Manatee Memorial Hospital

What is the size of your EP lab facility and number of staff members? What is the mix of credentials at your lab? Our EP lab at Manatee Memorial Hospital consists of one EP lab. We currently have four electrophysiologists doing a variety of cases. We have three dedicated EP staff members. We have an RN who also holds an RCIS credential, an RTR, and an RCIS who recently received the RCES credential. When was the EP lab started at your institution? Our EP program began in the summer of 1998 with Dr. Jeffrey Rothfeld and Dr. Joseph Pace. Dr. Kenneth Zide and Dr. Jagan Akella brought the more complex ablation procedures, such as atrial fibrillation and ventricular tachycardia, in August of 2009. What types of procedures are performed at your facility? Approximately how many are performed each week? We perform pacemaker, implantable cardiac defibrillator, and biventricular device implantations. We perform EP studies, loop recorder implants, and device generator changeouts. We perform all types of ablations such as SVT, atrial flutter, AV node and more complex ones such as for atrial fibrillation and ventricular tachycardia. What is the primary goal of your program? Our goal is to educate the community about cardiac arrhythmias and treatment procedures, and to provide them with state-of-the-art technology and specialized care for arrhythmias which has only recently been available. Who manages your EP lab? Sheri Sanford, RN is the manager of the cath lab and EP lab. She has worked with patients with cardiac arrhythmias for many years. She oversees daily operations in the EP lab and works directly under Paula Jefferson, Director of Imaging Services. Is the EP lab separate from the cath lab? How long has this been? Are employees cross-trained? Our EP lab is geographically separate from the cath lab. This has been since the opening of our new chest pain center last year. We have a dedicated EP staff that transferred from the cath lab 2 years ago and went to several EP training opportunities. The EP staff floats to the cath lab when there are no EP cases. How is inventory managed at your EP lab? Who handles the purchasing of equipment and supplies? Our RTR and RCES keep track of equipment and supplies used on a daily basis. They also take responsibility for ordering catheters, cables, NavX patches, etc., through Horizon Supply Source (McKesson, San Francisco, CA). The manager handles ordering of new equipment and supplies with the vendors. Have you developed a referral base? Our referral base has increased because of the availability of new procedures. We now have more patients in town coming to our EP lab that formerly would have been referred elsewhere. Has your institution formed an alliance with others in the area? Yes, we recently have aligned with Sebring Heart Center for ablation procedures. We also have invited other hospital staff members in the area to our educational opportunities. These hospitals have also been more than willing to lend supplies and/or equipment when needed. What types of continuing education opportunities are provided to staff members? Our EP staff participate in EP training at the hospital provided by vendors. We have also been fortunate to have been offered extra training by Bonnie McDonald, EP Lab Coordinator at Florida Hospital Zephyrhills. We have been given several continuing education opportunities from all of our device reps. How do you prevent staff burnout? Coffee and rice crispy treats! Does your lab utilize any alternative therapies? Yes, we have warm blankets and we play music to suit each patient’s musical tastes. Please describe one of the more interesting or bizarre cases that have come through your EP lab. What lessons did you learn from it? We had a male patient in his 60s who came to our lab two days after coronary artery bypass graft (CABG) with nonsustained runs of ventricular tachycardia. The patient had been shocked multiple times and even coded before coming to our EP lab. We did a VT ablation with EnSite (St. Jude Medical, St. Paul, MN) and ablated his clinical ventricular tachycardia, but during the case we were able to produce three different ventricular tachycardias. The patient returned to the CVICU. Two days later, the patient was still having runs of ventricular tachycardia, but was stable and alert. He came back to the EP lab for a second ventricular tachycardia ablation for the other VTs. The patient was discharged a few days later. We realized that no matter how bad a patient’s condition seems, you should always have hope. We learned that when things feels hopeless, keep going and there can be a phenomenal outcome. Approximately what percentage of your ablation procedures are done with cryo? What percentage is done with radiofrequency? We do not use cryo in our EP lab; 100% of our cases use radiofrequency. Do you perform only adult EP procedures or do you also do pediatric cases? Our lab only performs adult cases, including young adults from 18 years of age. What measures has your lab taken to minimize radiation exposure to physicians and staff? We wear radiation badges to measure exposure. Our RTR also inspects our lead every three months for any rips or tears. One of our EP physicians relies completely on the use of the ICE imaging equipment, which reduces radiation exposure dramatically during lengthy atrial fibrillation cases. What innovative EP techniques are being utilized in your lab? We use St. Jude Medical’s EnSite three-dimensional mapping system and will soon be upgrading to EnSite Velocity. In addition, there is novel use of ICE imaging for atrial fibrillation cases. What are some of the dominant trends you see emerging in the practice of electrophysiology? How is your lab preparing for these changes? Trends include the ability to practice with more evidence-based proof and with current guidelines to provide excellent care as EP professionals. We will prepare for the future by keeping abreast of changes through continuing education with EP physicians and staff. Give an example of a difficult problem or challenge your lab has faced. How it was addressed? Scheduling with anesthesia due to some lengthy procedures has been a challenge. There has also been some confusion with the different types of procedures to determine different sedation needs. Anesthesia schedules their staff according to length of procedure, so sometimes they are not available. This has been addressed by consistent education with EP staff and anesthesia staff. Our EP physicians have also had several meetings with the anesthesiologist to help resolve some confusion. Describe your city or general regional area. How does it differ from the rest of the U.S.? We are located in Bradenton, Florida. Bradenton is a medium-sized, coastal community with industry including Tropicana, Champ Sports, and IMG Academy. We are located one hour south of Tampa, and an hour and a half north of Naples on the west coast. Please tell our readers what you consider unique or innovative about your EP lab and staff. Our EP staff and physicians like to sing and tell jokes to keep the humor. Our EP RN owns an Italian restaurant in town, our RTR is a holy roller with sarcasm like a heathen, and our RCES is an experienced wakeboarder. Our EP physicians are all family men who have kind hearts and inspire us to continue to learn and become proficient in the EP profession. When glitches occur, we can all come together as a team to get the procedure done safely and efficiently for our patients. We are all here for our patients. For more information, please visit www.manateememorial.com