Bay Medical Center

Shirley Goodman, RN, BSN and Dana Rushing, RN
Shirley Goodman, RN, BSN and Dana Rushing, RN
What is the size of your EP lab facility and number of staff members? What is the mix of credentials at your lab? Currently, we have 5 staff members consisting of 2 nurses and 3 radiology technologists. We are part of a large cath lab consisting of 5 procedure rooms. All 15 RNs in the lab rotate through and circulate during EP cases. When was the EP lab started at your institution? Our lab first started doing EP studies in 1998, when Dr. Joey Trantham came to Bay Medical Center. Dr. Hari Baddigam came in 2002, and both cardiologists are board-certified in Electrophysiology. What types of procedures are performed at your facility? We do a number of invasive procedures, including: AV atrial flutter ablations, A/V nodal ablations, VT studies with subsequent ICD placement, transeptal ablations, EPS with arrhythmia induction, A/V, biventricular and single-chamber pacemaker insertions, and non-invasive tilt table studies. Approximately how many are performed each week? What complications do you find during these procedures? We do approximately 3-4 ablations per week, on average. Thankfully, we have not experienced many complications only one in the last year, which was a cardiac tamponade. Who manages your EP lab? Shirley Goodman, RN, BSN is our Direct Supervisor, with Dennis Holloway, BA, CVT, as our Department Director. Together they manage the EP lab as well as the cardiac cath lab. Is the EP lab separate from the cath lab? How long has this been? Are employees cross-trained? No, the EP lab is not separate from the cath lab. Out of 40 employees in our cath lab, we have 5 dedicated personnel who run the EP studies; however, all of our nurses are trained to circulate EP cases. Do you have cross training inside the EP lab? What are the regulations in your state? We have an exceptional staff who have learned EP studies. We have 3 RTs: Adrian Warren, Tim Powell and Walt Baltrym, and 2 RNs: Linda Hood and Dana Rushing, who are trained and cross-trained to operate the stimulator, mapping, LocaLisa, and ablation equipment. There are 13 other RNs who can circulate as they give the necessary medications to the patients. 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? LocaLisa and 8 mm tip ablation catheters have been introduced, with the 8 mm catheter allowing for less exposure time to x-rays by the staff. Who handles your procedure scheduling? Do you use a particular software? How do you handle physician timeliness? We have a central scheduling department. The doctor s office or secretary from the inpatient side calls Central Scheduling to schedule a day and time for the particular procedure. Tempus is the software we currently use. The physicians know ahead of time when their procedure is scheduled. Most of the time, they have other procedures scheduled on the same day in the lab, which makes it easy to coordinate their timeliness. How is inventory managed at your EP lab? Who handles the purchasing of equipment and supplies? Inventory is handled through Pyxis and Central Supply. We have a full-time inventory tech who stocks and orders according to our Par and Reorder levels in Pyxis. We also maintain a visual inspection of our inventory. Has your EP lab recently expanded in size and patient volume, or will it be in the near future? EP procedures have increased from fiscal year 2004 to 2005 by 10%. This last year, we performed over 280 EP studies and over 800 implants. How has managed care affected your EP lab and the care it provides patients? Clinical practices and services we provide to our patients is exceptional. We take pride in our service and outstanding care. 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 throughput? We currently reprocess our diagnostic EP catheters and use as little disposable equipment as possible. Due to our own Value Analysis Team, who looks at best pricing and products, we developed a special disposable procedure tray that was a cost savings over a 12-month period of $44,000. We also negotiated on pricing of EP catheters that will equal a savings of $23,000 annually. Does your EP lab compete for patients? Has your institution formed an alliance with others in the area? There is no direct competition in our area. We have patients from all over the panhandle area of Florida who come to Bay Medical Center. What procedures do you perform on an outpatient basis? Currently, tilt table procedures and electrophysiology studies without ablation are done on an outpatient basis. How are new employees oriented and trained at your facility? New employees are placed with a preceptor for 90 days. During that time, they gradually learn all procedures, and protocols and are reevaluated weekly. What types of continuing education opportunities are provided to staff members? We send our staff to as many conferences and seminars as possible. Representatives from our vendor companies do inservices as needed. How is staff competency evaluated? We have yearly (annual) competencies that we go through that are department specific. However, at present, the EP staff is continually training and learning from each other, as well as from the physicians. How do you handle vendor visits to your department? All vendors must check in with the purchasing department before coming to the cath lab. Competitive vendors may not come on the same day, and all must have physician permission to enter the procedure room. Does your lab utilize any alternative therapies? No, we do not. Please describe one of the more interesting or bizarre cases that have come through your EP lab. We recently had a patient who was diagnosed with SA nodal reentry tachycardia. How does your lab handle call time for staff members? 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? The EP staff is cross-trained in all cath lab procedures; therefore, they can take call with the rest of the CVL staff. We take call on average 3-4 weekdays during the month and only 1 weekend a month. On average, we are called in about every third day. We usually stay and finish all cases and help each other so the call staff doesn t have to stay late. Our call teams consist of four people: generally two techs and two nurses, unless the nurse has been cross-trained to scrub. Then there can be three nurses and one tech, or even four nurses. Does your lab use a third party for reprocessing? Yes, we do. We reprocess several of the EP catheters that generate a big savings. Do you perform only adult EP procedures or do you also do pediatric cases? Is there cross training for pediatric cases? We only perform adult EP procedures. What trends do you see emerging in the practice of electrophysiology? As companies compete for business with newer and better products, there is a trend toward longevity in generation life, as well as therapies that can be delivered by a device and the amount of arrhythmias the device can recognize. With the current implants of biventricular devices, we are seeing more implants of these devices and fewer restrictions by insurance companies on coverage of these implants. Does you lab undergo a JCAHO inspection? Yes. We are due for re-accreditation in November 2005. Does your lab provide any educational or support programs for patients who may have additional questions or those who may be interested in support groups? No, we do not. Give an example of a difficult problem or challenge your lab has faced. How it was addressed? Our EP cardiologists would love to have a dedicated EP room with dedicated EP staff. We are working with administration and Six Sigma team in potentially achieving this goal. Our present EP personnel are cross-trained to perform all other procedures in the lab and take call with the rest of the staff. We share responsibilities in our lab and have a great team. Describe your city or general regional area. How does it differ from the rest of the U.S.? Our area is a mixture of young adults to retirees. During the summer, we see many tourists and young people, while during the winter we see the Snowbirds (visitors from up north and Canada). The population tends to be rural with a booming population ever closer to the city locations. The biggest income provider for the city and county is the tourist industry. We have an Air Force base, Navy base, and other military facilities within a 100-mile radius. The housing market has recently experienced a 40-60% increase in property values. Bay County has been marked as one of the fastest growing counties in the US. Panama City Beach is listed in the top 10 of the World s Most Beautiful Beaches. Please tell our readers what you consider unique or innovative about your EP lab and its staff? I believe you could question any of our staff and the answer would be how well we work together as a team. We work long and hard hours to take care of all of our patients, and the day is done when the last patient procedure is completed. We find humor in every day, and everyone enjoys their job and is proud to be a part of our team. The entire cath lab, including EP, Recovery and Ancillary staff total 42. We are proud of the fact that we currently have a 100% retention rate. The most recent "Employee Satisfaction Survey" this year was 91% in employee satisfaction.