Spotlight Interview: Tallahassee Memorial HealthCare

Founded in 1948, Tallahassee Memorial HealthCare (TMH) is a private, not-for-profit community healthcare system committed to transforming care, advancing health, and improving lives with an ultimate vision of leading the community to be the healthiest in the nation. Serving a 17-county region in North Florida and South Georgia, TMH is comprised of a 772-bed acute care hospital, a psychiatric hospital, multiple specialty care centers, three residency programs, 27 affiliated physician practices and partnerships with Doctors’ Memorial Hospital, Florida State University College of Medicine, and Weems Memorial Hospital.

What is the size of your EP lab facility? When was the EP lab started at your institution?  

The electrophysiology program at Tallahassee Memorial HealthCare includes two EP labs. Our program was started in June 1996 by Marilyn Cox, MD, FACC.

What is the number of staff members? What is the mix of credentials at your lab? 

Our EP team is led by 4 cardiac electrophysiologists and made up of 10 staff positions, including 6 RNs, 3 RTs and 1 CVT.

What types of procedures are performed at your facility? Approximately how many catheter ablations (for all arrhythmias), ICD implants, and pacemaker implants are performed each week? 

At TMH, we perform about 2,200 procedures annually, including atrial and ventricular ablations, device implants, laser lead extractions, the Convergent procedure (nContact, Inc.) and WATCHMAN device (Boston Scientific) implants.

Who manages your EP lab? 

We are currently looking for an experienced EP lab manager.

How long has the EP lab been separate from the cath lab? Are employees cross trained? 

In Spring 2015, we officially separated the EP lab from the cath lab. We do have several colleagues who were previously cross trained.

Do you have cross training inside the EP lab? 

We are currently in the process of cross training our EP colleagues (those not already proficient) to scrub, monitor and circulate.

What types of EP equipment is most commonly used in the lab? 

We have fluoroscopy systems by Philips and GE Healthcare (1 GE room and 1 Philips room). We also use St. Jude Medical’s EnSite Velocity and Biosense Webster’s Carto mapping systems. For lead extractions, we heavily depend on Spectranetics’ laser lead extraction systems with backup from Cook Medical. 

How is shift coverage managed? What are typical hours (not including call time)? 

We schedule patients from 8:00AM to 6:00PM. Our colleagues do not take call, but agree to stay until the work is complete for the day.

What new equipment, devices and/or products have been introduced at your lab lately? How has this changed the way you perform those procedures? 

Over the past two years, we introduced the WATCHMAN left atrial appendage closure device (Boston Scientific), the Convergent hybrid AF ablation procedure (nContact, Inc.), the LARIAT Suture Delivery Device (SentreHEART, Inc.), epicardial VT ablations, and cryoablation for atrial fibrillation. 

Does your program utilize a cardiovascular information system (CVIS), picture archiving system (PACS), or cardiology picture archiving system (CPACS)? 

We currently use Fujifilm Synapse Cardiovascular.

Who handles your procedure scheduling? Do they use particular software? 

We are currently in the process of implementing Cerner Scheduling for all of our invasive and non-invasive scheduling. We have just placed 2 schedulers within our heart and vascular services in order to streamline our scheduling process.

How is inventory managed at your EP lab? Who handles the purchasing of equipment and supplies? 

Any new equipment or significant supply has to go to the EP Co-Management Council, which is made up of EP physicians, administration, materials management, finance and colleagues. Relevance of equipment or supply is presented with cost analysis and clinical significance.

Has your EP lab recently expanded in size and patient volume, or will it be in the near future? 

We recently added an EP physician this past year, for a total of 4 board-certified electrophysiologists: Venkata Bavikati, MD, Marilyn Cox, MD, FACC, Farhat Khairallah, MD, FACC, and Gadi Silberman, MD.

In what ways have you helped to cut/contain costs and improve efficiencies in the lab? 

Co-management has helped to have all parties at the table discuss topics such as cost analysis and ways to improve patient flow.

How do you ensure timely case starts and patient turnover?

We monitor times from the pre-procedure area to lab start times as well as turnaround times for rooms to be cleaned. Lab utilization times are tracked as well. 

How is staff competency evaluated? 

Competency tools have been created to evaluate a colleague’s initial competency after the first 90 days. At 6 to 9 months, they complete a more in-depth competency on the roles of scrub, circulate and monitor. The competency tool has a self-evaluation portion, a preceptor evaluation and a final signoff by a physician.

Approximately how many of your ablation procedures are done with cryo versus radiofrequency? 

About 22% of cases are done with cryo.

Do you perform only adult EP procedures or do you also do pediatric cases?  

Our primary focus is on adult EP procedures.

What innovative EP techniques are being utilized in your lab? 

We were the first hospital in the Southeast, and third in the country, to commercially implant the WATCHMAN device. We perform LARIAT procedures on a very select group of patients. We also work with a CV surgeon for Convergent procedures.

What are some of the dominant trends you see emerging in the practice of electrophysiology?

Trends we see emerging include left atrial appendage management, epicardial ablation, and hemodynamic support during ablation.

How are coding and coding education handled in your lab? 

We have a Reimbursement Analyst who works within our heart and vascular services. She monitors all EP procedures to assure charges and documentation match and that appropriate charges and coding have been submitted. She provides real-time education when corrections need to be made. She also coordinates reimbursement presentations when we obtain new technology, and all coding, billing and reimbursement specialists within the hospital are invited to participate. This has been very successful in our program, as the non-clinical colleagues have enjoyed learning more about the clinical relevance of the procedures they are coding and billing.

Is your EP lab currently involved in clinical research studies? Which ones?

Yes, we are heavily involved in research including device trials (the MADIT series of trials, NAVIGATE X4 trial, RIO study) and ablation studies including CABANA, OAT and others.

Describe your city or general regional area. How is it unique from the rest of the U.S.?  

Near but far from the castles and crowds of Disney, lies another magical place in the Sunshine State — one with a fascinating past, a diverse population, a buzzing political center, and great pride. Often described as “The Other Florida” with its deep-rooted history, rolling hills, mild climate, Southern-style hospitality and canopy roads of moss-draped oaks, it is a Florida few have seen.

Best known as Florida's state capital, Tallahassee is a medium-sized city where the power of state government and a vibrant academic and artistic community are complemented by old-fashioned charm. It is even considered one of the most educated cities in the country. Tallahassee Memorial HealthCare is proud to service the Capital City, its suburbs and the mostly rural region in the Florida Panhandle, southern Georgia and southeastern Alabama.