Good communication skills are the ability of a person to communicate with the other in an effective manner. The electrophysiology lab requires effective communication among several disciplines and departments in order to run efficiently. Factors identified that are affected by communication include: patient care; procedural flow/scheduling; physician and employee satisfaction; interdepartmental relations; and patient outcomes. Within this blog I will describe the connection of communication and the several factors that are affected.

Patient Care:
It is imperative that all members of a specific EP lab communicate in order to provide exceptional care for the patient. The communication needs to involve each member of the team, equipment involved and physician. If anything is missed with this process, it could prove to be detrimental to the patient outcome.

Example: Communication of Heparin Administration.
During complex ablations that involve a left-sided approach, it is a common practice for the physician to request heparin administration in order to keep the patient anti-coagulated and reduce the chance of a clot during possible ablation. This communicated order by the physician must be heard and acknowledged by everyone on the team. If this order is not heard and acknowledged by the person administering the heparin - in our case, the anesthesia staff - there is a possibility that the medication will not be given, increasing the risk for stroke.

One of the National Patient Safety Goals includes the process of repeating any order that is given by the doctor if given verbally. Once the order is given, it is repeated by either the monitor nurse or circulating nurse, acknowledged and verified by the anesthesia staff, and then the medication is administered.

Procedure Scheduling:
Scheduling of patients and procedural flow can prove to be a common struggle on a daily basis in the electrophysiology labs. There are so many variables that require attention to detail when dealing with scheduling. Any miss in the communication chain can result in a poor outcome for the patient. It is important that all parties involved in the communication of scheduling a patient are on the same page.

Example: Communication of Diagnostic Procedures before Atrial Fibrillation Ablations.
A good majority of the patients having an atrial fibrillation ablation require a lot of attention to detail in terms of scheduling. Important diagnostic tools that need to be included with the scheduling of these patients include TEEs and cardiac CTs to assist with the procedure. Not all patients require these items, but we have a team consisting of an EP scheduler and charge nurse who communicate these facts with the specific departments and Afib Nurse Educators to assure they are completed before the procedure. If not completed in a timely fashion, it may result in a delay of case(s), physicians delayed and an overall decrease in patient satisfaction.

Interdepartmental Relations:
It is important to have good relations and communication between all departments involved in patient care. In the EP lab there are several departments that require continuous interaction on a daily basis. If communication is lost or strained in any way with any department, this may result in a poor patient outcome and decrease patient satisfaction. Departments that interact on a daily basis to provide exceptional patient care may include: Office schedulers, Pre-procedural department, Anesthesia, Telemetry units, Surgical services, and so on.

Example: Communication with Anesthesia Departments.
It has been a struggle in the past for the anesthesia department and electrophysiology labs to have a strained relationship. In most hospitals, anesthesia resists covering cases requested by Electrophysiology Services. At St. David’s Hospital, we have a wonderful relationship with the anesthesia department. In order to successfully run the lab there needs to be constant communication regarding time changes, adding of additional patients/room for the day and specific anesthesia required for procedures (TIVA or general). The interaction of the staff and anesthesia needs to be fluent in order to provide positive patient outcomes.

During specific cases, such as a PVC case, most of the physicians want the patient to be awake in order to observe the arrhythmia needed to ablate. If this is not communicated effectively before the case starts, the arrhythmia may be suppressed with unnecessary medications, making it difficult to perform the case.

Effective communication in the EP lab setting is imperative to operate an efficient lab. The importance of identifying the proper contents of the communication and the appropriate manner of relaying the message is a key component in providing the best outcome for the patient. Always remember, though there is an importance to relaying the message in a clear, concise manner, it is also equally imperative to listen to the message being relayed.

Tami Metz, RN is the Manager of EP Labs and Barbara Thomas, RN is the Director of Electrophysiology Services at the Texas Cardiac Arrhythmia Institute at St. David’s Medical Center in Austin, Texas.