Implementation of a Highly-Performing Electrophysiology Device Implant Program: Is There a Role for Niche Hospitals?

Implementation of a Highly-Performing Electrophysiology Device Implant Program: Is There a Role for Niche Hospitals?
Implementation of a Highly-Performing Electrophysiology Device Implant Program: Is There a Role for Niche Hospitals?
Implementation of a Highly-Performing Electrophysiology Device Implant Program: Is There a Role for Niche Hospitals?
Implementation of a Highly-Performing Electrophysiology Device Implant Program: Is There a Role for Niche Hospitals?
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Author(s): 

Jeffrey L. Williams, MD, MS, FACC and Julie Miksit, RN, BSN, MBA*
Lebanon Cardiology Associates, PC and *Good Samaritan Hospital
Lebanon, PA

Good Samaritan Hospital (GSH) and Lebanon Cardiology Associates (LCA) recently partnered to create a community hospital EP program caring for elderly, ill patients, and experienced lower overall implant complications compared to available national trials and single academic centers. Find out more information here.

Background
After approximately two years of planning, Good Samaritan’s invasive cardiac EP lab was opened on July 1, 2008. There are two full-time technologists (David Lugg, BS, RCIS and Douglas Hollis, RCIS) and one full-time nurse (Robert Gray, BSN, RN). In addition, we have one part-time technologist, Michelle Stoner, BS, CVT, who still participates in traditional coronary and peripheral interventional cardiology procedures.

Jeffrey L. Williams, MD, MS, FACC is the Director of Cardiac Electrophysiology and is board-certified in Internal Medicine, Cardiovascular Disease and Clinical Cardiac Electrophysiology. In July 2009, he was joined by Co-Director of Electrophysiology Robert Stevenson, MD, who is board-certified in Internal Medicine, Cardiovascular Disease, and Nuclear Cardiology. Julie Miksit, RN, BSN, MBA is the Assistant VP of Cardiovascular Services at Good Samaritan. Alicia Wike, RN, is the Cardiac Catheterization and EP Lab Supervisor, and the manager of the Cardiac Catheterization and EP Labs is Jennifer Hemperly, RN.

The implementation of the GSH EP device implant program is best described using key premises outlined by the Baldrige National Quality Program: leadership, strategic planning, customer focus, workforce focus, process management, measurement/analysis/knowledge management, and results (Figure 1).1 Of note, GSH also utilizes Lean Six SigmaSM principles for certain process improvements.

We routinely perform ablations for supraventricular tachycardia, ventricular tachycardia, and atrial fibrillation in our state-of-the-art procedure room; however, our device implant program is the focus of this report.

Leadership and Planning
The implementation of the Good Samaritan EP program began 18 months prior to program inception in July 2008. Dr. Williams and Mrs. Miksit began a systematic planning strategy for lab implementation with the full support of Good Samaritan and Lebanon Cardiology Associates. The demographics of the area, especially serving Health Professional Shortage Areas, necessitated the Good Samaritan EP lab have capabilities to perform all aspects of device implantation. Electrophysiology equipment acquisition was based upon the desire of Good Samaritan Hospital and Lebanon Cardiology Associates to offer state-of-the-art cardiovascular care to the Lebanon Valley community. The Good Samaritan Hospital’s invasive cardiac electrophysiology laboratory is 800 square feet and fully-equipped to function as a cardiothoracic surgical suite. We have our own anesthesia equipment that consists of a traditional ventilation machine and full anesthesia cart (Dräger Fabius® Tiro compact anesthesia system, Draeger Medical, Inc., Telford, PA) and the Monsoon Jet Ventilator (ACUTRONIC Medical Systems AG, Switzerland). The fluoroscopy system is a GE Innova 2100 single-plane unit (GE Healthcare, United Kingdom).

References: 

1. 2009-2010 Health Care Criteria for Performance Excellence, The Baldrige National Quality Program at the National Institute of Standards and Technology, Gaithersburg, MD. 2. Trentman TL, Fassett SL, Mueller JT, Altemose GT. Airway interventions in the cardiac electrophysiology laboratory: A retrospective review. J Cardiothorac Vasc Anesth 2009;23:841-845. 3. Barritt AW, Clark L, Teoh V, et al. Assessing the adequacy of procedure-specific consent forms in orthopaedic surgery against current methods of operative consent. Ann R Coll Surg Engl 2010;92:246-249. 4. Santolin CJ, Boyer LS. Change of care for patients with acute myocardial infarctions through algorithm and standardized physician order sets. Crit Pathw Cardiol 2004;3:79-82. 5. Williams JL, Lugg D, Gray R, et al. Patient demographics, complications, and hospital utilization in 250 consecutive device implants of a new community hospital electrophysiology program. Am Heart Hosp J 2010;8:33-39. 6. Aggarwal RK, Connelly DT, Ray SG, et al. Early complications of permanent pacemaker implantation: No difference between dual and single chamber systems. Br Heart J 1995;73:571-575. 7. Alter P, Waldhans S, Plachta E, et al. Complications of implantable cardioverter defibrillator therapy in 440 consecutive patients. Pacing Clin Electrophysiol 2005;28:926-932. 8. Lee DS, Krahn AD, Healey JS, et al. Evaluation of early complications related to De Novo cardioverter defibrillator implantation insights from the Ontario ICD database. J Am Coll Cardiol 2010;55:774-782. 9. Lin G, Meverden RA, Hodge DO, et al. Age and gender trends in implantable cardioverter defibrillator utilization: A population based study. J Interv Card Electrophysiol 2008;22:65-70. 10. Curtis JP, Luebbert JJ, Wang Y, et al. Association of physician certification and outcomes among patients receiving an implantable cardioverter-defibrillator. JAMA 2009;301:1661-1670. 11. Greenberg JO, Dudley JC, Ferris TG. Engaging specialists in performance-incentive programs. N Engl J Med 2010;362:1558-1560. 12. Cardiac Surgery in Pennsylvania 2006-2007: Information about hospitals and cardiothoracic surgeons. Pennsylvania Health Care Cost Containment Council. August 2009. http://www.13.org/reports/cabg/07/docs/cabg2007report.pdf 13. U.S. Department of Health & Human Services and Centers for Medicare & Medicaid Services (CMS), Hospital Compare, (http://www.hospitalcompare.14.gov), Accessed 2-8-10. 14. Reynolds MR, Cohen DJ, Kugelmass AD, et al. The frequency and incremental cost of major complications among medicare beneficiaries receiving implantable cardioverter-defibrillators. J Am Coll Cardiol 2006;47:2493-2497. 15. Saba S, Ravipati, LP, Voigt A. Recent trends in utilization of implantable cardioverter-defibrillators in survivors of cardiac arrest in the United States. Pacing Clin Electrophysiol 2009;32:1444-1449.



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