Spotlight Interview: Adventist Health Medical Center Hanford

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EP LAB DIGEST. 2023;23(9):13-14.

When was the cardiac electrophysiology (EP) program started at your institution, and by whom?

Adventist Health Hanford is a 153-bed acute-care hospital located in Central California. The EP program at Adventist Health Hanford was started in June 2020 with the arrival of Sukh Bhajal, MD.

Who manages your EP lab?

Joe Croft, MSN, RN, is the Director of Cardiovascular Services. The day-to-day operations are coordinated and managed by Marilyn Benitez, Cath Lab Manager.

What is the number of staff members? What is the mix of credentials?

At Adventist Health Hanford, we have a dedicated staff of approximately 12 members that are cross trained in EP, cardiac catheterization, and interventional radiology.

The credentials of the staff members are a mix of registered nurses (RNs) and radiology technologists (RTs).

What types of procedures are performed at your facility?

We offer a full range of EP services, including transesophageal echocardiography/cardioversions, device implantations, and catheter ablation procedures. All types of device implantations are performed, including for implantable loop recorders, transvenous pacemakers, and implantable cardioverter-defibrillators (ICDs), biventricular ICDs, traditional cardiac resynchronization devices, and subcutaneous ICDs. Ablation procedures are performed to treat supraventricular tachycardia (SVT), right- and left-sided atrial flutter (AFL), bilateral AFL, atrial fibrillation (AF), and atrioventricular node arrhythmias.

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

We have the CardioLab recording system (GE HealthCare) in our lab, with Micropace EP stimulators. We use Carto (Biosense Webster, Inc, a Johnson & Johnson company) as our 3-dimensional (3D) mapping system, and use diagnostic EP catheters from Abbott and Biosense Webster. We use intracardiac echocardiography (ICE) with CartoSound (Biosense Webster) and AcuNav/Vivid (GE HealthCare) mapping for complex ablations.

How are new employees oriented and trained at your facility?

New employees undergo a preceptorship for 5 weeks with various roles in the lab under a seasoned employee. After the 5 weeks, the employee may work independently with close supervision. The EP lab is not separate from the cath lab. Employees are cross-trained to assist all EP, coronary, and interventional radiology procedures.

What approaches has your lab taken to reduce fluoroscopy time?

We use 3D mapping to reduce use of fluoroscopy during procedures as well as low-dose settings for all our EP procedures.

How is inventory managed at your EP lab?

Supplies are currently managed by the lead EP techs, who also monitor expiration dates.

In what ways have you cut or contained costs in the lab or device clinic?

In the lab, we work closely with our industry partners for more competitive pricing. We also use a third-party reprocessing for ICE catheters and certain diagnostic EP catheters.

In what ways did the COVID-19 pandemic impact your hospital, EP lab, or practice?

In 2020, Adventist Health Hanford and our other locations across the Central Valley were heavily impacted by the COVID-19 pandemic. It significantly curtailed our procedural volume, particularly at the beginning and during the subsequent peaks. Only urgent cases were being performed. These cases required an extensive process to sterilize the rooms and prevent the spread of COVID-19. As a result, case volumes were dramatically reduced, especially in EP, as a large portion of those cases were considered elective. At one point, many of the hospital beds were occupied by COVID-19 patients. Over the past year, EP procedures have significantly increased and continue to grow in volume each month.

Please tell our readers what you consider special about your EP lab and staff.

Our staff are skilled, dedicated, and passionate about serving the community. They are highly diverse with varying cultures, religion, and languages, which is reflective of the community we serve. The EP program was a new service line introduced into the catheterization laboratory. One particularly unique aspect of our program is our ability to provide these services without an onsite cardiac surgery program. Due to the dedication of our staff and the support of our institution for growth and development, we have been able to safely offer high-quality, state-of-the-art procedures with reproducible results. The ability to provide these services that were previously unavailable to our local community is one of our proudest achievements.