Improving Efficiencies in Patient Through-put in Today's EP Lab

Condensed and Edited by Jodie Miller
Condensed and Edited by Jodie Miller
What measures has your electrophysiology lab implemented in order to cut or contain costs and improve efficiencies in patient through-put? The following accounts of improving efficiencies in the EP lab were taken from Spotlight Interviews published in EP Lab Digest since September 2001. Please note that each manager s comments were edited slightly so as to focus solely on the improvements in their EP labs. From 2004, Vol. 1, No. 3: At Tufts-New England Medical Center and Cardiac Arrhythmia Center in Boston, Massachusetts, they have implemented reprocessing of catheters and some bulk purchases. To improve patient through-put, each physician gets one full day in the EP lab. From 2004, Vol. 1, No. 2: At St. Luke s-Roosevelt Hospital Center in New York, they are trying to improve basic nursing coverage in the laboratory, and have instituted staggered scheduling for the nursing staff so the lab is able to run longer hours without incurring expensive overtime costs. Their EP staff is a highly dedicated and collaborative group. Everybody pitches in to move cases as quickly as possible through the lab. In turn, the lab is able to increase throughput. They pride themselves in being able to limit the amount of time between cases. They try to do an extremely efficient job each time. The bottom line is that they place a premium on limiting the amount of time that the labs are inactive. From 2004, Vol. 1, No. 1: At Parkridge Medical Center in Chattanooga, Tennessee, the EP lab does a lot of bulk purchase on higher amount items, but uses consignment on most of the other items. From 2003, Vol. 3, No. 9: At Emory Crawford Long Hospital, Atlanta, Georgia, the cardiac observation area has had a great impact on lab efficiency. Since each patient is in a private room with telemetry, oxygen, and suction, they use this area to perform conscious sedation procedures that do not require instrumentation. Consequently, all cardioversions, noninvasive programmed stimulation, chronic ICD defibrillation testing, and tilt table tests can be performed without utilizing time in the EP lab. In the lab, they use competitive purchasing and the leverage of our large volume to control equipment costs. They also limit catheter counts for routine EP studies and ablations. They have opted against a resterilization program for designated single-use EP products to avoid potential liability. From 2003, Vol. 3, No. 8: At St. John Hospital and Medical Center in Detroit, Michigan, they have initiated an inventory program that ensures cost-effective purchasing. Specifically, they rely heavily on the use of bulk buys with vendors, particularly with respect to pacemaker and ICD procurement. From 2003, Vol. 3, No. 7: At the UCLA Cardiac Arrhythmia Center in Los Angeles, California, they have monthly administrative meetings that have hospital administrative people and lab staff in attendance. This has helped them to understand their true costs, and they have a mechanism of value analysis for new EP products. From 2003, Vol. 3, No. 5: At the University of Iowa Hospitals in Iowa City, Iowa, they try to minimize the unnecessary use of multiple catheters. They have negotiated with the device companies and the catheter companies for good prices. They have become more cognizant of the need to perform procedures efficiently. They run two laboratories (and the second Prucka system, which is portable even for use in one of the catheterization laboratories, and the recovery room) for other procedures. They minimize overtime use of the laboratory. They have nurse practitioners (attending directed service) to manage our overnight patients. They write the history and the physical examination when the patient arrives. They follow and discharge the patient under the supervision of the attending electrophysiologist. From 2003, Vol. 3, No. 4: At the University of California - San Diego in California, they have an ongoing process that evaluates EP lab utilization efficiency. They continuously monitor staffing requirements to maintain optimal cost-effective utilization of staff. They regularly review our procedures, practices, and contracts with vendors in order to reduce costs and maximize our reimbursements. They were currently reviewing payer contracts in order to ensure optimal reimbursements. From 2003, Vol. 3, No. 3: At the University of Rochester Medical Center at Strong Memorial Hospital in New York, they have a computer-based inventory system (TS 2000) that partners with purchasing to achieve complete pricing contracts with our vendors. They utilize consignment whenever possible. From 2003, Vol. 3, No. 2: At Advocate Illinois Masonic Medical Center in Chicago, Illinois, all lab work is done ahead of time on an outpatient basis and patients are admitted the morning of their procedure. After their procedure, they stay for six hours and then are discharged depending on their status. From 2003, Vol. 3, No. 1 At the Carle Heart Center in Urbana, Illinois, they are negotiating with all vendors to provide catheters and other equipment on consignment. They have a contract with an outside company to provide re-sterilization of catheters. From 2002, Vol. 2, No. 6: At Mercy General Hospital in Sacramento, California, the recruitment of Material Management Coordinator David Yamasaki to evaluate usage/cost of supplies and help with vendors negotiations, enables them to offer the best technology at the best price. Their active involvement in research allows them to be familiar with the technology before the actual availability of the product, physician involvement is essential. In addition, they have recruited a Clinical Nurse Specialist, Nancy Beck, who has responsibility for many aspects within the cardiovascular programs. Other improvements include evaluation/update of coding and billing to meet the CPT Coding changes and the implementation of policy and procedure to improve the accuracy of procedure billing and staff training. Efficiency has also been enhanced through the development of pre-op checklists, pre-printed admit and discharge orders. This allows smoother transition for patients throughout the process. Their expansion will provide a greater opportunity to meet the growing need for electrophysiology and implantable device therapies, while providing the care in the most effective manner possible. From 2002, Vol. 2, No. 5: At Einstein Heart Institute in Philadelphia, Pennsylvania, with the addition of pass-through items, the billing process has been streamlined and computerized to make certain bills are processed as soon as a patient is discharged. These items are flagged in the system ahead of time to ensure efficient processing. From 2002, Vol. 2, No. 3: At Riverside Methodist Hospital in Columbus, Ohio, they have initiated a rounding nurse program in their lab to improve patient flow. One of the staff nurses comes in daily at 6:00 am to round on in-patients and ensure their readiness for procedures (i.e., a running IV, NPO, consent forms signed). This has definitely helped. Riverside also has a Tender Hearts program for all outpatient cardiac procedures. The Tender Hearts coordinators facilitate outpatient flow by helping to educate patients and families about procedures, direct people to and from waiting areas and update families about patient progress during lengthy procedures. From 2002, Vol. 2, No. 2: At Saint Vincent Heart Center in Erie, Pennsylvania, their EP service has to be as efficient as possible, since operating two dedicated EP labs allows them to do more procedures and decrease hospital stay. They are able to schedule more outpatients and elective procedures and still take care of inpatients in a timely manner. From 2002, Vol. 2, No. 1 At the EMH Regional Healthcare System, which is part of a two hospital system with campuses in Elyria and Amherst, Ohio, their Pacemaker Clinic follows over 2,000 patients. The EP lab and Device Clinic work very closely with staff and physicians on a daily basis. This helps to coordinate implant procedures and physicians that are accessible when device troubleshooting is needed. The Pacemaker Clinic has two procedure rooms and also performs transtelephonic monitoring. Their clinic has an open-door policy. This means that a patient who feels that they need to be seen for a device-related problem will come into the clinic for an unscheduled check. Cardiologists and nurse practitioners are then consulted immediately for any problems noted. After hours, patients with symptoms are instructed to place a call to the Cardiac Care Unit for TTM monitoring. From 2001, Vol. 1, No. 2: According to Walter Reed Army Medical Center in Washington D.C., by using the Omni-cell inventory control system, they have been better able to control their inventory and avoid stockpiling expensive equipment. This reduces the risk of inventory loss due to expiration or the equipment becoming obsolete. From 2001, Vol. 1, No. 1: At Morristown Memorial Hospital in Morristown, New Jersey, the cardiac rhythm management staff provides outpatient evaluation and management services in hospital-based offices, geographically separated from the laboratory. Ancillary noninvasive tests are obtained through the hospital's available services, or via the patient's personal cardiologist's office. Patients with implantable defibrillators are followed at regular intervals. For patient satisfaction, as well as for insurance of optimal management, one of the electrophysiologists is present at each interrogation session.