Spotlight Interview: St. Vincent's Medical Center

St. Vincent’s Medical Center is a licensed 473-bed community teaching and referral hospital with a Level II trauma center. St. Vincent’s is a member of Ascension Health, the largest Catholic non-profit healthcare system in the nation. The Medical Center has more than 450 active physicians and employs more than 2,000 people. St. Vincent’s Medical Center is proud to have achieved Magnet^® recognition by the American Nurses Credentialing Center (ANCC) in 2012. St. Vincent’s was also the recipient of HealthGrades’ Five-Star Award in 2013 for coronary interventional procedures and valve surgery. Our Regional Heart & Vascular Center at St. Vincent’s Medical Center is the area leader in state-of-the-art cardiovascular care.

What is the size of your EP lab facility and number of staff members? What is the mix of credentials at your lab?

We currently operate one EP lab and often utilize a cath lab room for device implantations. Our EP lab is staffed with three full-time employees, Diane Tornatore, RN, Rochelle Gibson, RN, and Nancy Prince, RT, as well as a 30-hour RN, Donna Brennan, and a per diem RT, Dawson Haffner. We also utilize a nurse anesthetist for all of our cases. Our EP physicians include EP Lab Medical Director Joseph Tiano, MD, FACC, Adam Lottick, MD, Michael Pittaro, MD, and Nimrod Lavi, MD.

When was the EP lab started at your institution?

Our EP lab was established in January 2000.

What types of procedures are performed at your facility? Approximately how many are performed each week? 

The EP lab performs implants including loop recorders, pacemakers, defibrillators, and biventricular devices. On average, we implant approximately 12 devices a week. In addition to implants, the staff also supports our EP physicians in the main operating room for complicated device extractions.

The ablations we perform consist of supraventricular tachycardias, including flutter, AVNRT, and atrial fibrillation (AF), and ventricular tachycardias including Impella-assisted ischemic VT ablations. On average, we perform eight ablation procedures, including two atrial fibrillation ablations, per week.

What is the primary goal of your program?

The goal of our EP lab at St. Vincent’s Medical Center is to provide the highest level of cutting-edge electrophysiology care in the  region.

Who manages your EP lab?

The management of our EP lab includes the Director of Cardiac Services, Catherine Winkler, PhD, RN; EP Lab Medical Director, Joseph Tiano, MD, FACC; Nurse Manager, Kathy Gearing, MSN, RN; and Cath/EP Lab Charge Nurse, Cindy Perretta, RN.

Is the EP lab separate from the cath lab? Are employees cross trained?

Since its inception in 2000, the EP lab has not separated from the cath lab. Though we typically operate with a dedicated EP team, many of the cath lab staff are cross-trained to circulate in EP as needed or help with implants in our cath/EP swing room. Our EP staff are cross trained as well. Diane Tornatore, RN and Nancy Prince, RT can function within their credentialed roles in the interventional cath lab, and Donna Brennan, RN is cross trained in the noninvasive cardiology department.

All three of our EP nurses are trained to scrub for implants and to operate our recording system and stimulator. Both of our EP radiology technologists are trained to scrub for implants. As lead technologist, Nancy Prince, RT also operates our recording system, stimulator, and 3D mapping system. Though our RTs can assist with circulating during cases, an RN must be available to perform the circulator role.

What new equipment, devices and/or products have been introduced at your lab lately? How has this changed the way you perform those procedures?

A hybrid operating room was built in the Medical Center’s main OR in 2012. This operating room is being used for TAVRs and will soon be outfitted with the EP equipment necessary to perform our hybrid atrial fibrillation ablations, which are currently being done in a staged two-part procedure.

Who handles your procedure scheduling? Do they use particular software? 

Each of our electrophysiologists have dedicated days of the week to book cases in the EP lab. Our procedure scheduling is handled by our shared EP/Cath Lab Clinical Support Associate, Kisha Mann, using our Centricity scheduling program.

How is inventory managed at your EP lab? Who handles the purchasing of equipment and supplies?

Currently, inventory and supply ordering is managed by our lead radiology technologist, Nancy Prince. Ed McAuley, our department’s inventory specialist, and EP nurse Diane Tornatore also assist with the purchasing of supplies and equipment. All catheters, sheaths, wires, etc., are counted and crosschecked with par levels on a weekly basis. Our supply orders are placed using the online ordering system OmniBuyer. In the near future, our hospital will be transitioning to a new, more automated, inventory and order system called PeopleSoft. With the addition of this new inventory system, supplies will be more easily counted and ordered as needed using a barcode scanning method.

Has your EP lab recently expanded in size and patient volume, or will it be in the near future? 

Patient volume is rapidly expanding with the recent addition of our newly appointed EP Medical Director, Dr. Joseph Tiano. As our number of atrial fibrillation ablations has dramatically increased, a dialogue among our physicians and administration has begun in regards to a timeline for building an additional dedicated EP lab.

Have you developed a referral base?

We have increased our referral base in the community by being the first in the region to offer a hybrid atrial fibrillation procedure which offers the most advanced thorascopic mini maze procedure in conjunction with a transcatheter approach.

What measures has your EP lab implemented in order to cut or contain costs?

We have recently adopted a dual vendor contract system with our device companies to help reduce cost and promote competitive contract pricing between our three vendors.

What types of continuing education opportunities are provided to staff members?

Each Monday morning our cardiologist hold a cath/EP lab conference. The physicians lecture on new procedures being performed in our labs, present interesting cases, and discuss upcoming difficult cases to explore possible options for treatment.

What committees, if any, are staff members asked to serve on in your lab?

All of our EP staff members serve on hospital committees. Rochelle Gibson, RN and Nancy Prince, RT are a part of our Cardiology Values Analysis Team (CVAT). This team of lab and purchasing department staff and management gather information, access, and approve or deny the usage of all new products brought to them by vendors. Rochelle is also a member of the Unit Practice Council and Nancy is a member of the Radiation Safety Committee. Diane Tornatore, RN is a member of Joint Practice and Nursing Levels of Practice. Donna Brennan, RN is on the Shared Governance Professional Practice Council.

How does your lab handle call time for staff members? 

Unlike the cardiac cath lab staff, our EP lab staff does not take call. Instead of call, our EP lab mandates that, on your scheduled work day, you are expected to stay until the last case is completed. Most nights our procedures are complete by 5 pm, but as with any EP lab, there are occasional late nights finishing challenging cases in the lab.

Does your lab use a third party for reprocessing? How has it impacted your lab?

Historically, catheter tips were cut and collected at the end of each EP case to be sent out for platinum recovery. More recently, in a hospital-wide effort to go green, we have switched from catheter tip collection to sending our used catheters and cables for reprocessing. Though we do not currently use reprocessed catheters in our lab, our department is recouping a portion of our costs by participating in this program.

Approximately what percentage of your ablation procedures are done with cryo? What percentage is done with radiofrequency?

One hundred percent of our ablations are done using radiofrequency ablation. During our recent equipment upgrade, our EP lab obtained an IBI generator along with a Cool Point^™ Pump (St. Jude Medical) that is utilized with irrigated ablation catheters during left-sided ablations.

Do you perform only adult EP procedures or do you also do pediatric cases? 

Our lab currently only performs procedures on adults.

What measures has your lab taken to minimize radiation exposure to physicians and staff?

In addition to full coverage, wrap around lead skirts and vests, and leaded eye protection, we use a leaded glass shield suspended from our ceiling and a leaded table skirt for EP studies and ablations. For device implants, our physicians drape a sterile RADPAD^® (Worldwide Innovations & Technologies, Inc.) on the field and wear sterile leaded gloves for added radiation protection. All of our physicians are cognizant of the radiation acronym ALARA (As Low As Reasonably Achievable) and limit their use of fluoroscopy with the help of our 3D mapping system and ICE catheter, when in use. Our fluoroscopy equipment alarms at the standard five-minute intervals, and we also have policies in place to periodically inform our physicians of exposure time and dose to the patient throughout extended procedures as a helpful reminder.

Do your nurses/techs participate in the follow up of pacemakers and ICDs? 

Unfortunately, our nurses and technologists do not have the opportunity to participate in the follow up of pacemakers and ICDs. All of our patients’ follow-up visits are handled at our physicians’ offices with the device representatives and office staff.

Describe your city or general regional area. How does it differ from the rest of the U.S.?

Incorporated in 1821, Bridgeport is the most populous city in Connecticut. The city had an estimated population of 144,229 in the 2010 United States Census. Bridgeport is located on the coast of Connecticut in Fairfield County, which is the southwestern-most county in Connecticut. Though this area of Connecticut is known for its many wealthy communities, Fairfield County is also home to lower-middle and working class-cities such as Bridgeport and Norwalk. There exists a wide gap in income among the suburban towns for which Connecticut is known and its urban centers, such as Bridgeport, which has a large population of poor and underserved residents. St. Vincent’s Medical Center is proud to provide exceptional medical services to its widely diverse patient population, and because of its mission of caring for all regardless of means, provides charity care to many area residents each year through a number of facilities and programs.

Please tell our readers what you consider unique or innovative about your EP lab and staff.

The EP lab at St. Vincent’s Medical Center is staffed with thoughtful medical professionals who are dedicated to their patients’ comfort and care during their entire visit to the lab. From our nurses’ radio karaoke with nervous patients, to our post-procedure, circulation-stimulating back rubs, our patients are given the care and attention they need to set them at ease during an otherwise stressful occasion. 

For more information, please visit: http://www.stvincents.org/