Establishing a Full-Time EP Service

Background

White Plains Hospital, founded in 1893 by 22 women and 3 men, is a non-profit community hospital and a member of the Montefiore Health System network. When it first opened its doors, the hospital was located in a four-room house in Chatterton Hill and treated 31 patients its inaugural year. By 1924, the bed capacity had grown to 100 and the hospital expanded to larger quarters on East Post Road.

In 1901, the Training School for Nurses opened with 6 students; among them was Margaret Higgins Sanger, who established an organization that later became Planned Parenthood. Community support has always played an important role in the hospital’s growth. In 1942, the White Plains Auxiliary group enlisted 250 female volunteers to make 10,000 pieces of linen for the hospital. In 2018, the group raised almost $1.5 million dollars for the hospital.^{1, 2}

The expansion of services has continued, and in 1999, the Dickstein Cancer Center opened, becoming the first freestanding center to treat residents in the community and Westchester surrounding areas without needing to travel to New York City. In 2015, White Plains Hospital expanded its cardiac catheterization services to include a second lab. In 2016, White Plains Hospital was the first community hospital to use the da Vinci surgical system, facilitating complex surgeries using a minimally invasive approach. Nursing excellence has been recognized with Magnet designation in 2012 and 2016 by the American Nurses Credentialing Center (ANCC). Today, White Plains Hospital is a 292-bed hospital that treats over 200,000 patients annually.³

Building the EP Program

In 2010, Susan Fox, MBA, who previously worked as a pediatric ICU nurse, joined White Plains Hospital as senior VP administrator during a time of declining revenues and increasing costs for the hospital. In 2013, she became the hospital’s president, and in 2015, she became the first female in the county to be named CEO of an acute care hospital. Under her leadership, White Plains Hospital has grown to include a $100 million expansion and a continued partnership with Montefiore Medical Center.⁴

Among this expansion, our EP program was established in February 2018. Daniel Y. Wang, MD, FHRS, joined White Plains Hospital at this time and was tasked with launching a full-time EP service for the arrhythmia patient population in White Plains. Previously, our hospital provided limited EP services such as pacemaker and defibrillator implants. Accessibility, patient need, and service to the community were our key goals for creating the full-time EP service. A $1 million renovation to cath lab room 2, now dedicated to EP procedures, allows for ablations to be performed routinely at White Plains Hospital. Cath lab team members are cross-trained to EP procedures, and several have become dedicated EP lab staff. Working closely with cath lab nursing leadership, staff, and nurse practitioners, we identified workflows to integrate “EP-centric” patient education and EP nursing orders, and operationalized it to avoid delays in discharges. Many in-services for arrhythmias, procedures, new EP technologies, and patient care were also added.

A family nurse practitioner with a doctorate degree in nursing, Martha G. Ferrara, DNP, FNP, CCDS, FHRS, was offered the assistant director seat in January 2018. She manages patient care as well as handles the daily operations of a growing EP service, including coordinating inpatient services and outpatient follow-up. It is important to note that clinical and administrative leadership roles in health care systems are unique for allied health professionals. Nursing leadership is highly valued in any health care organization, and most especially in a senior leader capacity.

Championing patient care requires strong, compassionate, and active participation with all members of the team, empowering others to improve the quality of care delivered. Navigating the challenges and building pathways in a technology-heavy service is rewarding and exhilarating. Education for patients, hospital staff, and physicians in an EP-naïve environment is a priority goal on a daily basis. Administration coupled with nursing leadership, cooperation, and commitment all play a crucial role in moving our projects forward and supporting our vision to establish and provide cutting-edge services.

EP procedures, ablations, and device implants using evidence-based protocols and implementing best clinical practices are performed daily. Our patients are offered state-of-the-art implantable devices with standard of care follow-up via remote monitoring. In fact, our remote monitoring service has a consistent connectivity compliance rate of >90%.

The dedicated EP staff and White Plains Physician Associates (WPPA) administration (Figure 1) have been integral in establishing the EP office and outpatient EP services. In our inaugural year, we performed over 600 EP procedures; Table 1 shows our growth in the past year. White Plains Hospital’s EP team continues to grow (Figures 2 and 3), increasing its staff to 5 EP-dedicated cath lab members; in addition, a nurse practitioner with EP training has been added to the staff.

Building a new program has been a challenging endeavor on many fronts, such as in the areas of marketing, education, training, rapid growth, and expansion. Engaging the various departments, from our valet parking staff, registration desk, admissions, nursing units, information systems (IT), billing, hospitalists, and referral practices has required time, patience, and communication skills.         

As a tertiary center to Montefiore Medical Center, the collaborative and collegial environment with their EP staff, led by Luigi DiBiase, MD, PhD, extends from physicians working in the lab, mentoring in new procedures, and sharing workflow protocols to enhance patient care and outcomes.

James Peacock, MD, MS joined the practice in March 2019; his presence confirmed the need for a full-time service in the community. Referral growth patterns have increased as much as 300% from private practices in one year.

Summary

Building an EP service with state-of-the-art and cutting-edge technologies in an EP-naïve community, as the tertiary center in a major health care system network, is only accomplished through a team effort. A handful of visionaries dedicated to delivering exceptional patient care and serving our communities have helped support this endeavor. A unique culture of values, traditions, beliefs, and respect are the underpinning pillars at White Plains Hospital. WPPA leadership has surpassed expectations in their support of our program. The challenges inherent in building the EP service have not been unexpected. Communication with stakeholders, most especially nursing personnel in all departments, has been key in finding solutions and establishing patient care pathways. Daily education regarding our EP services and delivering a message of teamwork, cooperation, competence, dedication, and friendliness are leadership tools learned and rooted in nursing education.

We are on track for opening our Atrial Fibrillation Center in 2020, and excited at the opportunity to continue delivering outstanding and exceptional care to Westchester County and the surrounding areas. 

Disclosures: The authors have no conflicts of interest to report regarding the content herein.   

1. Cary B. White Plains Hospital: 125 Years of Healing. Westchester Magazine. Published October 1, 2018. Available at http://www.westchestermagazine.com/Westchester-Magazine/October-2018/White-Plains-Hospital-125-Years-of-Healing/. Accessed September 11, 2019.
2. White Plains Hospital Foundation Data, 2018.
3. Montefiore-White Plains Hospital Partnership Finalized. White Plains Hospital. Published January 8, 2015. Available at https://www.wphospital.org/about/latest-news/montefiore-white-plains-hospital-partnership-final. Accessed September 11, 2019.
4. Partridge AR. Susan Fox: President, White Plains Hospital, White Plains. Westchester Magazine. Published November 11, 2014. Available at http://www.westchestermagazine.com/Women-in-Business-2014/Susan-Fox/. Accessed September 11, 2019.