Spotlight Interview-Washington Regional Medical Center

Walker Heart & Vascular Institute at Washington Regional Medical Center (WRMC) is located in Fayetteville, Arkansas. The current hospital facility was constructed in 2002, and is licensed for 366 beds. We have the most advanced cardiac services in the area, and are a great asset to our community. Our hospital achieved Level 2 Trauma Center designation in 2012, and is accredited by The Joint Commission.

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

The EP, cardiac cath lab, and endovascular neurosurgery labs are integrated together. There is one dedicated EP lab, one hybrid lab that can be utilized for EP studies, devices, or heart caths, three other labs for heart caths and devices, and one dedicated hybrid neuro lab. 

The EP program was started in 1996 by Dr. James Cooper. He performed a variety of ablations and device implants at the facility until 2008. In 2006, a board-certified electrophysiology specialist joined the EP program; his primary focus is on EP studies, PPM, ICD, and CRT device implantations, and a few ablations. Many of the complex ablations such as for atrial fibrillation (AF) were referred to other physicians in Little Rock and Oklahoma City; in 2012, a second board-certified electrophysiologist joined the EP program to handle those cases. Since then, the EP program has flourished, and our facility is now able to provide services to our community that no other area hospital can provide.

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

We employ 15 technologists, eight registered nurses (RNs), two transporters, one financial coordinator, one PACS manager, and one inventory manager. We have two working managers — one who coordinates the technologists and another who coordinates the nurses. We also have a director for cardiac services and radiology. Each team is comprised of one RN and two technologists. The nurse circulates the case, while the technologists alternate the scrub or monitor positions and perform pacing maneuvers during the case.

What types of procedures are performed at your facility? Approximately how many EP cases are performed each year?

We perform a variety of procedures in our EP lab: AV nodal, AF, right- and left-sided atrial flutter, AVNRT, right- and left-sided atrial tachycardia, accessory pathways, ventricular tachycardia (ischemic, non-ischemic, and idiopathic) ablations, EP studies, PPM, ICD, CRT, and loop recorder insertions. Last year at Washington Regional, we performed roughly 390 ablations, 320 permanent pacemaker implants, 80 internal cardiac defibrillator implants, 65 CRT device implants, and 410 EP studies.

Do you have cross training inside the EP lab?

Everyone in the cardiac cath lab has been trained to work in the EP lab. However, because we cover three separate modalities and a wide variety of procedures in our lab, each person has their own dedicated niche (i.e., neuro, peripheral intervention, cardiac cath, and EP) that they specialize in and become the super user of that lab.

What type of hospital is your EP program a part of? 

Washington Regional is the only not-for-profit, community-owned and locally governed community hospital in Northwest Arkansas.

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

Biosense Webster primarily covers all of our ablation supplies. St. Jude Medical covers most of our diagnostic supplies. We have a few catheter/cables from Bard.

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

The EP lab primarily does cases Monday-Friday from 7 a.m. to 7:30 p.m. We have seven different teams to cover all three modalities in our department. We have staggered shifts to help cover labs until 7:30 at night, and after that, it is the call team that takes over cases.

Tell us what a typical day might be like in your EP lab.

Our first electrophysiologist schedules EPS and devices throughout the week, Tuesday being his primary day for cases. Our second electrophysiologist primarily works in the lab Wednesday through Friday. We generally start the morning with an AF ablation using general anesthesia. In the afternoon, we will either do a redo AF, or several EP studies with ablation to follow if there is an arrhythmia induced. Often, there are scheduled devices in another lab.

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

We were the first EP lab in Arkansas to use Biosense Webster’s ThermoCool SmartTouch catheter. This new technology has greatly reduced our AF procedure time as well as improved our ablation accuracy. Having the ability to recognize how much contact and force is being applied to an area using Biosense Webster’s Carto has improved lesion maintenance. This has increased our room turnover and our ability to perform more ablations each day.

What imaging technology do you utilize?

A year ago, our EP lab was reconstructed. We installed Siemens Healthcare’s Artis zee biplane system, and use their ACUSON X300 ultrasound system for intracardiac echo. We also have chest CTs performed on our AF ablation patients to help verify the anatomy of the left atrium and pulmonary veins, and to confirm the Carto map. Implementing all three technologies has greatly reduced procedure fluoro time.

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

Yes, we use PACS and we have a PACS/CVIS coordinator, who is in charge of making sure all images have been properly stored. He also ensures that if medical records or a requesting physician office needs a copy of the films, they are received in an efficient and legal manner.

Do you employ travel RNs, RT(R)s, or RCISs?

No, we do not employ locum tenens. Our staff turnover rate is minimal.

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

We have an inventory manager who negotiates prices with our vendors and does price comparisons among different supply retailers. 

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

Yes, the arrival of our second electrophysiologist in 2012 remodeled our EP program, which has grown immensely. The more education that is introduced to our area physicians, the more our referral base is increased, because now physicians have more options in addition to medical management. 

Does your EP lab compete for patients? Has your institution formed an alliance with others in the area?

Since we are the only EP lab in Northwest Arkansas that performs a wide variety of ablations, there is no competition in this area. Most of our referrals come approximately 100 miles away from Fayetteville.

Do you use radiofrequency or cryo energy during your ablation procedures?

We are 100% radiofrequency; we have never performed cryo procedures in our EP lab.

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

We perform only adult EP procedures. Our surrounding area has many retirement communities, and it is a great asset for Northwest Arkansas to have a facility that specializes in EP procedures such as for AF. 

What measures has your lab taken to reduce fluoroscopy time and minimize radiation exposure to physicians and staff?

With the reconstruction of our EP biplane lab, our fluoro time and mGy have been significantly reduced. The X-ray equipment is more efficient and produces better images than our previous lab. Also, the use of Carto allows our physicians to rely more heavily on those images than fluoroscopy. The use of intracardiac ICE also aids in reducing fluoro times.

Do your nurses/techs participate in the follow up of pacemakers and ICDs?

No, all devices are seen in the physician’s clinic. Either the physician or nurse practitioner will examine the incision site. The device representative will be present to analyze the device to ensure that all settings are appropriate and the device is functioning properly. 

How is coding and coding education handled in your lab?

We have a dedicated financial coordinator who reviews all the GE-generated reports and physician dictation to make sure all procedures are charged and coded properly. She uses many different sources to stay current with coding such as the HBO program and Current Procedural Terminology from the American Medical Association. As a secondary precaution, a compliance oversight officer reviews random cases periodically to ensure all guidelines are being met.

For more information, please visit: https://wregional.com/