Community Memorial Hospital

Dr. Ishu V. Rao, Director of Electrophysiology Services Ventura, California
Dr. Ishu V. Rao, Director of Electrophysiology Services Ventura, California

What is the size of your EP lab facility and number of staff members? What is the mix of credentials at your lab?

Our EP lab is a single lab in a three-lab complex that houses procedures including interventional radiology, cardiology, and EP. Our EP team is comprised of a nurse, two CVTs, and an X-ray tech. We also utilize anesthesia services for most of our cases.

When was the EP lab started at your institution?

Our EP program was started five years ago when Dr. Rao was recruited out of a busy heart hospital in Dallas to lead the development of the EP service line. Prior to that, the hospital had only performed simple AV node ablations and pacemaker implantations What types of procedures are performed at your facility? Approximately how many are performed each week?

The lab performs anywhere from 8 to 15 procedures each week, including ablations for atrial fibrillation, atrial flutter, supraventricular tachycardia, and ventricular tachycardia, as well as pacemaker, ICD, and CRT implantations. Additionally, we perform lead extractions in the cardiac OR.

Who manages your EP lab?

Our EP lab coordinator is Junior Nanalis, CVT. He has been the “EP Champion” from the inception of the lab and coordinates all aspects, including product ordering and management, education of staff, and staff assignments.

Is the EP lab separate from the cath lab?

Our EP lab is a shared lab with the cath team. Two to three days a week, we are a dedicated EP lab. On the other days, cases in the lab may include procedures from any of the disciplines (IR, cath, or EP).

Do you have cross training inside the EP lab?

Our staff is being cross trained such that any team member can scrub, monitor, or operate the recording and stimulation system.

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?

In the next few weeks we will be installing a Stereotaxis Odyssey monitoring system. We have taken this opportunity to also reconfigure the physical layout of the lab to create smoother workflow. Additionally, we intend to create a robust EP educational system for our staff and for the floor, telemetry, and CCU nurses. Our vision is built around the central concept of education and that if everyone that cares for EP patients is knowledgeable about the disease states and treatments, our patients will have improved outcomes.

Who handles your procedure scheduling? Do you use particular software?

Our procedural scheduling is primarily coordinated by Tina Trotter. She is in close contact with the individual physicians’ office schedulers, as well as with anesthesia and vendors.

What types of quality assurance measures are practiced in your EP lab?

Standard OSHA and JCAHO requirements are rigidly adhered to. “Time-outs” are imperative before the cases commence. Post procedurally, our dedicated Cath Recovery Unit monitors patients until they can be safely transferred to a floor, telemetry, or CCU bed.

Has your EP lab recently expanded in size and patient volume, or will it be in the near future?

Our EP lab is constantly growing as the community and its physicians become more aware of the state-of-the-art care that we are capable of delivering. In addition, we are adding new procedures to the service line, which expands the patient volume.

How has managed care affected your EP lab and the care it provides patients?

As Director of EP Services, Dr. Rao meets regularly with Diane Cornell (cath lab manager), the chief operating officer, purchasing director, and chief financial officer of the healthcare system to discuss upcoming or ongoing changes in reimbursement.

What measures has your EP lab implemented in order to cut or contain costs?

We have always aggressively monitored revenue and costs, and try to keep disposable and implantable costs low. We are considering a limited vendor contract for implantable devices, and we recently began resterilizing EP catheters.

How are new employees oriented and trained at your facility?

When new employees join our lab, they receive a mentor to “shadow” and learn from. Workflow, equipment, and procedures are often new to them, and this allows them to be absorbed into our culture. After some time, we try to allow them to take on individual tasks with a backup, and then to work solo.

What types of continuing education opportunities are provided to staff members?

Dr. Rao provides regular lectures on EP topics not only to the EP team, but to the nurses throughout the hospital. The cornerstone of our philosophy is education, and we feel that everyone in the hospital who cares for the EP patient is part of the team. Additionally, the EP staff are given opportunities to attend various EP conferences and have made site visits to centers of excellence as well.

Please describe one of the more memorable cases that have come through your EP lab.

Many cases come to mind, but one that made a lasting impression involved a 21-year-old girl who totaled her car by hitting a tree at full speed. She and her six-week-old son in the back seat were miraculously unharmed. She was brought to our facility and her ECG showed classic long QT syndrome. She recovered from minor injuries and an ICD was placed via a midaxillary incision behind her breast and pectoralis muscle for optimal cosmesis. Her family was evaluated for LQTS as well and luckily, no siblings had the disease. Her mother did have the findings, however, as well as a history of syncope, so she received an ICD as well. This case occurred in my first month here in Ventura. I saw the patient again last week, and she is now doing well and is pregnant.

How does your lab handle call time for staff members?

Because we are a shared cath/EP lab, all of the team members take general cath call. However, the core EP team stays until all of the EP cases are completed on any given day.

Does your lab use a third party for reprocessing?

Yes, we use Sterilmed.

Approximately what percentage of your ablation procedures is done with cryo versus radiofrequency?

We do not utilize cryo; all ablations are performed with radiofrequency energy.

What trends do you see emerging in the practice of electrophysiology?

I believe there are two big trends we will see. The first is that smaller communities and practices will start hiring EPs to practice some proportion of EP and the remainder general cardiology. This will allow EPs to stay in larger communities in hospitals, with the finances capable of supporting an advanced EP program. Smaller practices will find that they need to offer EP services in-house, but they may not have the volume to do so. General cardiology will be required to offset the lack of EP volume for the electrophysiologist. Secondly, I think hybrid procedures will begin to take hold more and we will see further collaborative efforts between EP and interventional cardiology, or EP and cardiac surgery.

Describe your city or general regional area. How does it differ from the rest of the U.S.?

Our hospital, located in Ventura, California, is a 250-bed hospital serving a population of 400,000. Our community is small and tight knit. Physicians are integrated into all facets of the local society, and many are well known for other ventures outside of the hospital. Patients in the community are very loyal and eager to support our efforts to bring “big city” medicine to this small surf town.

Please tell our readers what you consider unique or innovative about your EP lab and its staff.

Our EP lab and staff pride itself above all else on its concept of “team.” We have tried to create and maintain a culture that breeds cooperation and satisfaction. We believe that intellectual satisfaction and mutual respect for one another make our workdays enjoyable and worthwhile.

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