Andrea Riefenstahl, MBA, RN is the Director of Electrophysiology and Pacing at Lancaster General Hospital (LGH). Tell us about your medical background and how you came to work in the field of electrophysiology. What interested you about this field? I have been an RN for 30 years. I attended the University of Pennsylvania and graduated from the Lancaster General Hospital School of Nursing. I worked for many years in critical care and cardiology, and also spent several years as a Nurse Manager and house-wide Nursing Supervisor. I cared for post open-heart surgery patients when Lancaster General started an open-heart program in 1983. I earned a BS in Healthcare Administration in 1996, and received my MBA in May 2010. The opportunity came up to work with the EP staff and physicians 8 years ago when the manager left the organization. I worked with this group of physicians and understood their expectations. Cardiology was in a service line configuration, providing lots of contact with the EP manager and staff. The EP procedures they were doing were very interesting and unknown to most other clinicians. Since EP was in the early developmental stages, I implemented many of the successful strategies used to build a strong nursing department at LGH within the EP department. Describe your role as Director of EP and Pacing at Lancaster General Hospital. What is a typical day like for you? The director role provides long-term oversight and direction, along with the section chief, for EP services. My main responsibilities are handling budgets, building new programs, monitoring outcomes, building the team (doctors and staff), patient satisfaction, and maintaining strong ties with ancillary departments such as nursing and anesthesia. In addition, I actively work at building community and other non-profit relationships by volunteering for the American Heart Association and United Disabilities Services. What is one of the more unusual EP cases that you have ever worked on? Several years ago, a patient presented for a device; this patient had what folks would consider a misunderstood and scary disease due to its potential to be contagious. This made all the providers fearful of providing care. I found a local expert to come in and talk to everyone who would be involved in the case. I also asked the patient’s wife to come in and talk to us about her husband. The day the patient came in, the team felt like they already knew him and his family personally. All the necessary safety steps were taken, and great care was provided to the patient and wife. Several weeks after the procedure, I followed up with a phone call. Both the patient and wife were thrilled with the outcomes. The patient was treated with utmost respect. The patient and his wife sent in small gifts for key staff members who provided care in a very empathetic and genuine manner. Recently we learned that this patient died. The entire EP team and physicians signed a card for the wife and wrote online condolences via the funeral home’s website. The coordination of the events for the procedure was very time consuming, but in the end, extraordinary care was provided. What aspects of your work do you find most rewarding? What is most rewarding is ensuring a great workplace environment and then stepping back and allowing the team to accomplish great outcomes. A great work environment encompasses many things, such as state-of-the-art equipment, dedicated and committed staff members and physicians who have a voice in how they practice every day, strong educational support, and visionary hospital leadership. My overarching goal is to create the desire for the staff and physicians to come back the next day and do it all over again. If I can meet the needs of the staff and physicians, our patients and their families ultimately benefit. What initiatives have you implemented as director that you have found to be most successful? EP had a high rate of case cancellations at one point due to volume and duration of cases. Strategies were developed to reduce cancellations. We developed a Pre-EP clinic to help streamline patient readiness for outpatient procedures, which helped to reduce our cancellation rate to 1–2%. Device infection rates are below 0.03%, for an annual device volume of >1,300, which is fabulous. The chart of each patient who develops a device infection is reviewed thoroughly to look for trends or information that would change clinical practice. I was also intimately involved in laying the groundwork and providing help on the pre-work for the first accredited degree-granting EP program at Lancaster General College. The program was more than 7 years in the making. In addition, we implemented a clinical ladder program for the EP techs, closely mirroring what had been done in nursing. Currently 60% of the RNs and 100% of the technologists participate in their respective clinical ladders. Finally, the Core Group was developed 8 years ago, with membership changing periodically. Core Group members are the communicators in the department. Their role is to be representative of the other staff members in determining how EP functions. This committee of five works closely with the EP supervisor in day-to-day operations, and also helps perform team interviews when there is a recruitable position. What advancements do you hope to see in the field of cardiac electrophysiology in the next five years? What specific areas of EP and/or patient care need more attention? I would be interested in more technology and available options to address the radiation exposure concerns for patients, staff, and physicians. There should be standardization among the industry to support real-time reporting of fluoroscopy dosing. The whole challenge related to fluoroscopy reporting and exposure is very important and needs to be addressed. EP is standardizing our internal process here at LGH. We are a beta site developing a software product that would provide real-time accurate dosing. What advice would you give to others in EP who are currently at the start of their career? EP is a very intensive field of practice that takes time and patience. A new practitioner needs to read, learn, and apply! Never stop reading or learning. Do not be discouraged, as it does take some time to understand what the book says and then to apply that to clinical practice. Build a network of support through peers, both internal and external. Use the extensive knowledge of local vendors to help you build confidence. Attend HRS and other nationally recognized educational and training sessions. Has anyone in particular been helpful to you in your growth as an electrophysiologist? Yes, I would like to mention Sue Deck, education coordinator, and Lisha Esbenshade-Smith, staff educator. Sue and Lisha taught me EP 101 and answered my ridiculous questions without laughing...too much! They helped me understand what motivates people in the EP world and then apply that to building a strong program at Lancaster General. Also, Dr. Doug Gohn, EP Medical Director, helped me understand the clinical practice of EP from a physician’s perspective. He has been supportive, always willing to listen and provide appropriate feedback. Describe your involvement with Go Red For Women. My history with the American Heart Association (AHA) goes back 16 years when my father died suddenly at the age of 61 from a massive heart attack. I wanted to be able to give back in his memory. I was on the AHA board for 10 years and served as secretary a good portion of that time. I took a hiatus for several years, helping at times with events such as coordinator for the Heart Walk at Lancaster General. Last year a friend and manager in the non-invasive department agreed to chair and plan the Go Red For Women event in May. She asked me to help, and of course, I said yes! This reignited my love and passion for the AHA. The theme for this year is heart disease and women through the ages. The event is Friday, May 6, 2011, and includes educational sessions such as Know Your Numbers and Financial Wealth. There will be a fabulous silent auction, followed by a luncheon and fashion show sponsored by Macy’s. The fashion show will feature mother and daughter duos walking through the audience interacting with attendees. There are 3 speakers slated for the afternoon: Hannah Brewer, 13, Miss Appalachia’s Outstanding Teen 2011, who has a personal knowledge of how heart disease impacts families and a passion for educating teens about heart disease; Dr. Scott Deron, a local cardiologist with the Heart Group at Lancaster General Health, who will be sharing his thoughts on the mind, body, spirit connection and how that relates to heart disease; and Rebecca Sieg, a young heart disease survivor who will tell her story and encourage attendees to get involved in the movement by financially supporting the Go Red For Women. Additional information and tickets can be purchased via the website at www.heart.org. You can also follow our progress on Facebook. I am looking forward to the event. It has been a labor of love. Is there anything else you'd like to add? At Lancaster General there is a commitment to support successful programs. EP has certainly had the support of hospital administration, and for that we are grateful. The administration’s support has allowed us to increase staffing, build new rooms, start an EP degree-granting program, and develop the skill sets of the staff and physicians. To that end, the EP staff love to have others come and visit. We feel part of our role is to provide education and support to others who are just beginning the journey or want some fresh ideas. Lancaster General is committed to being a leader in the industry.