch high-resolution LCD display that will accept up to eight sources simultaneously and can resize and enlarge information at any time and position on the screen, while maintaining full sharpness. The lab will also feature the EnSite Velocity™ Cardiac Mapping System (St. Jude Medical, St. Paul, MN). This system will enable Dr. Acevedo to simultaneously create a detailed cardiac model and electrical map using multiple catheters and electrodes, which allow him to collect and display more relevant patient information in a shorter amount of time. The EnSite Velocity System provides real-time, side-by-side views of the live procedure and previously recorded portions of the procedure, giving a quick and easy comparison of events and results at different times throughout the procedure without losing the ability to visualize and navigate catheters in real time. Additionally, this system has an open platform, which means that it is compatible with essentially all diagnostic and ablation catheters, recording systems, and energy sources used for ablation procedures. The purpose of Munroe Heart’s innovative, technologically advanced EP lab is to enhance efficiencies in workflow, ensure greater navigational accuracy, have shorter procedure times and significant x-ray dose savings — all supported by high quality imaging. Construction and Implementation The EP lab will be located in an old cardiac catheterization lab, which was shut down in the summer of 2008 when Munroe Heart opened a new cardiac catheterization lab in its interventional cardiology department. Construction began in December 2009 on the permanent EP lab, which will be located adjacent to Munroe Heart’s four interventional cardiology labs and four cardiothoracic operating rooms. The permanent location of the EP lab will be completed and running the first of March 2010. “The location for the EP lab was chosen by our Catheterization Lab Medical Director, Dr. Robert Feldman,” said Carol Floyd, RN, MHA. “His desire was to build the electrophysiology program within the physical location of the interventional cardiology department. He felt this would maintain the autonomy of the ‘heart hospital within a hospital’ concept, which would benefit the patients and their families for finding their way around, the physicians and staff for consults and cohesiveness, and operational efficiency for the placement and storage of equipment and supplies.” Prior to the permanent lab opening in March 2010, Munroe Heart’s electrophysiologist will rotate his schedule between one of the Medical Center’s cardiac catheterization labs and one of the cardiothoracic operating rooms. What this Means for Patients “The opening of Munroe Heart’s EP lab signifies a significant step in completing the comprehensive cardiovascular program at Munroe Regional Medical Center,” said Pam Michell. “Now patients who have rhythm problems and have previously had to choose other facilities for their care, have access to Munroe Heart and its cardiovascular center of excellence.” In addition, local cardiologists and surgeons now have access to the experience and knowledge of Munroe Heart’s skilled electrophysiologist. “Sometimes it's difficult to find out why patients have a rhythm or disturbance,” said Dr. David Lammermeier, cardiothoracic and vascular surgeon at Munroe Heart. "An electrophysiology service can map out the heart to see what is the source of the rhythm disturbance. It's another piece in the puzzle." By adding the electrophysiology lab to Munroe Heart’s program, this piece of the puzzle will enhance the team of cardiothoracic surgery and interventional cardiology within Munroe Heart and provide patients with the quality and safe care they expect from Munroe Regional Medical Center. For more information, please visit: www.munroeregional.com/