Background and Introduction The intent of this article is to familiarize the reader with not only the minimum standards associated with the design of electrophysiology labs, but also guidance and innovations in the planning and design of EP labs. Through personal experience, it is not uncommon to find the EP lab being one of, if not the most neglected physical component of the Cardiology Department. Often, the EP lab is found to occupy the oldest, smallest, or more remote areas of the department. Staff often become accustomed to working in these conditions and are not aware of standards and innovations that would facilitate a more productive environment. This occurs despite the fact that the EP lab requires the greatest amount of supporting equipment, supplies, work space and functionality. Prior to embarking on an expansion program, equipment upgrade, or lab modernization, physicians and technicians should make themselves aware of key strategies in innovative EP lab design to maximize their opportunity for improvements in efficiency and work flow. Compliance with Minimum Standards The American Institute of Architects and the Facility Guidelines Institute, Inc. regularly update, revise and publish the Guidelines for Design and Construction of Hospitals and Health Care Facilities. This document is nationally recognized by Federal and State government bodies, departments of health and other authorities having jurisdiction over the design and construction of hospitals and healthcare facilities. Section 5.4 of the Guidelines addresses Interventional Imaging Facilities, which is written around cardiac catheterization labs. Recent revisions to this Guideline are now inclusive of the electrophysiology lab, and authorities having jurisdiction will hold the EP lab to the same spatial and functional standards as a cardiac catheterization lab. These standards include provisions for a sterile environment, patient preparation, holding and recovery, and support areas such as Scrub Facilities, Control Room, Electrical Equipment Room, Viewing Room, Clean and Soiled Work Rooms and other incidental support services. An often overlooked aspect to the Guidelines is the specific requirement for the facility to provide within the EP lab, a minimum of 400 square feet of clear floor area. This equates to an area in dimension of 20 x 20 , exclusive of fixed cabinets and shelves (Figure 1). This 400 square foot standard is an essential component to the first step in designing an innovative and functionally proficient EP lab. It is recommended that physicians and technicians insist that facility planners and architects appropriately allocate sufficient space to meet not only the minimum floor area, but also factor in additional space for necessary storage and support functions. It is recommended that the minimum EP lab gross room area should be at least 560 square feet in area. EP Lab Departmental Organization and Flow Strategies Outside of the required minimum standards within the lab, additional strategies can be employed to significantly improve the flow of patients, staff and supplies. These departmental strategies will involve further space requisites that will in all likelihood be at a premium, but will yield significant improvements in flow and function. These planning strategies go beyond the EP lab and involve the entire invasive cardiac suite. Figure 2 represents a schematic planning diagram demonstrating the ideal association between the lab and its associated support functions. Note the zoning of the lab and its Patient Care Zone in relation to the Patient Access and Materials Management Zones. This model is not based on a central supply area, rather it decentralizes supplies and materials management. Decentralization of supplies and equipment storage more closely associates the support spaces with the lab, reducing cross circulation patterns and distances traveled by staff for replenishment. Adequate space in the control room facilitates operations and provides needed work areas for both physicians and technicians. A centralized nurse and technician station provides space for interaction, charting, and integration of information sharing and room monitoring technologies. This Patient Access Zone also incorporates alcoves for static placement of stretchers during cases, relieving the equipment load from the patient access corridor. These basic modifications to the standard planning model will improve flow, efficiency and the overall character of the invasive cardiac care suite. EP Lab Procedure Room Planning Strategies Successful applications of internal lab planning strategies will further ensure functionality and efficiency. When planning a new lab, physicians and lab technicians should clearly analyze and understand their work flow process and convey this information to the design professional. Innovative labs are based on the creation of work zones. Figure 3 presents a typical EP lab floor plan. Note the creation of specific work zones about the perimeter of the lab. Space has been allocated such that on entry to the lab, users have immediate access to a hand washing station that also contains refrigeration and storage space. An information management work station has been established and is centrally located in the lab, affording access to the patients EMR, PACS, mapping and other systems. Additional storage space within the lab should be provided for the storage of pacemakers. Ideally, at least one console should be provided in the lab allowing for easy access and storage of calibration, stimulation and programming equipment. Through the grouping and access of key zones for work stations, the EP lab work process can be structured to be significantly more efficient. Employ the use of ceiling-mounted booms and surgical lights to further organize the EP lab. In addition, employ the use of multi-shelved equipment booms and medical gas delivery systems to bring services and equipment cleanly and efficiently into the sterile field. Booms can be modified to accommodate programmers and mapping systems, thus providing ready access. Cable runs can be adapted to run through the overhead boom to the information management work station, further avoiding clutter and improving the visual appearance of the lab. Video surveillance tied to the suite s control station will expedite room turnover and patient flow. Magnetic Navigation Planning Should magnetic navigation be planned, staff should be aware of planning issues specific to this process. Room size should be evaluated to accommodate additional equipment requirements. This includes not only spatial issues, but weight and magnetic fringe field issues. The facility should consult with an architect and engineer early in the planning process to ensure the load-bearing capacity of the facility s structural system. Due to the increased weight of these systems, floor systems may require reinforcement. A site placement assessment should be performed to evaluate not only the load-bearing capacity of the building, but access issues in the floor below, which may impact access to the building s structural system for reinforcement should it be necessary. Additionally, staff should be aware of the increased constraints that will be placed on the control room as a result of implementing a magnetic navigation system. It is recommended that a 25% increase in available work station space be provided to accommodate additional systems, thus avoiding control room clutter and congestion. Be aware of proximity issues related to the magnetic navigation system; it is possible that silicon steel shielding may be necessary to amend the fringe fields to safely site this type of system. Integration of Information Management Systems Information management continues to play an ever greater role in the delivery of health care. This does not stop at the EP lab. Innovative EP labs should welcome information management. Information management accommodations can facilitate communication between labs on or offsite, participation in conferences, teaching venues, and intradepartmental communication to facilitate room readiness assessment, room prep and case progress. Wellness Features Innovation also means green. Facilities may wish to implement a LEED (or Leadership in Energy and Environmental Design) program in conjunction with lab improvements. LEED means using sustainable, environmentally-friendly products and building systems. Facilities can retain a LEED Accredited Professional to work in conjunction with their healthcare planner and/or Architect to bring wellness into the EP lab. Those interested in green design should visit www.usgbc.org to learn more about the LEED process. Additional innovations employed to support wellness include the addition of windows to the lab to promote access to daylight (planning should evaluate access to exterior walls for windows), quality lighting, and task lighting at work stations. Be aware of lead-lining issues related to windows if the lab s exterior walls necessitate barrier shielding. Highlights to Innovative Lab Planning In summary, innovation in electrophysiology lab design evolves around the following key issues: Understand the regulatory requirements associated with EP labs. Before embarking on an equipment upgrade or modernization program, be sure to understand space needs and allocations. Start with the basics concerning flow and zoning when planning a department. Be sure to convey your work process to the design professional. Structure your EP lab s physical layout to mirror your work process, equipment and information management system needs. Again, within the lab establish flow and zoning relationships. Build in adequate space for your supplies and equipment to avoid clutter. Employ booms and overhead mounts to gain further efficiencies in equipment management. Be sure to fully understand the needs of special systems such as magnetic navigation, and add additional space into your program needs to accommodate their specific requirements. Plan on incorporating the ever-expanding digital information sharing technologies that are now available, bringing them into the EP lab to improve patient care and gain operational efficiencies. Go Green and incorporate wellness features, natural lighting and sustainable products and furnishings. Ultimately, the success of your new lab will rest in the level of involvement you and your staff provide in its planning. Get involved with your design professional, invite them into your lab, and involve them in your procedures and work flow. Only you and your staff know how you work. Convey your patient care process to the architect, review their work, be sure you understand how to read the drawings, and insist on innovation. If you do, your lab will be a success.