When the 372-bed Grandview Medical Center opened its doors in October 2015, significant investments had been made in electrophysiology (EP), including 3 state-of-the-art laboratories, a dedicated EP team, and strategic partnership with a local cardiology group. Over the past year, the Grandview EP program grew rapidly to become a high-volume EP center. In 2016, we performed over 2000 procedures: 1050 ablations (800 of which were atrial fibrillation [AF] ablations), 500 cardiac implantable electronic device (CIED) insertions, 70 lead extractions, 70 left atrial appendage occlusion device (WATCHMAN, Boston Scientific) implantations, and many implantable loop recorder implantations, cardioversions, and transesophageal echocardiograms (TEEs).
The increasing volume and sophistication of EP procedures has resulted in the need for dedicated EP laboratories and support staff at most high-volume centers. Moreover, as the EP field has matured, standards specific to its unique requirements which define the critical components and processes of a modern EP laboratory have emerged. A 2014 consensus document1 by the Heart Rhythm Society (HRS), developed in collaboration with and endorsed by the American College of Cardiology (ACC), the American Heart Association (AHA), and the Pediatric and Congenital Electrophysiology Society (PACES), as well as endorsed by international EP societies, provided hospitals and physicians with the recommended requirements for building and maintaining an EP laboratory with excellent patient outcomes while minimizing risk for physicians and staff members.
In May 2016, we learned about the newly created Cardiac Electrophysiology Accreditation program, launched by the HRS in partnership with the Intersocietal Accreditation Commission (IAC), PACES, and the Society of Invasive Cardiovascular Professionals (SICP). The purpose of the IAC Cardiac Electrophysiology Accreditation program is to improve patient care via guidelines and standards. It is designed to accredit hospitals that perform cardiac electrophysiology procedures when the facility meets benchmarks for quality based on resources, training, and outcomes. We viewed achieving accreditation as an opportunity to enhance our EP service. Our goal was to use the accreditation process as a vehicle to create and update appropriate protocols, as well as to develop quality improvement (QI) programs to ensure our continued growth with an emphasis on quality and patient safety.
IAC accreditation is voluntary, and it provides accreditation in 3 areas: Testing and Ablation, Device Implantation, and Chronic Lead Extraction.
Our first step was to engage the HRS and IAC to assist us in initiating the process. These organizations provided extensive materials that helped and coached us through the process. This toolset became the framework as we compared the needed documents and protocols with what we had in place.
To coordinate our accreditation effort and also as a necessary component of it, a separate EP Quality Committee was created. Initially, we had weekly meetings to guide the process, but we have since transitioned to once a quarter. The most important tasks of the committee were to:
- Review, update and create the necessary protocols. The main goals of the protocols are patient and staff safety. Updating our protocols to reflect these standards ensured that essential steps were in place to prevent complications and to efficiently manage a complication if it occurred.
- Create Quality Improvement projects.
- Create a quarterly review of outcomes and complications.
- Revise training and credentials required for EP physicians, nurses, and technicians.
- Standardize procedure notes and patient care processes.
- Create an educational program for the hospital staff on EP services, with special emphasis on atrial fibrillation.
The EP laboratory staff, electrophysiology physicians, and ancillary staff participated in all stages of the process. This group effort allowed for a better understanding of each team member’s role, improving communication and collaboration.
Over the course of most of 2016, we finalized all the required steps. After a thorough review by the HRS and IAC, we became the first hospital in the Southeast, and one of a few in the country, to earn the accreditation distinction.
Our EP Quality Committee continues to meet on a quarterly basis. It ensures that protocols are current and Quality Improvement projects are moving forward. We continue to review outcomes and complications, and compare our data to published benchmarks and data from other centers. The committee also reviews any EP procedural complications. The ultimate goal is that the processes we have put in place ensure we provide high-quality and safe patient care.
In summary, as EP has matured as a subspecialty, the volume and complexity of the procedures have increased, necessitating standards unique to our specialty. The IAC Cardiac Electrophysiology Accreditation program has empowered us to take a closer look at our patient care processes. In choosing to pursue accreditation, we have been able to compare our processes to a gold standard framework and utilize their toolset to further enhance our program and our strong commitment to quality. An added benefit of our group effort is that our EP team has become more cohesive. All the necessary steps to ensure patient safety and quality outcomes are in place. The EP Quality Committee assures that we will maintain these high standards of care and meet new challenges as our field continues to evolve.
Disclosures: The authors have no conflicts of interest to report regarding the content herein.
- Haines DE, Beheiry S, Akar JG, et al. Heart Rhythm Society expert consensus statement on electrophysiology laboratory standards: process, protocols, equipment, personnel, and safety. Heart Rhythm. 2014;11:e9-51.