Mon Health Medical Center recently became the first hospital in West Virginia to be recognized by the American College of Cardiology (ACC) as earning the Atrial Fibrillation (AF) with Electrophysiology (EPS) Accreditation for its expertise and commitment to treating patients with atrial fibrillation. In this interview, EP Lab Digest speaks with Dr. Robert Hull, Director of Electrophysiology at Mon Health Medical Center in Morgantown, West Virginia.
Tell us about the EP program at Mon Health Medical Center.
Our EP program is based in a regional-level hospital. We have two outlying hospital facilities and several clinics that are part of our health care system. Our program provides CT surgery, interventions, a structural heart disease program, and electrophysiology services. We’re adding two additional electrophysiologists this year, which will bring us to three cardiac electrophysiologists. We do the full gamut of EP procedures. We have a dedicated EP staff that includes one RN and three EP techs who are all IBHRE certified.
Approximately how many atrial fibrillation patients does the hospital see annually?
In West Virginia, we are at the epicenter of atrial fibrillation due to demographics of an aging population, comorbid factors, hypertension, coronary disease, and obesity. We have one of the highest per capita rates of atrial fibrillation in the United States. We literally care for thousands of people with atrial fibrillation. We have a central hub hospital, Mon Health Medical Center, and when patients come into this program, they’re generally seen by cardiac electrophysiology, and at least part of their management is formulated by EP.
When did Mon Health Medical Center achieve the ACC’s AF with EPS accreditation? What members of the staff were involved in the AF accreditation process?
We were approved in December 2019. It was a team approach that included myself and Lisa Henry, nurse practitioner, who was the coordinator of everything from our end, including our interactions with the ACC. We then formed a team comprised of an emergency room physician, a hospitalist, general cardiology, EP, a nurse administrator from the emergency room, a nurse administrator from the Heart and Vascular Center, and the emergency EMS director. So it was a diverse group, because to address all those aspects of care, you need those people engaged.
What can you tell us about the process for achieving AF accreditation?
The process, which takes about a year, is overwhelmingly positive, but there are some things that are cumbersome. The accreditation process helps to organize care from the time the patient is in the emergency room, through hospitalization, and with certain parameters regarding discharge and follow-up. It involves standardization of your algorithms to approach patients, standardization of the order sets used to treat patients, and certain guidelines for follow-up care. It also evaluates your assessment of bleeding risk, stroke risk, and anticoagulation. In general, you find out things that you’ve taken for granted, and it opens your eyes to things that were not maybe going as well as you had anticipated.
Of course, anytime you enter into a standardized process that is nationwide, you also have to be willing to accept certain things that might not be as ideal for your practice or hospital. There are certain standard time requirements for follow-up of an INR that aren’t individualized based on the patient. Certain issues are standardized on how to assess bleeding risk. For example, a HAS-BLED score is required, although I personally feel this doesn’t bring much value to the table. Also involved are certain rote deadlines for follow-up that are difficult and not individualized to each patient.
I also disagree with the recommended door-to-ECG time of 10 minutes for AF patients in the ER. We live in an era of evidence-based medicine, but in this case, I don’t believe there is scientific evidence for this. You can’t reliably determine what symptom complex represents AF upon presentation. So it seems a little bit misdirected. For us, we’re trying to convince patients that once we’ve addressed stroke risk, that most aspects of AF care are not a crisis — it’s a lifelong disease. If patients who come to the ER are rushed back for an EKG within 10 minutes, I’m worried we may be giving them a mixed message.
So we believe this process is just the beginning, because AF care is an all-encompassing process that is individualized for each patient. So our emphasis, in addition to the ACC accreditation for inpatient care, is how we’re managing them as outpatients, how we have coordinated their care throughout our entire system, and how we have focused on important outpatient modification factors (eg, reduction in obesity, aerobic conditioning, etc.) that are critically important for our population.
Why were you interested in pursuing this accreditation?
Number one, the process is there to help us grow and improve both our ER and inpatient care for AF. Number two, it lends some true validity to who we are and what we’re doing. Finally, it provides us with a standardized value that shows the AF patients in our region that we deliver individualized, comprehensive care.
What tips do you have for other labs considering this accreditation process?
Before you engage in the process, you need to have critical parts of your team in place. You would never start this process without a functioning lab and experienced administrators in place in your ER and cardiac program. You want people who are very familiar with what your goals are before you start, because it’s a lot of work.
What does achieving AF accreditation mean for the staff at Mon Health Medical Center?
In achieving AF accreditation, everyone at our institution feels pride and a sense of mission. We take a special interest in the education of our patients, scheduling of appointments, and follow-up.
What other initiatives is Mon Health Medical Center doing beyond ACC Accreditation?
We have also received the Chest Pain Center Accreditation and we are going to be receiving the HeartCARE Center designation. We are also launching an extensive outpatient program across our system for AF. We’re pursuing a grant to look at ways of impacting the community with education about increasing aerobic conditioning and weight reduction.
Disclosures: Dr. Hull has no conflicts of interest to report regarding the content herein.