Increasing Efficiency and Elevating Patient Care in the Electrophysiology Lab Through Innovative Design and Operations: An Academic Medical Center’s Journey

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EP LAB DIGEST. 2024;24(4):1,8-10.

Situated on the fourth floor of an academic medical center building built in 1975, the project presented a myriad of challenges that necessitated innovative and creative solutions. Overcoming hurdles such as limited ceiling height, full mechanical chases, and compact electric/technology rooms, the design process involved extensive collaboration with various hospital departments and coordination with multiple equipment vendors. 
The goal was to achieve a state-of-the-art procedural suite within the existing structure. With a commitment to operational continuity throughout the construction, the project adopted a 10-phase construction sequence spanning 15 months. This article explores the complexities of how the design and clinical team tackled these challenges, ultimately delivering a modern, high-quality design.
In the dynamic realm of health care, the quest for excellence and efficiency is a constant journey. Fueled by innovative design and operational expertise, this journey served as a beacon for institutions navigating the challenges of outdated infrastructure and the rising demands to serve a growing population of complex cardiovascular disease.

Outdated Space and Equipment: Recognizing the Need for Change

University of Iowa Health Care, located in Iowa City, Iowa, is an 866-bed academic center and home to a large and experienced team of electrophysiologists and arrhythmia specialists. A wide variety of advanced treatments are offered, from atrial fibrillation to rare inherited arrhythmias.
The impetus for change began with the acknowledgment that the EP laboratory had outgrown its functional capacity, including outdated space and equipment. This led to a proactive exploration of growth forecasting to estimate future patient and procedural volume. This preliminary forecasting illustrated the need to add 1 to 2 incremental EP laboratories at the time of construction as well as future flexible space in the coming years.

Innovative Design Solutions: New Zones, Booms, and Cords 

A bottleneck in efficiency was acknowledged due to the current 2 EP laboratories sharing a control room, a small equipment space unsuitable for contemporary needs, and a lack of defined workspace within the laboratories. There were additional challenges with increased procedural complexity and an augmented demand for personnel, including anesthesia support. 

This prompted a critical examination and creation of laboratory zones, which are sectioned off into 3 primary zones: nurse zone, anesthesia zone, and procedure zone. The creation of these dedicated zones has allowed for optimization of workflow for each team member, ensuring that supplies and equipment are readily accessible throughout key portions of the case (Figure 1). Also included in the novel design is the integration of several booms in each laboratory. This not only has allowed cords to be lifted off the floor, ensuring cleanliness and organization as well as facilitating quick turnover of rooms. The integration of mapping systems into the boom design has further elevated the efficiency of procedures. We utilize 3 mapping systems at UI Health Care: Rhythmia (Boston Scientific), EnSite X (Abbott), and Carto 3 (Biosense Webster, Inc, a Johnson & Johnson company). We allocated these systems across different laboratories based on scheduling and user preferences. Each laboratory features an equipment boom where the mapping systems are securely mounted, seamlessly integrated into the laboratory environment. This setup eliminates the need for cables and cords to extend across the floor to the control room, resulting in a notable reduction in equipment noise. The commitment to placing 5 booms in every EP room underscored a dedication to creating an environment that met the demands of contemporary EP advancements in care.

The control room, once plagued by noise and space constraints, also underwent a transformation. The redesigned space now boasts improved flow, reduced distractions, and an overall environment conducive to focused work. Each laboratory includes a dedicated control room connected by a main corridor, allowing for visibility to the other laboratories in the procedural area (Figure 2).

The location and dimensions of the pre/post recovery area remained unchanged throughout this project. However, to mitigate bottlenecks in patient flow, we relocated certain minor EP procedures, such as cardioversions and loop recorder implants, from the pre/post recovery space to our Heart and Vascular minor procedure area. This adjustment necessitated a redistribution of workload and a training period. As a result, it created more space availability in the pre/post recovery area.

Transformation to a Class 3 Imaging Space and Establishment of Unidirectional Flow Patterns

To better align with societal recommendations and Facility Guidelines Institute guidance, as well as stay at the forefront of clinical innovation, the design and clinical team determined there was a need to shift from a Class 2 to a Class 3 imaging space (Figure 3). We opted for single-plane fluoroscopy utilizing a ceiling-mounted Azurion 7 Series (Philips) equipped with a 12” flat detector. Technological advancements have enabled our EP services to conduct specific procedures without relying on fluoroscopy. Our goal is to minimize radiation exposure wherever feasible. Given these considerations, investing in a biplane system for EP optimized laboratories seemed impractical to us.

A dedicated effort was required to educate faculty and staff on the new expectations of the restricted, semi-restricted, and non-restricted zones required of a Class 3 space. Tours and educational sessions were offered prior to opening to help orient the staff to this new standard of care.

Goals were also set for achieving efficient flow to meet procedural needs, including implementation of unidirectional flow while embracing an on-stage/off-stage model of care. This approach separates staff flow from patient flow, effectively reducing traffic jams and enhancing overall efficiency. Entrances and exits were strategically designed with directions to staff on how to enter the space and exit into the main hall of the hospital. The on-stage aspects of the space are patient focused and esthetically conducive to a healing and calming environment, while the off-stage staff areas focus on ergonomics and efficiency. 

Remaining Operational During Construction: A Strategic Approach to Construction Phasing 

A vital aspect of the project was maintaining operations during an extensive construction period. The phasing of almost 10 construction stages, spanning from January 2020 to December 2022, required a systematic approach. The phased construction resulted in operational downtime for labs, limiting our team to only 4 labs for 6 months. To address this challenge, a scheduling template was implemented that ensured continuous access for patients in need of cardiovascular care services. This scheduling method maintained access without extending operating hours or delaying procedures.

Sound control measures were in place to minimize interference with ongoing procedures, as depicted in Figure 4, which shows the use of sound blankets during the construction phase. Thorough planning accounted for downtimes related to electrical work and work on heating, ventilation, and air conditioning. Strategic scheduling of these downtimes was crucial to minimize their impact on availability for emergency cases. On some occasions, after-hours emergency services were relocated to the pediatric catheterization laboratory and main operating room, necessitating detailed contingency planning. 

The scheduling of the transition for medical supplies and equipment was carefully coordinated. Collaboration with the Bioengineering and Rad-engineering departments was instrumental in facilitating the movement of equipment during off hours, thereby minimizing downtime in the laboratories.

Strategic planning was employed for supply relocations to ensure sufficient storage and supplies throughout the construction phases. In some instances, adjustments to the phase planning were necessary to bring storage space online during a different phase than initially intended when transitioning from the old laboratory space to the new laboratory space.

Effective communication across various departments played a crucial role throughout the project’s numerous phases and transitions.

A Triumph of Innovation and Vision

The academic medical center’s journey stands as a triumph of innovation and vision in the realm of EP laboratory design and operations. From recognizing the limitations of outdated space to embracing novel design solutions, navigating complex renovations, and adapting to clinical innovation, our experience serves as a blueprint for health care institutions seeking to redefine standards and elevate patient care. The commitment to operational efficiency and creation of a safer environment has paved the way for a new era in cardiac arrhythmia diagnosis and treatment. 

As the journey continues, the lessons learned serve as an inspiration for the broader landscape of health care innovation and transformation. It is our hope that the University of Iowa Health Care can serve as a beacon for other institutions, highlighting the potential for innovative design and operations to elevate patient care and meet the ever-growing demands of the health care industry. As the health care realm continues to evolve, the lessons learned from this project offer valuable insights and inspiration for institutions navigating their own path toward excellence and efficiency in patient care. 

Acknowledgement

A special thanks to our architectural design partners, INVISION Architecture (Waterloo, Iowa). We would also like to acknowledge our colleagues in the Capital Management Department at University of Iowa Health Care for their expertise and guidance on this project.  

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest, and report no conflicts of interest regarding the content herein.