EP Lab Digest - February 2008 - (Page 16)

16 SPOTLIGHT SPOTLIGHT Continued from page 14 INTERVIEW FEBRUARY 2008 How is staff competency evaluated? There are multiple competency programs provided by our nursing education department to provide individualized benchmarks for our staff. Most of these computerized applications are designed to emphasize strengths and accomplish objectives in areas where help is needed. An example of the detail of the left atrium and surrounding structures we get from our new 3-D rotational angiography. How do burnout? you prevent staff had improved to 50%. The bacteria was sensitive to gentamicin and doxycycline and the patient was successfully treated from an infectious disease standpoint. However, the dilemma we faced was whether or not to reimplant his device given his improved EF and resolution of heart failure.We performed an EP study, which was negative, and then elected to watch him closely. To date, he has not required a new device or heart failure therapy and his EF remains the same. We are currently hopeful that this unprecedented case will be published in the literature. PA, a fellow or an attending physician. Our parttime nurse practitioners run the outpatient device clinic in our cardiology department with cross coverage from the EP nurses during vacation times. We use multiple vendorsupported device databases for patient An example of how we can take a CT image and superimtracking, including pose it on real-time fluoroscopy during AF ablation. St. Jude Medical’s Housecall Plus, Home Monitoring, Medtronic’s CareLink in addition to our regular academic genand Boston Scientific’s LATITUDE. eral cardiology fellowship program. Routine outpatient device follow-ups do not usually require physician supervision, Does your lab provide any educabut physician office visits are often cou- tional or support programs for pled with an add-on device check for patients who may have additional patient convenience. questions or those who may be We are fortunate to be in a field of cardiology that provides a wide array of patients, and therefore, procedures. This diversity gives our staff the opportunity to rotate through all types of procedures, which helps to keep everyone fresh. In addition, no weekend or holiday call is required. How do you handle vendor visits to your department? Do you contract with vendors? All vendors in our institution are required to register in administration and to wear visible time-stamped badges once they have stepped into the building. We contract for bulk purchases with many of our vendors, and our involvement in clinical trials also helps to cut patient costs. Company representatives are present for all implants. How does your lab handle call time for staff members? Our staff does not take call. Does your lab use a third party for reprocessing? Yes, we are contracted with SterileMed Inc. Please describe one of the more interesting or bizarre cases that have come through your EP lab. We cared for a patient originally from Albania residing in the Boston area over the past decade who had undergone BiV/ICD implant at our facility in 2003. He had originally presented with a wellestablished non-ischemic cardiomyopathy prior to implant with NYHA Class III heart failure symptoms accompanying an EF of 20%. The patient experienced dramatic improvement in his symptoms over the ensuing year such that he was able to travel back to Albania to visit family.While there, the patient consumed some traditional meals that included goat's milk and meat. He presented nearly two years later with symptoms of bacterial endocarditis and blood cultures growing the rare bacteria Brucella melitensis, likely from his goat product exposure.We performed an extensive literature search and were unable to find any case reports of Brucella endocarditis with BiV/ICD. The device and leads were extracted with surgical backup without complications, and his postoperative echocardiogram revealed an EF that Approximately what percentage of your ablation procedures are done with cryo? What percentage is done with radiofrequency? All ablation procedures performed in our laboratory are done with radiofrequency. interested in support groups? What trends do you see emerging in the practice of electrophysiology? How is your lab preparing for these future changes? We are definitely seeing an upward trend in referrals for atrial fibrillation ablations, which drives our desire to optimize current imaging techniques and improve the efficiency and safety of these procedures. Our EP staff provides comprehensive education to patients and their families before and after every procedure. We also provide counseling through our inhouse Cardiac Rehabilitation Program, where other cardiac disease management risk factors and treatment plans are reinforced. Do you perform only adult EP procedures or do you also do pediatric cases? Is there cross training for pediatric cases? Our lab is primarily an adult EP lab; therefore, pediatric crosstraining is not an issue. What are your thoughts about non-EPs implanting ICDs? Our hospital and the associated network require board-certified electrophysiologists to perform implants. Please tell our readers what you consider unique or innovative about your EP lab and staff. One of the biggest compliments we receive from patients is our staff's ability to minimize procedural anxiety through careful explanation and listening skills.These attributes, coupled with technical expertise and a spirit of collaboration, make our EP lab uniquely meaningful to our patients and staff. For more information, please visit: www.semc.org Do your nurses/techs participate in the follow up of pacemakers and ICDs? If so, how many device visits per week do they handle? Do you use any particular software for follow up? How many of your ICD/pacemaker patients require a doctor for their visits? The nurses in our EP lab do almost all inpatient device follow-up and interrogation in collaboration with either the When was your last JCAHO inspection? Our last inspection took place in early November. Are you ACGME-approved for EP training? What do you think about two-year EP programs? We are approved for two EP fellows http://www.semc.org

Table of Contents Feed for the Digital Edition of EP Lab Digest - February 2008

EP Lab Digest - February 2008 Creating the U-M Center for Arrhythmia Research: Interview with José Jalife, MD Texas Cardiac Arrhythmia Institute and St. David’s Medical Center Launch State-of-the-Art Training Center Contents Letter from the Editor Spotlight Interview: Caritas St. Elizabeth’s Medical Center 10-Minute Interview: Sue Deck, BS, RN, RCES Keeping Pace With a Blog Roundtable Discussion on Cryoablation Procedures Email Discussion Group: February 2008 Events Calendar Industry News and Products Classifieds Advertisers Index

EP Lab Digest - February 2008

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