Spotlight Interview: Sunrise Hospital & Medical Center

Pamella Leslie, RN, BSN
Pamella Leslie, RN, BSN
What is the size of your lab facility and number of staff members? What is the mix of credentials at your lab? We currently have one interventional electrophysiology laboratory, three coronary intervention rooms, one Pediatric Bi-Plane interventional room, one peripheral vascular suite, and one implant room. On March 28, 2005, two new state-of-the-art flat panel GE rooms were added to bring us to seven labs.To augment our service line, we have a clinical educator, inventory specialists, EP Coordinator, Cath Lab Aide, scheduler, and clerical support staff. What types of procedures are performed at your facility? Approximately how many are performed each week? We perform a multitude of procedures in our lab, servicing neonates through geriatric age groups. Procedures include: Diagnostic left and right heart catheterizations Coronary Interventions AFib Ablations Device Implants (adults and pediatrics) EP studies (pediatric and adult) Ablations (radiofrequency and cryoablations) PFO, ASD, VSD closures Peripheral diagnostics/interventions IABP insertions Carotid Stenting (coming soon) 3D mapping Loop recorders Congenital heart anomaly interventions Alcohol septal ablations We service over 100 patients per week and implant approximately 1,000 devices annually. What procedures do you perform on an outpatient basis? Our outpatient procedures include diagnostic heart caths, peripheral diagnostics, cardioversions, generator changes, EP studies, ablations, some congenital closures, and loop recorders. Do you have cross training inside the EP lab? In our EP labs, one RN circulates, one tech scrubs, and one tech assists with monitoring equipment. Anesthesia is present on all pediatric and EP cases. Staff are cross trained to function in the main cath lab providing a more efficient work flow. What are some of the new equipment, devices, and products introduced at your lab lately? In the last year we have introduced new stimulators, RF perforation system, upgrades to generators, mapping systems, upgrades to our IVUS technology, and cryoablation.We are the first facility in the state of Nevada to offer this new ablation technology. Partnerships with our device vendors brings the latest device technology to our EP lab. Is your lab filmless? Currently we are running a completely digital lab that is integrated into the Gemnet archiving system by GE. This allows us to have reviewing stations in separate areas of the department as well as surgery for the CV surgeons. Recently our hospital installed a PACs system, which will eventually allow our labs to be linked throughout the hospital. We are able to maintain an efficient flow by immediately archiving each case after the procedure is complete, enabling access for physician review. How is inventory managed at your lab? Who handles the purchasing of equipment and supplies? Managing inventory has always been a struggle for our cath lab in particular, due to the size and complexity of procedures. Specialized equipment is utilized for our pediatric patients, but like many labs, we struggle for shelf space. Strong relationships with our major vendors have proven to be very successful in managing our inventory. We are in the process of evaluating a computerized inventory system that will assist with cost containment and analysis, ordering, and management of expired products. It is our goal to have an inventory system in place by 2006.We have two inventory specialists that are responsible for ordering, stocking, and managing our lab supplies and implantable devices. Has your lab recently expanded in size and patient volume, or will it be in the near future? In March 2005 we added one additional coronary interventional lab, and have plans on consolidating our recovery area to 30 beds. Our pediatric interventional volume has increased by 135% since last year, and our EP volume has grown exponentially as well. Currently we are under construction installing new GE imaging equipment and redesigning a new EP laboratory. This will allow us further opportunity to expand our EP program. Is your lab involved in clinical research? We are an active participant in cardiology research in our community and currently have 25 open cardiology procotols. Additionally, Sunrise conducts physician Bi-V implant education in partnership with Guidant Corporation. A two-day hands-on teaching course conducted by one our electrophysiologists brings physicians from all across the country to gain clinical time implanting Bi-V ICDs. What measures has your lab implemented in order to cut or contain costs? In addition, in what ways have you improved efficiencies in patient throughput? Currently, we have a contract with two major suppliers for implantable devices that covers the Far West Division of HCA facilities. While this contract has provided our Division with substantial savings, we continue to explore opportunities to improve product availability, pricing, and physician satisfaction. In addition, we regularly review our CV contracts with vendors to explore shifting market share to obtain better pricing on products based on sole source, dual-source vendors, etc. It is a fine balance between containing costs, maintaining a superior product line, and physician satisfaction.We have moved all of our higher priced items over to consignment to minimize our expenditures on expired products. Does your lab compete for patients? Has your institution formed an alliance with others in the area? Las Vegas has become a competitive market in adult interventional cardiology. Quality of imaging, available technology, and efficiency of lab turnover time has played a major role in competing for market share. It is an area that we never take for granted. Sunrise Health encompasses three HCA facilities located in the Las Vegas Valley; Sunrise Hospital, Mountain View, and Southern Hills. Collectively as a market we provide quality cardiology services that supports the mission and vision statements of our organizations. We take a proactive approach with educational opportunities to maintain staff competency and to improve job satisfaction and staff retention. How are new employees oriented and trained at your facility? RNs are required to have a valid nursing license, ACLS, and a critical care background. RT and RCIS are required to have proper credentialing. CVTs are provided on-the-job training if needed, but generally must have a cardiology background and/or acute hospital experience (i.e., paramedic, OR tech, etc.). New employees are paired with a preceptor, and depending on employee s background, orientation can last 2-16 weeks. All licensed staff working with pediatric patients must be PALS-certified within one year. What types of continuing education opportunities are provided to staff members? Various continuing education opportunities are available through our Clinical Educator, Education Department, vendor-sponsored events and various cardiology seminars. We also have an educational fund available to employees; this allows them to attend various cardiovascular conferences. How do you handle vendor visits to your department? We currently have a closed lab to vendors. Vendors are allowed in by appointment only to provide in-services for new products, changes to existing products, and annual in-services on equipment. All vendors must check in with our Medical Staff office and are issued an identification badge before entrance into any areas of the hospital. Our pacemaker reps have Allied Health privileges and have a hospital-issued ID badge. Vendors who have consigned product in our lab are given one day per month to check their inventory levels and remove expired products. How is staff competency evaluated? Staff competency is evaluated annually by performance evaluation and skill days.Our high-risk, low-volume procedures are in-serviced and evaluated a couple of times per year. IABP certification is required of all RN staff and re-certified every 12 months. Does your lab utilize any alternative therapies? We have music available in all procedure rooms, and if patients have a special request for music, we try to accommodate, especially for our teenage patients. Child Life Specialists are utilized for pediatric patients. 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? Our call team consists of four (two RNs and two techs). Our tech mix is generally at least one licensed tech (RT or RCIS) with a CVT. Staff takes call one night per week and one weekend every five to six weeks. Staff that work in EP are exempt from call in the cath lab since their workday varies so greatly. The majority of our staff work 4/10-hour days and have the day following their call night off. We have a separate team that stays after hours to complete cases that may run over, allowing our call team to be available for emergencies.We do not have multiple shifts. Operational hours are from 6:30am - 5:00pm Monday through Friday and closed all major holidays. Give an example of a difficult problem or challenge your lab has faced. How it was addressed? Every department is faced with challenges, and our lab is no exception.Two challenges that we struggle with is control of inventory and throughput of patients. Like many hospitals, we are tight on available beds with many departments competing for the same bed. Often times, our recovery room gets bogged down with hold patients, preventing us from moving patients through our area in an efficient manner. Describe your city or general regional area. How does it differ from the rest of the U.S.? Las Vegas is a unique area of the west.We have a multitude of visitors that come to our city on business and/or vacation and become ill while they are away from home. In addition, we have an influx in our population in the winter months due to seasonal residents, which impacts our volumes. There are several rural areas around Las Vegas that do not offer interventional cardiology services. Often these patients are air lifted to our facility for a higher level of care. At Sunrise Hospital, we do a large number of pediatric interventional procedures, which are long and labor-intensive cases. At times it is a challenge to staff after-hour adult call cases, EP, and pediatric cases simultaneously. For more information about Sunrise Hospital and Medical Center, please visit their website: www.sunrisehospital.com