Spotlight Interview: Avera Heart Hospital

What is the size of your EP lab facility and number of staff members? What is the mix of credentials at your lab? The Avera Heart Hospital EP lab has 4 EP-trained RCIS technologists. On each case there is 1 nurse and 3 techs. We have 4 total cath labs, 2 of which can be used for EP. When was the EP lab started at your institution? It opened the same day as the hospital, on March 20th, 2001. In fact, an EP case was the first case performed at the new hospital. What types of procedures are performed at your facility? Approximately how many are performed each week? The Avera Heart Hospital performs EP studies, ablations for all types of arrhythmias, including atrial fibrillation, and device implants, including pacemakers, defibrillators and Bi-Vs. Our EP lab performs approximately 60 cases per month. In addition, we offer drug testing for patients with suspected arrhythmia problems in our same-day area. What is the primary goal of your program? Our goal is to offer patients the best possible care and treatment options specific to their individual medical needs. We also strive to exceed patient expections in terms of local access to treatment options, and in customer service. Is the EP lab separate from the cath lab? Are employees cross trained? No, the electrophysiology lab is part of the cath lab. Nurses are cross trained to assist with EP cases. There are 4 dedicated EP technologists. Who manages your lab? Chris Wendt is our Cath/EP Lab Director. Do you have cross training inside the EP lab? What are the regulations in your state? No, EP technologists are not cross trained. State regulations do not allow technologists to administer medications. What new equipment, devices and/or products have been introduced at your lab lately? How has this changed the way you perform those procedures? The Avera Heart Hospital opened a new state-of-the-art EP lab in April 2009. This lab carries all new Siemens equipment. The design of the new lab allows the hospital to offer a better flow to patient care. There is also less radiation to the patient and staff members because of the new equipment. Some of the new technologies our lab is using include different types of cooled-tip ablation catheters and different sized intracardiac ultrasound catheters. We also are entertaining the possibility of upgrading our EnSite NavX system (St. Jude Medical, St. Paul, MN), and perhaps purchasing a Carto system (Biosense Webster Inc., a Johnson & Johnson company, Diamond Bar, CA) for electroanatomic mapping. New technologies offers EP specialists expanded options for patient treatment. Who handles your procedure scheduling? The EP technologists handle scheduling. What type of quality control/quality assurance measures are practiced in your EP lab? Lab staff members monitor infection rates in patients who have an implant. We also have quality controls on equipment, as well as time-outs and labeling to ensure patient safety. How is inventory managed at your EP lab? Who handles the purchasing of equipment and supplies? EP technologists manage inventory through the purchasing and materials department. How has managed care affected your EP lab and the care it provides patients? We provide services to all patients, regardless of their ability to pay. Have you developed a referral base? The Avera Heart Hospital is owned by three equal partners: MedCath, Inc., North Central Heart Institute (a group of over 20 cardiologists, surgeons and EP specialists who do outreach at more than 60 sites), and Avera McKennan, which is part of a regional health system. Our referrals come from a variety of sources, including the Avera System, the North Central Heart physicians, Sioux Falls Cardiovascular PC, and other area physicians. What measures has your electrophysiology lab implemented in order to cut or contain costs? In addition, in what ways have you improved efficiencies in patient through-put? We contract with device manufacturers to maintain the lowest possible cost on devices. We also practice bulk buying. As far as efficiency, the monitoring booth is right inside the EP lab for ease of monitoring. Access has also been improved with the addition of the new room. Does your EP lab compete for patients? Has your institution formed an alliance with others in the area? Yes, we have an integrated health care market with two very competitive hospital systems. We are part of the Avera system. Avera is a regional health care family with more than 230 facilities in the five-state region of South Dakota, North Dakota, Minnesota, Iowa and Nebraska. How are new employees oriented and trained at your facility? We offer basic EP training with staff through the Heart Rhythm Society. Equipment vendors also offer training to EP staff. What types of continuing education opportunities are provided to staff members? We utilize the Heart Rhythm Society for continuing education opportunities. EP technologists also go through 6 months of continuous on-the-job training. How is staff competency evaluated? Staff members are evaluated annually on various competencies. How do you prevent staff burnout? In addition, do you practice any team-building exercises? Our EP staff work as a cohesive team to prevent burnout. They are a group who is passionate about helping patients, and we understand each other’s strengths. We strive to create an energetic work place and foster a culture of excellence. What committees, if any, are staff members asked to serve on in your lab? Staff members serve on the patient safety team and clinical governance team, and perform a variety of other departmental duties. How do you handle vendor visits to your department? Do you contract with vendors? Vendors are able to schedule visits on a monthly basis. Only one vendor is allowed at a time. Some vendors are present during procedures to assist with equipment or devices. Does your lab utilize any alternative therapies? No, not at this time. How does your lab handle call time for staff members? How often is each staff member on call? How frequently do they have to come in, on average? Is there a particular mix of credentials needed for each call team? Call time is rotational. The team on call covers EP, peripherals and coronary. EP procedures are typically not performed on the weekends unless it is on an emergency basis. Call teams include 2 RNs and 2 RCIS’s. Does your lab use a third party for reprocessing? No. Approximately what percentage of your ablation procedures are done with cryo? What percentage is done with radiofrequency? None. We use 100 percent radiofrequency for ablation procedures. Do you perform only adult EP procedures or do you also do pediatric cases? We do not handle pediatric cases. What measures has your lab taken to minimize radiation exposure to physicians and staff? Our EP lab has entirely new equipment, which helps to minimize radiation. The monitoring booth is behind lead in the lab. We also have a low fluoro rate. Do your nurses/techs participate in the follow up of pacemakers and ICDs? No. Monitoring of devices is handled through the North Central Heart Clinic. What are some of the dominant trends you see emerging in the practice of EP? How is your lab preparing for these future changes? Technology is always changing, especially in electrophysiology. There are more devices, more implants and newer ablation catheters. It is important to stay current on trends in research and technology. Our partner, North Central Heart, may add an additional physician to handle EP demand in the future. What about device recalls? How has your lab handled these? Our lab will replace any recalled device. Is your lab doing web-based/transtelephonic device follow-up? The North Central Heart Clinic uses telephonic device follow-up. When was your last inspection by the Joint Commission? Our last inspection was in 2007. Are you ACGME-approved for EP training? What do you think about 2-year EP programs? No, we are not ACGME-approved for EP training, but 2-year programs would be great. Does your lab provide any educational or support programs for patients who may have additional questions or those who may be interested in support groups? Yes, patients are provided with extensive information about their devices and procedures. We also have an ICD support group in conjunction with the other area hospitals in Sioux Falls. Give an example of a difficult problem or challenge your lab has faced. How it was addressed? There was once a problem with finding anesthesia coverage for extended cases. To solve this, the team set up parameters to schedule earlier for coverage. Describe your city or general regional area. How does it differ from the rest of the U.S.? The population of Sioux Falls is approximately 125,000 people. Sioux Falls is one of the most rapidly growing cities in the United States. Our service area includes eastern South Dakota, western Minnesota, and northern areas of both Iowa and Nebraska. Agriculture is the number one industry in this area. Although population in Sioux Falls is growing, the overall population of our service area is decreasing. Please tell our readers what you consider unique or innovative about your EP lab and staff. The lab at Avera Heart Hospital is staffed by people who are devoted to rhythm issues and solving them for each individual patient. They treat each patient as if they were a member of their own family. Our EP physicians and staff are incredibly knowledgeable, and are always interested in new technology and more effective treatment methods. For more information, please visit: www.southdakotaheart.com