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Electrophysiology Lab Efficiency in an Academic Medical Center: Is it Worth the Effort?
EP Lab Digest. 2022;22(12):18-19.
When embarking on a journey to improve electrophysiology (EP) lab efficiency, it is important to first consider your “why”. The word “efficiency” can often have a negative connotation that equates to cutting corners. However, it is quite the opposite—integrating better efficiency into clinical practice can result in better patient care, improved health care utilization, and reduced overall costs of care.
For our academic teaching hospital, the reason for the “why” began in Spring 2020, when the first months of the COVID-19 pandemic necessitated a shutdown of nonemergent EP procedures. When our lab finally began resuming those cases, we quickly realized that our prior process was no longer sustainable. The backlog of cases seemed insurmountable and the restrictions on bed utilization limited scheduling. Moreover, our patients, physicians, and staff were facing stressful challenges in their home and work lives.
During one of our first atrial fibrillation (AF) ablations since reopening, our second ablation lab went unused. It was frustrating witnessing this inefficiency, knowing that many of our patients were awaiting procedures at that time. We contacted Biosense Webster clinical account specialist Brandon Tran to facilitate a meeting with Dr Jason Zagdrodzky and his team on EP lab efficiency.
As the primary goal of lab efficiency is achieving timely and quality care for our EP patients, there is often a focus on AF given its increasing prevalence as both a primary and comorbid condition.1,2 Greater than 50% of patients with paroxysmal AF will progress to persistent AF within 10 years of diagnosis. Additionally, the longer the duration from diagnosis to rhythm management, the lower the success of that intervention, namely catheter ablation.3,4 Early catheter ablation of AF not only significantly decreases progression for AF, but also decreases health care utilization and improves cardiovascular outcomes.5-7 An efficient lab can help provide critical intervention for AF care, particularly as the number of AF patients continues to increase.
Another important factor in EP lab efficiency is addressing provider burnout and improving satisfaction with work-life balance. More than 50% of physicians exhibit symptoms of burnout.8 Workplace stress is the leading cause of work-related disability. It not only impacts the individual, but also has a significant effect on the work environment, resulting in decreased productivity as well as increased costs and accidents. In health care, we have a limited margin for error, so it is crucial to establish a positive work culture that decreases stress in the workplace.9 Provider burnout can be reduced by creation of more defined responsibilities and workflows to reduce redundancy. In the EP lab, this can be accomplished by maximizing licensure and increasing predictability during the day. The key is to minimize uncertainty. Just as patients benefit from knowing what to expect from any given procedure, staff and providers also benefit from having as much predictability in the day as possible. While altered plans are expected in health care, daily expectations can result in improved staff/provider retention and engagement.10 Improving the workplace for our staff and providers will only further improve our quality of care to patients.
Additionally, while efficiency in the EP lab can have an impact on health care utilization and overall cost of care, it can also allow for new approaches for reduced dependency on other limited health care resources. One example was the significant inpatient bed shortage during the height of the COVID-19 pandemic. To reduce dependency on bottlenecks such as inpatient beds, our group reviewed prior data showing safe outcomes using same-day discharge (SDD) following AF ablation.11 We developed SDD workflows for device implants and left-sided ablations, which has improved access to care. This approach also has the potential for significant cost savings, ranging from $917-$1676 per patient for AF ablation.12 If we can improve access to AF ablation, we have the potential to decrease cost of care by $300 per patient per month for those with AF and heart failure, and can make an impact on other facets of health care such as reducing emergency department visits, admissions, and cardioversions.13,14
Finally, an efficient EP lab translates to better quality patient care, which can be universally applied to both academic and nonacademic settings. While the way in which efficiency is obtained may be similar, both settings have a unique culture, requiring different approaches. The presence of learners should not be a deterrent to initiating this process, but rather, a core concept in training of fellows. Process improvement and quality initiatives instill the foundation for future progress in the field. Additionally, enhancement of quality and efficiency increases the number and variety of procedures in which fellows participate. When our institution began our efficiency efforts, our fellows were integral participants in the process to standardize workflows and review practices in an evidenced-based manner.
When considering efforts to increase EP lab efficiency, review the many possible benefits to your clinical practice, including better patient care, improved health care utilization, and decreased overall costs. Use your resources, collaborate with others, and review best practices as outlined by data and guidelines. Achieving lab efficiency is a team sport, so keep these objectives in mind when soliciting support from colleagues. While our lab began this process only one and a half years ago, we feel we are just scratching the surface and look forward to what the future brings.
Acknowledgements. I would like to thank Drs Jason Zagrodzky from the Texas Cardiac Arrhythmia Institute and Jose Osorio from Grandview’s AF Clinic and EP program for showing me, and many others, the significantly positive impacts of an efficient EP lab. I would also like to thank Brandon Tran, Biosense Webster clinical account specialist, for his support and assistance in this process.
Disclosures: Dr Wright has completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. She reports consulting fees, participation on an advisory board, and payment or honoraria for presentations from Biosense Webster.
References
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