Enhancing Workflow Efficiency and Collaboration: Achieving the “3 by 3” Goal in the Cardiac Electrophysiology Laboratory

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EP LAB DIGEST. 2024;24(2):1,10-11.

Baton Rouge General Medical Center recently embarked on a quality improvement project to optimize workflow and streamline processes within its electrophysiology (EP) laboratory. Through collaborative efforts, a multidisciplinary team implemented key improvements to enhance efficiencies and achieve the ambitious "3 by 3" goal of completing 3 atrial fibrillation (AF) ablations by 3 PM. This article explores the collaborative strategies and practices employed to optimize workflow, improve patient outcomes, and create a positive work experience within the EP laboratory at Baton Rouge General Medical Center.

Background

Baton Rouge General Medical Center, with a history dating back to 1900, is a 600-bed health system comprised of 3 hospitals. The main hospital, housing just over 200 beds, serves as a hub for various specialties, including cardiac EP. The EP laboratory at Baton Rouge General consists of a single EP laboratory and 3 independent cardiology groups, featuring 3 highly skilled electrophysiologists who perform a range of procedures. With plans to expand the EP team by adding 3 to 4 more electrophysiologists in the coming year, the focus on efficiency and collaboration has become increasingly crucial.

Recognizing the significance of optimizing workflow and streamlining processes within the EP laboratory, Baton Rouge General embarked on a project in 2022 to improve efficiencies. The project, known as a High Reliability Team (HRT) initiative, aimed to identify areas of improvement and implement best practices to enhance the overall performance of the laboratory and target EP laboratory space utilization. Collaborating with Biosense Webster, the hospital undertook an extensive evaluation of its current workflow. Additionally, the team sought insights and guidance from other hospitals with successful EP programs to learn from their experiences. As part of this research, team members conducted an in-person and virtual visit with Jason Zagrodzky, MD, at St David’s Healthcare in Austin, Texas.

The project involved a multidisciplinary team comprised of electrophysiologists, anesthesia professionals, cardiovascular recovery area (CVRA) staff, cardiac catheterization laboratory personnel, EP laboratory staff, perioperative directors, schedulers, coordinators, and administrators. This inclusive approach ensured that all relevant stakeholders contributed their expertise and perspectives to drive meaningful changes. Notably, effective collaboration and communication with the anesthesia team emerged as a critical factor in the success of the project, underscoring the significance of the partnership between EP and anesthesia in achieving desired outcomes.

Throughout the project, the team at Baton Rouge General identified several small workflow improvements that had a cumulative impact on overall efficiency and turnover time in the EP laboratory.

Data and Goal

At the onset of the project, the EP laboratory at Baton Rouge General Medical Center faced challenges in efficiently completing procedures. Initially, there was an expectation in the lab that more than 2 AF ablations could not be completed on a given day. Recognizing the need for improvement, the EP team set an ambitious goal known as “3 by 3”—to complete 3 procedures by 3 PM.

Key metrics such as “wheels out/wheels in” and “end of case to stick in following case” were carefully tracked and monitored throughout the 3-month project. Following the key improvements listed below, the laboratory was able to decrease “wheels out/wheels in” time by 32% and “end of case to stick in following case” time by 42%.

The “3 by 3” goal served as a benchmark to drive operational enhancements and streamline processes. Through the collaborative efforts of EP specialists and anesthesia professionals, along with the active involvement of the multidisciplinary team, the EP laboratory made significant strides toward achieving this objective.

Key Improvements to Achieve the Goal

Several key improvements were implemented in the EP laboratory at Baton Rouge General Medical Center to achieve the “3 by 3” goal.

1. Collaborative scheduling. Through close cooperation with EPs and valuing their input, the scheduling process underwent significant enhancements, becoming more efficient and closely aligned with the desired outcomes. Although it posed a challenge to request that physicians modify their schedules and place trust in the commitment to turnover times and procedural efficiency, the team’s  collective efforts allowed everyone to align their objectives and successfully achieve the goals set out in the HRT project.

2. Streamlining preprocedural preparation. The collaboration between EP and anesthesia begins well before the actual procedure, during the preprocedural preparation phase. Efficient coordination allows for thorough patient assessment, medical history review, and optimization of anesthesia plans. Through joint decision-making, the teams select the most appropriate anesthesia techniques and medications tailored to each patient’s needs. This collaboration ensures the smooth transition of patients from the preprocedural area to the EP laboratory, which minimizes delays.

3. Improved communication. Efforts were made to enhance communication with anesthesia professionals and physicians to ensure a smooth start to the day. By committing to a 7 AM start time, the EP laboratory team established clear expectations, enabling efficient scheduling and preparation.

4. Implementation of transesophageal temperature probe. To enhance patient monitoring during procedures, the EP laboratory implemented the use of a transesophageal temperature probe. This advanced monitoring technique allowed for accurate and continuous temperature monitoring, ensuring patient safety and optimizing procedural efficiency.

5. Implementation of ClearSight (Edwards Lifesciences). The adoption of ClearSight, a noninvasive monitoring system, brought significant improvements to the EP laboratory workflow. This technology eliminated the need for an arterial line in appropriate cases, reducing invasive monitoring requirements and minimizing procedural time.

6. Preemptive wake-up calls. In AF cases, anesthesia professionals began receiving notifications approximately 25 minutes before the procedure’s anticipated completion. This allowed them to initiate the process of waking up the patient, preventing delays that might occur if the physician completed the procedure before anesthesia started the wake-up process.

7. Streamlined patient transfer. To expedite turnover time, the CVRA team promptly retrieved patients from the EP laboratory and transported them back to the CVRA area. This enabled the EP staff to commence the turnover process earlier, optimizing efficiency and reducing procedural downtime.

8. EP staff involvement in room turnover. EP staff actively participated in the room turnover process, taking responsibility for ensuring a swift and efficient transition between procedures.

9. Advanced case preparation. To avoid any potential delays, EP staff began reviewing cases a day in advance, ensuring all necessary equipment and supplies were readily available and minimizing last-minute arrangements.

10. Turnover time goal on yearly scorecard. The EP laboratory recognized the importance of setting a turnover time goal on the yearly scorecard. The goal was to consistently achieve less than 25 minutes from wheels out to wheels in for consecutive EP cases. By incorporating this goal into the scorecard and reviewing it monthly, the EP team held themselves accountable and created a time for discussion to identify areas for continuous improvement.

Conclusion

In the pursuit of optimizing workflow efficiency and achieving the “3 by 3” goal, Baton Rouge General Medical Center’s EP laboratory has witnessed significant improvements. These enhancements have indeed streamlined operations, yet it is crucial to acknowledge encountered setbacks, as they are integral to the learning process and highlighting the team’s resilience. Challenges have included the loss of anesthesia resources, the establishment of a new outpatient lab in the local market for EP procedures, and some staff turnover. Despite these obstacles, the team consistently strives to pivot and discover new solutions, maintaining an unwavering commitment to the established goal.

This success stands as a testament to the EP team’s dedication, showcasing their adaptability and steadfast commitment to excellence in health care delivery. Ongoing efforts involve a renewed commitment to securing new anesthesia resources, and Baton Rouge General has responded by adding an extra EP laboratory while implementing block time for EP procedures. As the EP laboratory continues to evolve, the setbacks encountered become invaluable lessons, contributing to the creation of a more robust health care environment that fosters improved work experiences and enhanced patient outcomes.

Looking forward, plans are underway to track key metrics once again at the 1-year mark. This strategic approach ensures a comprehensive evaluation of the ongoing initiatives, allowing the EP team to gauge the sustained impact of their improvements and make data-driven adjustments as needed. By consistently monitoring key metrics, Baton Rouge General Medical Center remains dedicated to the pursuit of excellence and the delivery of high-quality, efficient, and patient-centered care within the EP laboratory. 

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. Dr Pollet reports payment from Abbott, Biosense Webster, and Medtronic for travel expenses and teaching honoraria.