Spotlight Interview: University of Florida

Mario D. Gonzalez, MD
Mario D. Gonzalez, MD
What is the size of your EP lab facility and number of staff members? What is the mix of credentials at your lab? We have four electrophysiologists, two EP fellows, two procedure lab RNs, four procedure lab cardiovascular technicians (all from an accredited CVT Program), one RN coordinator, and one nurse practitioner. When was the EP lab started at your institution? The electrophysiology service was started in 1990. During these last four years, we have built two new EP labs. What types of procedures are performed at your facility? We perform radiofrequency (RF) ablations, cryoablations, irrigated RF ablations, non-contact and magnetic mapping, intracardiac echo, pacemaker/ICD implants and revisions, and tilt table testing. We also act as a referral center for a large portion of the southeastern United States for atrial fibrillation and ventricular tachycardia (VT) ablations. Approximately how many are performed each week? We perform approximately 15 cases per week. Who manages your EP lab? The Cardiac Cath Lab Director manages the EP lab. Is the EP lab separate from the cath lab? How long has this been? Are employees cross-trained? The EP lab is located adjacent to the adult and pediatric cath labs. The EP lab has a dedicated staff but can cross-cover in all areas of the cath lab. We have had dedicated staffing in the EP lab for approximately 1 year. Do you have cross training inside the EP lab? What are the regulations in your state? All EP staff members are cross-trained to perform both devices and ablations; they rotate from area to area on a monthly basis. The technical aspects of EP are performed by CVTs, while the nurses are responsible for patient care, medication administration, patient assessment and cardioversion/defibrillation. What are some of the new equipment, devices and products introduced at your lab lately? How has this changed the way you perform those procedures? We have incorporated cryoablation, intracardiac echocardiography, and epicardial ablation. These technologies facilitate the performance of complex procedures. Is your EP lab filmless, or does it plan to become filmless in the future? The EP lab is totally filmless, and all images are stored via deep archive. Who handles your procedure scheduling? Do you use a particular software? We have a RN coordinator who schedules patients. We currently utilize a manual scheduling system. What type of quality control and quality assurance measures are practiced in your EP lab? We review select cases for evaluation in our quarterly Cardiology QA meetings. We also audit patient and medication safety compliance as well as all JCAHO regulations. How is inventory managed at your EP lab? Who handles the purchasing of equipment and supplies? The senior EP tech, in collaboration with the Cath Lab Director and Inventory Coordinator, manage, purchase and evaluate all supplies and equipment for the electrophysiology lab. Has your EP lab recently expanded in size and patient volume? The EP lab added a second room a year ago to meet the increased volume. How has managed care affected your EP lab and the care it provides patients? What measures has your EP lab implemented in order to cut or contain costs? In addition, in what ways have you improved efficiencies in patient through-put? Our Cath Lab is extremely cost conscious and has focused on efficiency and utilization while continuing to provide high quality care for all patients. We are very aggressive with vendor negotiations and inventory management to help reduce costs. Does your EP lab compete for patients? Has your institution formed an alliance with others in the area? Ours is an academic center that usually performs complex procedures, and as such we have no competition in the area. We receive patients referred from cardiologists and electrophysiologists from a broad area. What procedures do you perform on an outpatient basis? The procedures we perform on an outpatient basis include EP studies, ICD and pacemaker generator changes, tilt table procedures, event monitor implants/explants, cardioversions and EP studies via ICD. How are new employees oriented and trained at your facility? New employees undergo a six-month orientation that includes the cath lab, observation room and EP lab. What types of continuing education opportunities are provided to staff members? We have weekly in-services, conferences such as NASPE-HRS, anatomy demonstrations in the pig heart, and onsite training. How is staff competency evaluated? Staff is evaluated during their annual evaluations with competency review for all equipment and procedures. How do you handle vendor visits to your department? Vendors schedule appointments through the Inventory Coordinator or Cath Lab Supervisor. All vendors check in through the purchasing department and are provided with appropriate ID indicating they are vendors. The vendors then report in to the cath lab charge person at the time of their appointment. Does your lab utilize any alternative therapies? Our nurses utilize a combination of touch therapy and relaxation techniques with our EP patients. How often is each staff member on call? How frequently do they have to come in, on average? Is there a particular mix of credentials needed for each call team? Our staff members currently take call seven days every eight weeks. Our call teams include a physician, an RN, and two CVTs. Approximately what percentage of your ablation procedures are done with cryo? What percentage is done with radiofrequency? We perform most of our ablation procedures using radiofrequency ablation. Do you perform only adult EP procedures or do you also do pediatric cases? We currently only perform EP procedures on adults. Does your lab provide surgical backup for procedures (such as biventricular implants)? Our lab does not require surgical backup for any of our EP procedures. We are located adjacent to the operating room and have an excellent working relationship with the cardiovascular surgeons. Does your lab undergo a JCAHO inspection? Yes, we were just recently inspected (2003). In addition, we are inspected by the American Board of Internal Medicine with regards to the specialized training we provide in cardiac fellowships. Our hospital was also recently certified by the Magnet Program for Excellence in Nursing Care. Describe your city or general regional area. How does it differ from the rest of the U.S.? We are located in North Central Florida, where we are exposed to a large population of college students as well as retired people that snowbird (our transient northern population). Please tell our readers what you consider unique or innovate about your EP lab and its staff. We are a referral center for ablation of complex arrhythmias, lead extractions, and biventricular pacing. We perform almost equal amounts of ablations and device implants.