Team Work and Planning: The Keys to Success in an EP Lab Renovation

Cleveland Clinic Akron General is a 532-bed teaching and research hospital in Akron, Ohio. The 100-year-old hospital became part of the Cleveland Clinic Health System in 2015.

The hospital’s EP lab was nearly 25 years old when it underwent a major renovation starting in 2018. We sought the funding for this work for about four years, and were thrilled when we finally got the go-ahead to start. Today, the space is a modern and efficient lab that maximizes workflow, patient safety, and comfort, at a total cost of about $2.4 million, nearly $400,000 under budget.

Getting Started

One of the first things we did was assemble a team of a diverse group of employees to formulate a list of problems that we hoped the renovation would solve, room by room, and plan how to make those changes happen.

The team included representatives from anesthesiology, radiology, biomedical engineering, and information technology, as well as a physician champion, the lab manager, administrators, project managers, and field representatives. This group was big enough to present and process a wide array of ideas and develop productive suggestions, but not so big that it was difficult to reach consensus.

Forming this diverse team was, without a doubt, the best move we made. The insights gained were essential to the successful end result.

Setting Goals

The list of problems we identified was long. The space, which was originally designed to house a cath lab many years ago, had one functioning lab for devices, a “dead” lab that was equipped only for cardioversions, and a third one that facilitated ablations and extractions. These fell short of meeting our patient demand.

But the problems extended well beyond the actual labs. Space was tight throughout the unit, making everyday tasks more difficult than they needed to be and increasing everyone’s stress levels.

There was only one bathroom, shared by patients and staff, and it was not handicap accessible. We didn’t have a holding area for patients to wait before or after their procedures, and we had to line up their beds in the narrow hallway, which was not private or comfortable, and which often ended up blocking the bathroom door. These facts combined to create the awkward dynamic of routinely having to move a patient out of the way in order for another patient, or an employee, to use the restroom.

Office space was very limited, making it difficult for the staff to complete their work and nearly impossible to have a private conversation. The locker room was too small for anyone to comfortably change clothes. The staff often had to do what we jokingly called the “hamper dance,” navigating around the dirty clothes bin to get dressed. Meeting space and a break room were nearly nonexistent as well.

The doorways into the unit were too narrow to easily move patient beds through them.

In addition, the suite needed a major aesthetic refresh to bring it into alignment with the clean, modern look that has been implemented throughout the hospital since we affiliated with Cleveland Clinic.

Adding to the challenges was the fact that we are “landlocked” on the third floor of the hospital, unable to add square footage to our space.

Results

We are pleased to say that we improved upon all of the areas that were outlined.

The most important, of course, were the upgrades to our clinical capabilities. We now have two full-service EP labs, allowing multiple complex cases to be completed simultaneously and giving us the ability to double our capacity. This has significantly reduced our scheduling backlogs. We also have a fully functioning procedure area that facilitates cardioversions, tilt table testing, transesophageal echocardiograms, and loop recorder implants.

Technology upgrades that we implemented in these rooms include adding an ultrasound, 3D mapping system, intracardiac echo machine, reduced radiation fluoroscopy system, and new anesthesia equipment.

Every room has been redesigned for better workflow. An important component of that is having designated space for anesthesiologists to work at the head of each table.

We created a two-bed holding bay for patients and added a second entrance with double doors, remodeled the patient bathroom to accommodate wheelchairs, installed a staff bathroom, created offices and a break room, and widened the hallways. All of this greatly improved flow and comfort for staff and patients.

The new entrance to the suite now requires a badge for admittance, and is in the line of sight from the front desk, both of which contribute to a more secure environment.

We created a designated open space that gives the staff a place to work but also facilitates team communication, and the manager now has a dedicated office in which he can have private conversations, instead of having them while standing in the hallway.

A new meeting room lets us hold training sessions as well as daily huddles. An electronic control board similar to those seen at surgical control desks now displays patient status (anonymized for confidentiality) so the entire staff can see at a glance what needs to be done. Our control room was also upgraded by providing more square footage and promoting a work area where staff has room to perform tasks such as charting on the recording system and performing EP studies utilizing a stimulator. All computer systems were wired into a cabinet, allowing for optimal counter space.

We added anesthesia gas lines in all rooms, and new air handlers were installed to optimize air exchanges as well as maintain OR standard humidity and temperature. LED lighting systems were placed in rooms and hallways, and lights were positioned on the corridor edges so they did not shine in patients’ eyes while they were being transported. OR lighting was added on both sides of the bed in procedural rooms. Well-organized cabinetry was installed around the perimeters of each procedure room, which significantly reduced clutter, and all walls were painted.

Looking ahead, we have a few more items on our wish list, including updating the X-ray capabilities in the older procedural room and incorporating a suspended radiation protection system into the newest procedural room.

Managing the Transition

During the renovation, which spanned from April 2018 to January 2019, we closed off most of the lab, keeping only one room open at a time, accessible through a side exit. We augmented our capacity by temporarily repurposing one of the hospital’s operating rooms as an EP space.

Offices had to be relocated and personnel had to be flexible as they approached each day’s needs. It was a challenge to continue operations during this time, but thanks to a strong overall team effort, it went relatively smoothly.

One secret to our success: Regular conversations with the foreman of the construction team. Whether it was phone calls or texts, we communicated every day. This dialogue allowed us to quickly troubleshoot problems and navigate our schedules to stay out of each other’s way.

A project on this scale is inevitably stressful at times, but we believe that it went as smoothly as possible. Teamwork, planning, and an eye on the final outcome kept it all together.  

Dr. Schweikert is the chief of cardiology and medical director of electrophysiology at Akron General. Mr. Flavelle is the EP lab manager.

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