EP Lab Digest - September 2007 - (Page 12)

SPOTLIGHT INTERVIEW SEPTEMBER The staff members and physicians relate to each other like members of a close-knit family. Everyone’s input is vital to the success of the program. in the patients who have lower risk and in whom the risk of a device malfunction is relatively low. Recent reports have confirmed that the replacement surgery risk must be considered as well. Figure 5. Three of our extremely dedicated office staff members are shown here: Jennifer Mezic, Myra Hoffman (office manager) and Jared Katz. What are your thoughts about nonEPs implanting ICDs? Do you train such individuals? We do not support that approach.There may be some geographically underserved areas in the country where a patient cannot have access to ICD therapy, but that is not the case in most urban and suburban regions. ICD implantation is not an emergency procedure.The impetus for non-EP physicians to implant is often financial and not necessarily aimed at optimizing patient safety. Most cardiologists feel that their extra training, expertise and time commitment to their field allow them to provide superior cardiac care than a general practitioner would, and we have the same view with respect to electrophysiology. The physicians in our group are all board certified in cardiovascular disease management (as well as in Clinical Cardiac Electrophysiology), but we do not perform stress tests, echocardiography, nuclear studies, diagnostic catheterization studies, or angioplasty.We are focused on what we do best and admire other cardiologists who focus on what they do best. ICD recipients commonly have significant structural heart disease, and the additional risks of anesthesia in these patients, arrhythmia induction, etc. should not be discounted. We believe that as much as possible, patients at greatest risk should undergo electrophysiologybased procedures by board-certified electrophysiologists in facilities with appropriate on-site cardiac surgical back-up.We do not train others to implant, and believe that industry-supported training programs may be self-serving and not necessarily in the public interest. for use of conscious sedation, radiation safety, and ACLS. In-service sessions regarding new technologies and procedures are held periodically. How does your lab handle call time for staff members? How often is each staff member on call? How frequently do they have to come in, on average? Is there a particular mix of credentials needed for each call team? The electrophysiology laboratory does not have a formal call schedule for staff members.The service is fully staffed from 7 am to 7 pm, Monday through Friday. However, the members of the cardiac rhythm management service are frequently called upon to work well into the evening to complete procedures. There is no evening call, and each staff member has at least one or two days off during the week, as well as all weekends and holidays off.When nurses and technologists stay late, we express our deepest appreciation. We occasionally treat the staff to lunch and dinners where we relax as friends and family would. explored, leading to the development of mechanisms to prevent recurrences. In addition, formal reporting to the state is required, both with respect to procedure numbers as well as complication rates.The electrophysiology laboratory has been inspected by various parties including JCAHO, and has exceeded expectations both for efficiency and cleanliness. Do you contract with vendors? We contract with the vendors who provide our catheters and implantable devices. This helps to contain costs, and maintains an ongoing relationship with industry representatives, which in turn provides access to new technology and research endeavors. Our local representatives have also been instrumental in providing ongoing technical support. Regarding installed equipment, the hospital maintains service contracts in several areas to keep laboratory downtime to a minimum. We are most impressed and enjoy supporting manufacturers’ representatives who are knowledgeable in the field and can provide strong technical support during procedures when needed. defibrillators. A formal presentation as well as dinner is provided at each session.All staff members, including secretarial, nursing, technical staff and physicians, are represented at each meeting. Topics related to general cardiac wellness, as well as rhythm management, are presented.The social and psychological well-being of the patients is addressed as well. Patients and their families are also mailed a quarterly newsletter, which has been well-received. Our program functions as a family, sharing mutual respect among all members, be it the office manager and staff, the nurses, the technologists, and/or the physicians. Each member is a vital element to the program’s success. As a stand-alone electrophysiology group, we receive patient referrals from well over 100 cardiologists who work in several counties. Unless otherwise required (e.g., for device monitoring or adjustment of research-related medicines) or when requested by the referring physician, we do not provide routine outpatient follow-up for these patients after a post-operative or post-procedure visit; we want to support the relationship that the patient has with the referring physician.This type of broad referral pattern is often difficult to maintain by an EP physician who is part of a general cardiology group, since the referring physicians are often reluctant to send patients to a group that may be perceived as being in competition with them.This factor is helpful not only to our group but to our hospital as well. What type of quality control/quality assurance measures are practiced in your EP lab? Quality assurance is measured on several levels. First, there is a monthly cardiology conference at which both cardiac catheterization laboratory and electrophysiology laboratory complications are presented. Fortunately, as mentioned above, complications have been very uncommon. Another conference is devoted to the presentation of interesting lectures or cases relevant to cardiac rhythm management. As noted above, one of the electrophysiologists serves on the department's formal Performance Improvement Committee as well.Any problems that may occur as system errors are carefully How has your lab handled device recalls? There have been several serious device recalls and advisories over the past 15 years. We typically abide by formal recommendations from manufacturers and advisory groups. On more than one occasion we have dealt with recalls by holding all-day weekend sessions involving our physicians, nurses, technologists, office staff and manufacturer representatives. Patients have been counseled and advised individually of their options.We have advised surgical replacement when necessary, particularly for pacemakerdependent patients and for those who have required frequent ICD therapy.However,we have favored a more conservative approach Is there a problem or challenge your lab has faced? How was it addressed? The cardiac rhythm management program, like many similar services, is constantly facing new challenges. Scheduling conflicts, rising costs in conjunction with diminishing hospital reimbursement, and increasing patient expectations are constantly providing new challenges to health care providers. Nevertheless, professionalism and dedication have allowed us to continue to provide the excellent care that our patients deserve. The staff members and physicians relate to each other like members of a closeknit family. Everyone's input is vital to the success of the program. Please tell our readers what you consider unique or innovative about your EP lab and staff. Electrophysiology staff members have coordinated a quarterly patient support group that has been well attended and which appears to have improved patient morale and acceptance of implantable

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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