Spotlight Interview: Deborah Heart and Lung Center

What is the size of your EP lab facility? What is the mix of credentials at your lab? Deborah has just expanded and built an entire electrophysiology suite consisting of a six-bed admission/recovery area and three labs. Construction was just completed on the three new labs. The first has a biplane Siemens fluoroscopy system and will primarily be utilized for complex ablation procedures and device implants. The second is a single-plane Siemens fluoroscopy room primarily utilized for device implantation. The third and final lab is equipped with Siemens fluoroscopy as well as a Stereotaxis system, and will be used for complex ablation procedures. Our lab staff consists of eight Registered Nurses (RNs), two licensed Practical Nurses, two Cardiovascular Techs, and one Radiology Tech. When was EP started at your institution? The electrophysiology services here began in 1985, and were comprised mostly of serial drug testing as well as the first ablation performed in the state of New Jersey. Today, the electrophysiology department is divided into several components, including interventional, clinical, and consultative, which combined to form the Electromechanical Therapy Institute at Deborah Heart and Lung Center. What types of procedures are performed at your facility? Approximately how many are performed each week? Deborah performs approximately 2,468 procedures per year. This includes tilt table testing, cardioversions, diagnostic EP studies, SVT ablations, atrial fibrillation (AF) ablations, pacemaker and AICD implantation, and CRT therapy. In addition, we have a full-time device clinic, which follows approximately 5,565 devices annually. Who manages your EP lab? Our nurse manager is Rose Tuck, who oversees the day-to-day operations and staffing of the clinical labs as well as the device clinic. She reports directly to the director, Dr. Corbisiero. Is the EP lab separate from the cath lab? Are employees cross trained? The majority of the clinical EP staff is dedicated. There have been some employees cross trained to provide support and coverage. The device clinic has a separate dedicated staff. How is your procedure scheduling handled? The patients are contacted and given instructions through the EP secretaries prior to admission. All preliminary reports and tests are ordered and collected for the patient’s admission. The day-to-day schedule is directed by the physicians based on patient needs, staffing, and the case complexity. This is a dynamic and collaborative effort between the electrophysiologist and lab staff. What new equipment, devices and/or products have been introduced at your lab lately? How has this changed the way you perform those procedures? With the addition of our new labs, we selected Stereotaxis equipment for one lab. This technology will help us in our complex ablation procedures, especially during our atrial fibrillation ablations. This technology is innovative and should help us improve our procedure times while reducing risks to our patients. Additionally, we have an EnSite system (St. Jude Medical), which will also benefit us in a similar fashion. What type of quality control/quality assurance measures are practiced in your EP lab? Each quarter, we have a review of radiation safety, Joint Commission time out requirements, universal precautions, and moderate sedation quality assurance. How is inventory managed at your EP lab? Who handles the purchasing of equipment and supplies? Inventory is monitored by the Nurse Manager, Rose Tuck. All purchasing is handled through our purchasing department. Has your EP lab recently expanded in size and patient volume, or will it be in the near future? Yes, we have recently completed construction and are now utilizing a new EP floor consisting of three labs, a new six-bed holding area, as well as additional space for EP staff and a patient family waiting area. How has managed care affected your EP lab and the care it provides patients? As a “charity hospital,” managed care has not really effected our institution. What measures has your EP lab implemented in order to cut or contain costs? In addition, in what ways have you improved efficiencies in patient through-put? Much of this is handled through our purchasing department. Because of our volume, we have aggressively managed our vendor contracts. As far as through-put, with the addition of our new holding area, many of our procedures depending on the results can be discharged the same day. Does your EP lab compete for patients? Has your institution formed an alliance with others in the area? We have formed strategic alliances with some regional hospitals that may not provide some of the specialized cardiac procedures that we offer. This is mutually beneficial, ensuring their patients are getting state-of-the-art care while building a stronger referral base for our institution. What procedures do you perform on an outpatient basis? Outpatient procedures include tilt table testing, DFT testing, cardioversions, and some generator changes. How are new employees oriented and trained at your facility? Each new hire completes a 90-day orientation period with a designated preceptor. They then must complete a competency checklist prior to completing the orientation process. What types of continuing education opportunities are provided to staff members? Our staff attends many different conferences and receives a lot of support from our partners in industry. We are fortunate to be in relatively close proximity to Philadelphia and New York, where a lot of training occurs. Certain staff members are selected each year to attend a national conference such as HRS. In addition, each year Deborah sponsors a 1-2 day program, which brings in nationally renowned speakers to lecture to area physicians, nurses, and allied professionals. How is staff competency evaluated? Each staff member has a competency checklist. This is completed with input from physicians and management, and reviewed with the nurse manager and employee annually. How does your lab handle call time for staff members? We do not have call. Our staff has a rotating late shift to complete the daily case load. This has worked extremely well to ensure all of our procedures are completed and the staff has some control and do not burn out from constant late hours. What committees, if any, are staff members asked to serve on in your lab? Our staff members serve on a variety of hospital-based committees such as the hospital nurse practice committee, radiation safety committee, and NIAG. How do you handle vendor visits to your department? Do you contract with vendors? Generally these visits must be scheduled in advance. This ensures that both we and the vendor have proper time to discuss any new technologies or procedures. All contracts are handled through our purchasing department. Does your hospital use a third party for reprocessing? We did for a time, but have since discontinued this process. Approximately what percentage of your ablation procedures are done with cryo? What percentage is done with radiofrequency? Currently we do not utilize cryo, so all of our procedures are done with radiofrequency. Do you perform only adult EP procedures or do you also do pediatric cases? We do some very limited pediatric/adolescent procedures. What measures has your lab taken to minimize radiation exposure to physicians and staff? We have quarterly radiation safety meetings. This allows us to discuss ways to minimize exposure and risk. Additionally, we review doses from returned badges to ensure the safety of our staff. Do your nurses/techs participate in the follow up of pacemakers and ICDs? If so, how many device visits per week do they handle? Do you use any particular software for follow up? How many of your ICD/pacemaker patients require a doctor for their visits? We currently have a device clinic that is staffed by nurses, with some additional support from industry. Presently we see about 5,500 devices annually, and the clinic is open Monday through Friday. A lot of these follow-ups are moving into a remote status, which is allowing some relief to the volume. We currently have patients on Merlin (St. Jude Medical), LATITUDE (Boston Scientific), and CareLink (Medtronic). What are your thoughts about non-EPs implanting ICDs? Do you train such individuals? Some of the recent data shows that many of the non-EP implanting physicians miss a surprisingly high number of indicated patients; however, I do see a minor role for this, especially in underserved areas and where geography is a limiting factor to specialized implanters. Is your lab doing web-based/transtelephonic device follow-up? We do have patients on Merlin, Latitude, and CareLink. Some of our patients travel some distance to Deborah, so this has been a nice addition to our pacer clinic, which was already very busy. Is your EP lab currently involved in any clinical research studies or special projects? Deborah is known for its high quality research. We have three full-time research nurses and have participated in a number of high-profile clinical trials. We have enrolled very well in all of them, and our data compliance is excellent. Currently we have nine ongoing EP device trials as well as many non-EP trials. When was your last inspection by the Joint Commission? The Joint Commission visited our institution in March 2008. Are you ACGME-approved for EP training? What do you think about two-year EP programs? Our fellowship program is a DO program that is ACOI approved. We currently have one EP fellow per year. Although it is not the current mandate, I do believe that we are headed for a two-year EP fellowship requirement. 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? We currently have two support groups at our institution, the Zippers and the Zappers. These are volunteer groups at our institution that are chaired by our device clinic’s nurse practitioner. At their regular meetings, a guest speaker will talk with them about the psychological aspects of ICDs, coping mechanisms, or there will be a device expert to handle Q & A sessions. Describe your city or general regional area. The Deborah Heart and Lung Center is the only one of its kind in New Jersey. As an old TB hospital, it was purposely placed out in the pine barrens, so geographically, we are also sort of isolated. That being said, it really gives our physicians and staff a targeted approach to specific diseases and allows us to be focused in our field of expertise. Please tell our readers what you consider unique or innovative about your EP lab and staff. Our institution is lucky in that we specialize in heart and lung diseases. As a key player in research, we offer exciting new treatments and cutting-edge technologies to our patients. We have a brand new floor plan, with sophisticated technologies like Stereotaxis and EnSite, and we are on the forefront of new procedures. In addition, we have a very talented, technical staff taking care of the patient during their procedure, a floor service managing them throughout their stay, and a great team following them as outpatients. For more information, please visit: www.deborah.org.