The Importance of Staff Education in Performing Complex Ablations

As Congress debates on our health care system, many medical institutions have tightened up their fiscal spending. Reimbursements once made for educational seminars and conferences are either being limited or no longer offered to employees. It is imperative that electrophysiology (EP) professionals be up to date with the latest technology and procedural advancements in order to provide quality care to their customers. The customers include both the patient undergoing the elective electrophysiology study (EPS)/ablation procedure and the electrophysiologist. The electrophysiologist requires that the EP staff member have a certain level of expertise in order to assist during the procedure. As the field of electrophysiology continues to grow and complex ablations are being performed at more facilities, staff education is essential. With support from the hospital administration, the electrophysiologists, and the EP lab coordinator, a dedicated and well educated EP staff member will facilitate growth for the medical institution. EP professionals depend on continuing education to be provided by local vendors, seminars and online webcasts, often during off work hours. When the opportunity arises during an EPS/ablation, an electrophysiologist will often utilize this time to teach; however, not all staff members are usually present in order to take advantage of this educational opportunity. In addition, these indispensable educational opportunities tend to lengthen the procedural time. As we all know, the EP lab’s busy schedule places constraints on such educational opportunities. Staff education is further limited by management across the country that are staffing procedures based on the daily work schedule. In order to meet staff productivity levels, any down time is being replaced by staff being utilized to work in other areas of the cardiac catheterization lab, or staff being asked to leave early. EP lab staff down time is no longer dedicated toward education. It requires a highly motivated and dedicated staff member to take the initiative to advance their knowledge of electrophysiology. As an RCIS-credentialed staff member, the role of coordinating educational opportunities for staff has become both a challenging and rewarding endeavor over the years. I have approached staff education in several ways, one of them being live webcasts, CEUs and CMEs offered and endorsed by the Heart Rhythm Society (HRS), presented during dinner meetings held in various conference rooms. HRS also offers Allied Professional education, and the International Board of Heart Rhythm Examiners (IBHRE) offers certification in cardiac rhythm device therapy and certification in cardiac arrhythmias. Along with the Internet sites provided in EP Lab Digest, EPreward is another excellent site for those who are new to the EP lab. See Table 1 for some online educational sites I recommend you visit. Just ask your local Boston Scientific, Medtronic, and St. Jude Medical representatives to arrange luncheon meetings and one-day seminars on topics from basic to advanced ablations. The company representatives can provide any educational support when asked. An EP library should also be made available for staff to access EP journals and reference books. I also have the pleasure of working with David Gilligan, MD, FACC, a native of Ireland who often provides “tea time” meetings for staff, as time permits, discussing different topics of interest. EP labs across the nation are staffed by RCISs, RNs, RTRs, paramedics, and CVTs. The dedicated EP staff members work together as an integral team, each one contributing their knowledge and area of expertise. This enables RNs to monitor complex ablations. The RCIS’s, RTRs, paramedics and CVTs are able to circulate complex procedures. In most labs, all EP staff is trained to scrub and work the various radiofrequency and cryoablation systems, although only the RNs are licensed to administer medication. With this said, the technical aspect of monitoring complex ablations is now being taught to RNs and any other EP staff member wishing to learn the recording systems present in EP labs across the nation.

Training Opportunities for New Technologies

It has been my experience that as the three-dimensional (3-D) technologies evolve, complex ablation procedures are being performed more frequently as new EP lab facilities continue to emerge throughout the country. For example, two 3-D mapping systems, EnSite (St. Jude Medical, St. Paul, MN) and Carto XP (Biosense Webster, Inc., a Johnson & Johnson company, Diamond Bar, CA), are two systems often utilized by EP labs that perform complex ablations. Over the past two years, I was given the opportunity to learn the EnSite mapping system by a St. Jude Medical Field Clinical Engineer (FCE), becoming certified on both EnSite NavX (contact) and EnSite Array (non-contact) 3-D mapping systems. FCEs provide clinical support alongside staff learning the EnSite system; many FCEs provide support throughout the country. Formal classroom training was given at St. Jude Medical’s training facility in Maple Grove, Minnesota. The St. Jude Medical/AF Division coordinated this training, which enabled an RCIS-credentialed staff member to transition from being educated to becoming an educator. It is essential for hospital-employed EP staff to take the initiative to learn the field of electrophysiology and be given the opportunity to become trained on present and future technologies. Industry continues to play an instrumental role in the educational process of those employed by EP labs.

Procedure Success

Once given the opportunity, dedicated EP professionals become more confident in their abilities, and engage themselves more during the ablation. A personal sense of satisfaction comes by the end of the procedure, which results in the patient being in sinus rhythm. Dr. David Gilligan and Dr. Charles Joyner’s case of atrial tachycardia ablated from the aortic root, presented at the Poster Session during the 2007 HRS Scientific Sessions in Denver, Colorado, is a perfect example of this.1 I could have presented a more recent complex ablation; however, this case seemed to be more appropriate for this article as the staff that performed the procedure is very proud of its success (Table 2). Sinus rhythm is very rewarding to see after a long complex ablation. One starts mapping the RA, hoping to find a focus well ahead of the surface P wave. When you determine that the focus is coming from a location outside the chamber you are in, patient risk vs. benefit, as well as the staff present who will assist the electrophysiologist, becomes an issue. Once the electrophysiologist commits to mapping the left atrium and the aorta, the EP staff must be well educated and engaged in order to be able to assist the physician.

Summary

When you teach someone to perform a task and that person is then able to teach someone else the same task, you have accomplished your goal. There is always something new to learn, and we commend those who make it all possible. Given the opportunity, funding, and administrative support, EP professionals continue to provide exceptional service to our customers.