Spotlight Interview: University of Michigan Health System

What is the size of your EP lab facility and number of staff members? What is the mix of credentials at your lab? There are five labs total, including one with Stereotaxis, two biplane labs, and one procedure room for tilt table tests, cardioversions etc. There is also a sixth lab available (currently a shelled space) when needed. In total we have 28 staff members, 1 technical supervisor and 1 nursing supervisor. There are seven attending physicians, 10 fellows and 1 NP. In addition, six of the 13 techs are RCES or RCIS, and 12 of the 13 techs are graduates of an accredited program. When was the EP lab started at your institution? Our EP program was created 25 years ago by Dr. Fred Morady. What types of procedures are performed at your facility? We have an all-inclusive EP service, with a special focus on atrial fibrillation and atrial flutter cases. Approximately how many are performed each week? What complications do you find during these procedures? We perform approximately 40–45 procedures per week. We have a low complication rate (only some hematomas). Who manages your EP lab? Management of the EP lab is provided by Michele Derheim, MSN, RN - Director of Clinical Operations, Jim Bloom, RRT - Technical Supervisor, Sheryl Wagner, RN, BSN - Nursing Supervisor, Rodney Howell, BSN, RN - Nursing Educator, and Tammy Lemerand, RCES - Technical Education Coordinator. Our Medical Director is Hakan Oral, MD. Is the EP lab separate from the cath lab? How long has this been? Are employees cross-trained? Yes, the labs are separate. It has been this way since our new facility opened in June 2007. Only a few employees (2 techs) are cross-trained to cath and EP. Do you have cross training inside the EP lab? No. What new equipment, devices and/or products have been introduced at your lab lately? We have implemented the Stereotaxis system, although two of our physicians use it more often than others in the lab. Who handles your procedure scheduling? Do you use particular software? Scheduling is provided by Lisa Maddox and Tangela Cochran (clerical staff) and David Kaczmarek, RN, Ruth Scheller, RN, Anna Bollman, RN and Carol Dauma, RN. This group of staff manages the schedule, assesses and educates patients prior to their procedure as well as follow the nurses, and also follow the patients post procedure. They use the EWS (Enterprise Wide Scheduling) system. What type of quality control/quality assurance measures are practiced in your EP lab? We do scheduling of M & M (Morbidity and Mortality) stats, manage turnover, and handle medication labeling and safety. How is inventory managed at your EP lab? Who handles the purchasing of equipment and supplies? Our supply manager, Marlon Bird, and two staff members (Gemina Dean and Roel Beltran) manage inventory using the Q-site inventory management software. Has your EP lab recently expanded in size and patient volume, or will it be in the near future?Yes. We recently went from having 2.5 labs to 5 labs when we moved into our new facility in June 2007, so this has decreased patient wait time for procedures. Have you developed a referral base? Yes. We are known nationally and internationally for atrial fibrillation case referrals. What measures has your EP lab implemented in order to cut or contain costs? We have altered staff schedules to control overtime and negotiated contracts with vendors for better pricing (including bulk buys of devices to reduce costs). Does your EP lab compete for patients? Has your institution formed an alliance with others in the area? Yes, our lab competes for patients. We have formed an alliance with another hospital located about 40 miles away; the attending there has a clinic and consult service that brings us more difficult and equipment-intensive procedures to our lab. What procedures do you perform on an outpatient basis? Outpatient procedures include ablations and device implants. How are new employees oriented and trained at your facility? New employees must complete on-the-job orientation with a preceptor. They also need to be eligible for the RCIS or RCES to be hired. What types of continuing education opportunities are provided to staff members? Continuing education opportunities include participation in Grand Rounds and attendance at local and some national conferences. How is staff competency evaluated? Staff competency is evaluated by the Technical Educator as well as by our Nursing Educator. Feedback is also given by the attending physicians. How do you prevent staff burnout? To help avoid burnout, we offer flexible scheduling, breaks and staff meetings. What committees, if any, are staff members asked to serve on in your lab? Some of the committees at our hospital include the workload team and QA. The unit also has team members that participate in the Infection Control Committee, Medication Safety and Education. How do you handle vendor visits to your department? Do you contract with vendors? Yes, we contract with many vendors. However, vendor visits are limited to only those times they have a case. Does your lab utilize any alternative therapies? No. Please describe one of the more interesting or bizarre cases that have come through your EP lab. With Dr. Morady’s referral base being international, we see patients from many different countries. It is enjoyable to care for folks from many different cultures. 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? Staff members are only on call into the evening for late-running cases. There is no call on weekends or overnight. Staff members are on call on average 1-2 times in two weeks. However, they often stay 1-2 times per week. The on-call team consists of 1 tech and 1 RN. Does your lab use a third party for reprocessing? Yes, we use Ascent Healthcare Solutions. Approximately what percentage of your ablation procedures are done with cryo? What percentage is done with radiofrequency? Approximately 5–10 percent of our ablation procedures are done with cryo. The majority (90-95%) of our ablation cases are done with radiofrequency. Do you perform only adult EP procedures or do you also do pediatric cases? Is there cross training for pediatric cases? Yes, we perform mainly adult cases. However, we have one tech who is cross-trained from Peds to Adult. Do your nurses/techs participate in the follow up of pacemakers and ICDs? Not from the lab — we have a team of six nurses that do device follow up. What trends do you see emerging in the practice of EP? We predict further growth in CRT. What are your thoughts about non-EPs implanting ICDs? Do you train such individuals? We believe these cases should be performed by an electrophysiologist. Therefore, we do not train non-EPs. What about device recalls? How has your lab handled these? Our Device Clinic staff, not lab staff, handle device recalls. Is your lab doing web-based/transtelephonic device follow-up? No — this is also done in the Device Clinic. Is your EP lab currently involved in any clinical research studies or special projects? Which ones? Yes, we are involved in multiple studies involving atrial fibrillation, different types of ablation catheters, and device studies. When was your last inspection by the Joint Commission? We passed our most recent inspection in December 2007. Are you ACGME-approved for EP training? What do you think about two-year EP programs? Yes, that is offered as an option here. 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? An extension of EP is the Device Clinic — this area is staffed by RNs and pacemaker specialists that follow the patients after device implantation. They coordinate support groups and provide extensive education and individual support to the patient and their families through clinic visits. Give an example of a difficult problem or challenge your lab has faced. How it was addressed? Certainly preparing for and opening a new facility was a difficult challenge for us. There were many training days and much overtime for staff in order to get moved in and ready to open. Describe your city or general regional area. How does it differ from the rest of the U.S.? We are located in Ann Arbor, which is near Detroit. Unfortunately, Detroit is known for its recent struggles with the decline of the auto industry. Please tell our readers what you consider unique or innovative about your EP lab and staff. Our attending physicians are internationally known for their successful treatment of atrial fibrillation — they are truly leaders in the field of EP! For more information, please visit: www.med.umich.edu