EP Lab Digest - September 2007 - (Page 11)

SEPTEMBER 2007 SPOTLIGHT INTERVIEW 11 Catheters and sheaths are usually removed in the laboratory immediately after procedures by the physicians, or at times are assisted by staff members. In cases where patients may have received high doses of intravenous heparin, a cardiac technician dedicated to the removal of angioplasty sheaths will often remove in-dwelling sheaths from our patients in the recovery room or on a telemetry patient care unit. office. Select patients have been enrolled in home monitoring systems for ICD follow-up, while still being seen in the office periodically. Concerted efforts and constant communication among all lab members, including the physicians, nurses, technologists, office manager and staff (and even the housekeepers and transporters) keep our turnover time to a minimum between cases. How is inventory managed at your EP lab? Who handles the purchasing of equipment and supplies? Inventory is managed by the full-time nurse coordinator, the senior technologist, and several staff nurses. More costly or niche equipment and supplies are always purchased with appropriate physician and nurse input. How are new employees oriented and trained at your facility? New employees in our hospital all participate in a formal orientation program, inclusive of HIPAA training and infection control precautions. Furthermore, newer staff members who may be very experienced in other aspects of cardiac care but who are new to the electrophysiology service, undergo extensive training with peer nurses and technologists for lengthy periods of time before being asked to work independently. Figure 2. The second electrophysiology laboratory, a state-of-the-art biplane room, just opened in the summer of 2007. (Courtesy of Titus Photographics). Has your EP lab recently expanded in size and patient volume, or will it be in the near future? How has managed care affected your EP lab and the care it provides patients? Despite the decline in numbers for many other types of cardiac procedures, patient and procedural volume for the EP program has risen steadily over the past decade. In 1992, our first full year, we performed 377 cases with only one physician, one full-time and one part-time nurse, and one technologist; in 2006, there were 1,797 cases. Procedure complexity has also increased with the introduction of resynchronization devices and ablation for atrial fibrillation.We have been able to comply with managed care’s requirements to perform more procedures on an outpatient basis or with limitations in length of hospital stays without any compromise in patient outcomes and safety. The laboratory has consistently contained costs by using only the necessary equipment to perform procedures efficiently and safely, while minimizing waste. Furthermore, costly items such as implantable devices are selected based upon patient need (i.e.,singleversus dual-chamber versus CRT devices) and not on a routine basis. Device manufacturers must remain competitive with respect to pricing. Standardization of technical aspects of procedures among the four electrophysiologists greatly aids in accomplishing these goals. What types of continuing education opportunities are provided to staff members? Continuing education is important both to the physicians as well as to nurses and technologist staff members. In addition to attendance at national meetings, staff members have participated in courses throughout the country, both for ongoing education in electrophysiology in general, as well as for education for more specific reasons, such as when new equipment has been installed. Our electrophysiologists are extremely active in local, state, and national professional organizations. Our physicians remain very active in the New Jersey Chapter of the American College of Cardiology and on numerous committees of HRS, as well as the national ACC. We continue to participate in numerous controlled, randomized clinical trials that are oriented toward patient welfare.The physicians remain active in the submission of clinical abstracts and presentations at national professional meetings. In addition, we are very involved in the education of medical housestaff, medical students, and ancillary staff. We serve on numerous hospital committees, including the Medical Executive Committee, the Heart Hospital Executive Committee, the Hospital Foundation, the Cardiac Care Committee, the Radiation Safety Committee, the Cardiopulmonary Resuscitation Committee, the Research Committee, the Performance Improvement Committee, the Mount Sinai School of Medicine Affiliation Oversight Committee and the hospital Information Systems Committee. Grand rounds for the department of cardiovascular medicine occur every Friday Figure 3. Dr. Jon Sussman positions the mapping catheter during an ablation procedure for atrial fibrillation. What measures has your EP lab implemented in order to cut or contain costs and improve efficiencies in patient through-put? The cardiac rhythm management staff provides outpatient evaluation and management services in hospital-based offices, geographically separated from the laboratory. Ancillary noninvasive tests are obtained through the hospital's available services, or via the patient's personal cardiologist's Figure 4. Dr. Winters and staff members in Morristown Memorial’s EP lab (courtesy of Titus Photographics). morning. The electrophysiologists present cases with a thematic approach and/or a didactic lecture on the second Friday of each month. Another educational program was our participation in “OR Live,” during which we performed a live webcast of a defibrillator implant procedure. How is staff competency evaluated? Staff competency is evaluated on several levels. The nurse coordinator, who directs these evaluations to her immediate supervisor, performs the primary evaluations. There are periodic competency assessments

Table of Contents Feed for the Digital Edition of EP Lab Digest - September 2007

The ICD Shock and Stress Management Program: Interview with Samuel F. Sears Jr., PhD Universal ECG Screening: The Advocate’s Perspective Contents Letter from the Editor Spotlight Interview: Morristown Memorial Hospital 10-Minute Interview: About the Mended Hearts and Mended Little Hearts Organizations ICD Patient Support Groups Email Discussion Group: September 2007 Technology: Only As Good As the Attitude Behind It! Electrophysiologic Management and Treatment of Chronic and Acute Cardiac Device Infection First Annual EP Lab Digest Salary Survey Events Calendar Industry News and Products

EP Lab Digest - September 2007

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