Parkridge Medical Center in Chattanooga, Tennessee was recently named one of the Nation’s 100 Top Hospitals™. In addition, it was the only facility in Chattanooga to be recognized for this award. Since opening in 1971, the hospital and EP lab have established a reputation for excellence in cardiac care. They offer a wide range of EP services, including the Cardiac Rehab Program, which provides patients such as those with implanted pacemakers and defibrillators with education and counseling about their medical condition as well as information about preventing future cardiac problems. Read more about this interesting EP lab, which just expanded last year.

Back row (left to right): J. Wolverton, Cardiac Services Director; C. Bruell, RN; J. Bridges, RN, RRT; K. Williams, RN, BSN, CCRN; P. Trevino, RN, MSN; N. Vega, RN, BSN, Charge Nurse; E. Massengill, RRT; Dr. T. Talbert. Front row (left to right): B. Newmark-Pugh, RN; S. Defriece, CRT; S. Hall, Cardiac Services Material Coordinator.

What is the size of your EP lab facility and the number of staff members? What is the mix of credentials at your lab?
Parkridge Medical Center is a 296-bed facility. The electrophysiology department employs eight full-time employees, as well as one employee who functions as both an RN and an RRT. There are five other RNs and two other respiratory therapists.

What types of procedures are performed at your facility?
Our electrophysiology lab performs atrial fibrillation (AF) (both pulmonary vein isolations and liner), ventricular tachycardia (both idiopathic and ischemic), PVC right- and left-sided atrial flutter, focal tachycardia inappropriate sinus tachycardia, AVNRT and AVRT ablations. We also do basic EP studies for syncope patients. The lab does permanent pacemaker as well as internal cardiac defibrillator insertions. These are either single, dual or biventricular, when criteria is met.

Approximately how many procedures does your lab perform?
We have completed approximately 300 EP/ablations, 64 pacemaker and 64 ICD implants, and 23 biventricular ICDs this year, from January 1 to July 31, 2003.

How is your EP lab managed, and by whom?
Neci Vega, RN, BSN, is the charge nurse who coordinates scheduling with the physician offices and our Cardiac Recovery Unit. She makes assignments and manages the inventory with S. Hall, Materials Management Coordinator for Cardiac Services. The EP lab reports to J. Wolverton, Director of Cardiac Services.

E. Massengill, RRT.

Is the EP lab separate from the cath lab?
Yes.

Are employees cross-trained in the EP lab?
The EP lab employees are cross-trained to operate the Prucka monitoring system (GE Medical, Waukesha, Wisconsin), the Bloom stimulator (Fischer Imaging Corporation, Denver, Colorado) and the Carto mapping system (Biosense Webster Inc., Diamond Bar, California), as well as scrub for all cases. Our RNs are also cross-trained to sedate.

Do you have cross-training inside the EP lab? What are the regulations in your state?
As far as sedation goes, our physician has attended classes offered through our anesthesia department and gives Brevital during the case. The RNs monitor the patient and provide supplemental sedation as needed per physician orders. We have respiratory therapists available, per protocol, throughout the procedure that perform multiple functions in our lab.

Control Room in Lab #2.

What are some of the new equipment, devices and products introduced at your lab lately?
We operate two rooms with a Carto mapping system (Biosense Webster Inc.), Cardiolab 7000 (GE Medical), Bloom stimulator (Fischer Imaging Corporation), Stockert generator, and EPT 1000 (Boston Scientific, Natick, Massachusetts) in each room. We have a Chilli® ablation system (Cardiac Pathways Corporation, Sunnyvale, California) that we rotate from room to room when needed. We also rotate our EPT Basket cables and box from room to room when needed. Parkridge Medical Center is awaiting approval for a Stereotaxis system for one of our labs.

Is your EP lab filmless, or does it plan to become filmless in the foreseeable future?
Our lab is filmless.

Who handles your procedure scheduling? Do you use a particular software? How do you handle physician timeliness?
The Cardiac Recovery Unit schedules procedures for the CRU, the cath lab, and the EP lab. It is done manually on a scheduling book, due to the flexibility of the physician and patient needs. Physician timeliness is usually not an issue. Our physicians, for the most part, call ahead if a case will be delayed.

In Control Lab #1 (from left to right): J. Bridges, RN, RRT; S. Defriece, CRT; and K. Williams, RN, BSN, CCRN.

How are new employees in the EP lab oriented and trained at your facility?
Our standard orientation program lasts an average of six months and consists of both didactic and clinical training. We use the Competency-Based Orientation Program and each skill mix progresses from station to station once mastery is achieved. RNs are cross-trained to sedate, scrub, stimulate, monitor and map. RTs are trained in all stations with the exception of sedation. The Competency-Based Orientation is evaluated at the 6-month completion period, and goals are set for the next year. K. Williams, RN is in charge of keeping our education folders in order and keeping us on track with the EP lab as well as the hospital-based competency programs.

How is inventory managed at your EP lab? Who handles the purchasing of equipment and supplies?
The inventory is managed by the Cardiac Services Material Coordinator, S. Hall. He is part of ordering and contract negotiations in the labs along with other hospital management.

Has your EP lab recently expanded in size and patient volume, or will it be in the near future?
Our EP lab expanded to two labs in 2002; and our volumes have increased dramatically this past year.

Dr. Talbert mapping in Lab #1.

What measures has your EP lab implemented in order to cut or contain costs and improve efficiencies in patient through-put?
The EP lab does a lot of bulk purchase on higher amount items, but uses consignment on most of the other items.

Does your EP lab compete for patients? Has your institution formed an alliance with other in the area?
We compete with two other major facilities in this area. Dr. T. Talbert, MD, provides the majority of our care. Additionally, T. David Gbadebo, MD and Gershon Perry, MD, practice here. Several other cardiologists also implant pacemakers in our labs.

For more information about the EP lab at Parkridge Medical Center, please visit: www.parkridgemedicalcenter.com