Increasing EP Lab Efficiency While Improving Patient Care

Our lab is staffed by many individuals, all of whom bring their own expertise. There are four electrophysiologists who perform cases in our lab on a daily basis. In addition, our lab includes nine registered nurses, seven of whom have critical care experience. One of those nurses is our coordinator who is responsible for overseeing the various facets of the lab, including scheduling, evaluations, and other administrative duties. We also have three cardiovascular technologists (CVTs), two of whom are registered, and one who will be applying for the registry in the near future. The complexity of the cases performed in the EP lab requires that the staff works closely as a team. It is this team approach that allows our lab to run as smoothly as it does, keeping turn around time at a minimum. When the day begins, a team leader is assigned. If possible, the team leader is a staff member who worked in the lab the previous day, since he or she is usually more familiar with the scheduled cases. The team leader's responsibilities include communicating with the doctors about the schedule for the day, assigning staff to cases, and ensuring that a patient's labs are complete and fall within normal parameters prior to the procedure. The use of a team leader reduces the number of pages a physician receives and gives all staff members a central person to communicate with should any issues arise. While all staff members are responsible for getting a patient ready for a procedure, there are some individual responsibilities that are assigned to nurses and others that are assigned to CVTs. The nurse circulating during the case is responsible for giving medications, starting IVs, and recording pertinent information about the procedure on the patient's chart. At the end of the case, the nurse gives a report about the procedure and its outcome to another nurse who is responsible for the patient once he leaves the lab. The CVT assigned to the case prepares the table for EP and/or ablation procedures, and then prepares the patient for the procedure. While the case is ongoing, the CVT operates the stimulator, the physiologic and advanced mapping systems, the radiofrequency generator and the ultrasound machine. At the end of the case, the CVT removes the sheaths and restores hemostasis to the puncture sites. For the surgeries that are performed in our lab, a nurse circulates and either a nurse or a CVT scrubs with the physician. During the set up for surgery, if there is enough staff available, one staff member helps the scrub person by giving him/her fluids, supplies, or equipment that might be used during the case. The rest of the staff helps with the preparation of the patient by attaching him to the proper monitoring equipment and entering patient information in the recording and fluoroscopy systems. While maintaining efficiency is important in the EP lab, patient care takes priority. When a patient enters the room, he goes through a patient verification procedure ensuring that he is aware of what procedure we will be performing. At that time, the consent for the procedure is also verified. Once the patient verification is complete and the patient is on the procedure table, available staff gets him ready by attaching the proper monitoring equipment (e.g., blood pressure cuff, EKG, etc.). At the same time, the anesthesiologist, if one is to be used for the case, is paged. When the patient is properly monitored, the CVT begins the sterile preparation. The physician performing the procedure is paged as soon as the sterile preparation begins, to let him know we are almost ready for him. This allows the physician to get to the lab with minimal down time. As a case nears its end, a transport request is put in for the next patient. Since we use a hospital-wide transportation system, we find it saves time by entering a transport request via computer well in advance of the case. Transport takes the patient to the EP lab, or, if the lab is not yet ready for the patient, to the cardiac catheterization lab holding area, which is a short distance from the EP lab. To increase efficiency, once the case is complete, housekeeping is contacted immediately. The housekeepers are assigned to both the catheterization lab and the EP lab, and someone is usually available. While the lab is being cleaned, the staff members assigned to the next case start getting the necessary supplies and equipment ready for the procedure. In order to achieve our goal of efficiency, it is imperative that staff education be ongoing. Through education, our staff members become competent in the use of new supplies and equipment. That competency ensures that our cases will run smoothly with little or no down time due to equipment issues. Our EP lab staff members are afforded several opportunities throughout the year to participate in continuing education programs. At least two attend the Heart Rhythm Symposium and several attend seminars offered by vendors. We also schedule in-services when a new product is released that will be used in our lab. Whether it is about a new mapping system, a new programmer for defibrillators and pacemakers, or other new equipment such as the Biosense Webster CoolFlow system, these in-services provide us with the necessary information and skills to use the product. We firmly believe that continuing education helps keep us abreast of all new products, and gives us the necessary confidence to work with those products. In order for our EP lab to complete as many cases as it does in a year, there is no doubt that the staff members must work toward a common goal of being efficient while putting patient safety and care first. At Morristown Memorial Hospital, we have accomplished this by working as a team, being organized, maximizing educational opportunities, and putting forth our best effort for our patients. Through dedication and teamwork, the EP lab's physicians, nurses and CVTs all play an integral part in providing a professional and caring environment.