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Spotlight Interview: St. Joseph’s University Medical Center
EP Lab Digest. 2023;23(1):16-18.
Describe your city or general regional area.
St. Joseph’s University Medical Center is located 21 miles from Manhattan, about a half-hour drive (without traffic). Paterson is the third largest city in New Jersey, following Newark and Camden, respectively. The patient population is highly diverse. Paterson residents are identified as 57.6% Hispanic, 34.68% Caucasian, and 31.68% African American, including 52 other distinct ethnic groups.
Founded by the Sisters of Charity of Saint Elizabeth in 1867, St. Joseph’s University Medical Center in Paterson has grown from a 12-bed hospital in a farmhouse caring for 100 patients annually, to a multifaceted integrated health care system that provides a comprehensive spectrum of sophisticated services with more than 1.6 million visits per year.
We are a 651-bed academic tertiary care medical center and state designated trauma center.
When did the lab open? What is the size of the electrophysiology (EP) lab?
The EP lab opened in 1991 as part of the hospital’s 3-lab cardiac catheterization suite. Since that time, 3 labs have been added. In total, there are 5 interventional suites and 1 neuro-interventional lab, which was added in 2017. Two of the 5 suites are equipped with the CardioLab EP Recording System (GE Healthcare) and Carto 3 V7 Mapping System (Biosense Webster, Inc, a Johnson & Johnson company). One of the rooms has a biplane fluoroscopy system (AlluraClarity, Philips). The other 3 labs are used for cardiac and peripheral vascular procedures. Device implants are frequently performed in 4 of the 5 rooms. The neuro lab is located across the hall and is separate from the cath lab, but the neuro staff is still part of the department.
Are employees cross trained?
We have dedicated EP staff; however, they are shared with the cath lab when the need arises. Registered nurses (RNs) are cross trained in EP and cath procedures to assist with vacation coverage, sick calls, breaks, and a prompt turnover time in-between cases.
What EP procedures, including complex ablations, are performed? What type of EP technology is most commonly used in the lab?
We perform a full range of EP services, including tilt table testing and device implantation (eg, loop recorder, pacemakers, and defibrillators). We are increasing our volume of physiologic pacing such as His bundle pacing and left bundle branch pacing. We also implant subcutaneous defibrillators and leadless pacemakers.
We commonly perform ablations to treat supraventricular tachycardias and ventricular tachycardias. Atrial fibrillation (AF) is the most common type of arrhythmia treated in our lab, and we ablate using either radiofrequency energy or the Arctic Front cryoballoon (Medtronic) for those cases. We initially did most first-time AF ablations with the cryoballoon, but with the availability of irrigated force-sensing catheter technology, we have transitioned over time to performing the majority of those ablations with radiofrequency. That has allowed the average fluoroscopy time for ablation cases to be dramatically lower. We also perform a number of complex left atrial flutter ablations.
We started a left atrial appendage closure program in 2021; these procedures are performed in the EP lab using the Watchman device (Boston Scientific). It is commonly a joint procedure between electrophysiologists and interventional cardiologists.
Lead extractions are performed by electrophysiologists (with cardiothoracic surgeons on standby) in the cardiac operating room using technology by Spectranetics.
How many procedures are performed each year?
In 2021, we performed approximately 150 ablations and 400 implants. This was almost back to our prepandemic case volume.
What is the number of staff members and mix of credentials?
We have 20 RNs, all of whom are certified in basic and advanced cardiovascular life support. Eight radiology techs (RT) have certification from the American Registry of Radiologic Technologists (ARRT). Two cardiovascular techs were grandfathered into the department since its opening. The lead tech of the EP lab is a registered cardiovascular invasive specialist (RCIS), and the lead RN of the EP lab is also an RCIS/ARRT. One of our RNs is the designated charge nurse who works with our manager to oversee daily operation of the lab. The EP lab is also staffed by a designated anesthesiologist and support RT and RN.
The preop and postop areas (a total of 14 bays) are shared and staffed with 2-3 RNs, 1-2 transporters, and 1-2 patient care assistants from 6:30 AM to 10:30 PM, Monday to Friday.
How are new employees oriented and trained?
New employees undergo a 12-week period under an assigned preceptor. During this time, they become familiar with procedures, medications, and the products and materials used for each case. It is an ever-evolving process as standard practices change, but we always stress the key concepts that remain constant.
How is inventory managed at your EP lab?
We use Omnicell as well as a full-time materials management specialist/coordinator, who works closely with our supply chain and value analysis team. Our periodic automatic replacement level is maintained with frequently used catheters and devices. Our lead tech plays an important role in keeping an efficient inventory system, enabling us to track the serial numbers and expiration dates of each product. Our institution also has a new product committee that assesses the clinical efficiency and benefit of products that are being introduced into the EP and cath labs.
In what ways has the COVID-19 pandemic impacted your hospital, EP lab, or practice?
In 2020, both St. Joseph’s University Medical Center and the surrounding region were heavily impacted by the pandemic. For several months, only urgent cases were performed, since staff from the cath and EP labs were needed in the intensive care units and other areas of the hospital. When urgent cases were performed, they 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. When the first wave of the pandemic eased, it took a long time for patients to feel comfortable returning to the hospital for elective procedures. Additionally, during this time, we were able to increase the number of same-day discharges for patients undergoing device implants and ablations.
How do you handle vendor visits?
Vendor visits are handled through Vendormate. After registration, our security team verifies credentials upon arrival. We typically only allow 1-2 vendors within the department on any given day. We did not allow vendors during the 2 pandemic-related hospital closures.
Please tell our readers what you consider special about your EP lab and staff.
Our staff is highly diverse with varying cultures, religion, and languages, which is reflective of the community we serve. It allows patients to feel more comfortable when they are here to undergo procedures. We are a teaching hospital, so we have cardiac fellows who rotate through EP as well. We also recently collaborated with the school for cardiovascular intervention at Morristown Medical Center in Morristown, New Jersey. Through this partnership, we are able to acquire cardiovascular technologist (CVT) students on a 5-week rotation through all our labs. The students can observe and participate in a number of different procedures, preparing them for their career. It is becoming more and more difficult to find CVTs, as the trend seems to be gearing toward a more nurse-oriented and radiology-driven staffing structure. We collectively feel that CVT, RCIS, registered cardiac EP specialist, and cardiac interventional (RT) credentials have much to offer in the EP and cardiac cath labs.
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