Email Discussion Group: December Roundup!

It’s been a busy year for EP Lab Digest’s discussion group — I truly appreciate all of the help of those who participated! Unfortunately, there were also some questions that did go unanswered in 2008; take a look at the questions below and let us know if you can help answer any of them! You can respond by emailing us at eplabdigest@hotmail.com or visiting us online at www.eplabdigest.com. Remember, when responding to the discussion group, don’t forget to let us know if you would like your name and/or location listed. From February 2008: Inventory/Charging Does any lab use technology (bar coding, cabinets, etc.) to help them with their catheter and equipment inventories and charges? What technology, and how well does it work for you? Any input would be helpful. Thanks! — Dale R. Beatty, RN (To reply to this question, please type Inventory/Charging in your subject line.) We have been using the Pyxis system for our equipment, inventory, and charges. The cabinets are user friendly as we were able to set up the cath lab, EP lab, and vascular labs independently. We also have the system set up for our devices. It seems to work well and keeps our inventory under control. We also have someone within the department that keeps up with the changes needed. — Connie, Meriter Hospital, Madison, WI From April 2008: Hands-On Training Are there any symposiums or classes available in the United States that provide hands-on EP training? — Heather Vardon, Aurora BayCare Medical Center, Green Bay, WI (To reply to this question, please type Hands-On Training in your subject line.) From May 2008: Diastolic Time Indices I am a cardiology fellow at the University of Utah. My question is why aren’t abnormal phonocardiographic indices such as pre-atrial diastolic time and accelerated atrial diastolic time in heart failure used? Is the shortened diastolic time due solely to the abnormal systolic time intervals (prolonged EMD)? — Osman Ahmed, MD, University of Utah, Salt Lake City, UT (To reply to this question, please type “Diastolic Time Indices” in your subject line.) From June 2008: Mobile EP Labs I was wondering if anyone is aware of any functioning mobile EP labs? I have found little information on mobile electrophysiology laboratories. I am specifically wondering how one is set up, the cost to run a mobile lab, funding for the lab, and how staffing works for this type of facility. — name withheld by request (To reply to this question, please type “Mobile EP Labs” in your subject line.) From June 2008: Conscious Sedation The discussion of “moderate sedation” or conscious sedation has been the subject of a lot of discussion in our lab. We are supposed to be sedating moderately, but we often find the physicians pushing for deeper sedation for DFTs. Currently we do not use CRNAs or anesthesia for this purpose; the RNs in the lab maintain adequate sedation levels. I've recently been researching “procedural sedation” to see if that would better describe what we do as opposed to moderate sedation. I continuously am searching for standards of practice for sedation in EP labs, particularly for long cases and DFTs. Any discussion would be helpful. — Jill, RN (To reply to this question, please type “Conscious Sedation” in your subject line.) In our lab, sedation varies somewhat with each physician. We do use propofol and do a good amount of deep sedation for those long ablation cases. For devices we do moderate sedation and then propofol bolus for DFTs; it would be inhumane not to use deep sedation for DFTs. All EP RNs go through a designated training module for deep sedation; any cath lab RN interested in cross training must go through the module also. I am willing to share our process. We have annual competencies and in-servicing by anesthesiology. All conscious sedation throughout the hospital is tracked by a conscious sedation committee. We are working on risk stratification for sedation in order to screen for anesthesia-monitored sedation. — Martine Kinman, RN, CCT, RCIS, FSICP From August 2008: Procedure Scheduling I am looking for references pertaining to block scheduling of procedures in EP labs. Does anyone use this method and what are the rules? — LeeAnne Hockey, RCIS, Sentara Heart Hospital, Norfolk, VA (To reply to this question, please type “Procedure Scheduling” in your subject line.) We currently use a form of block scheduling. We took an average of times for procedures and use these as our blocks (i.e., a pacer takes two hours, so that is what is scheduled for within our schedules). An atrial fibrillation ablation is slotted for six hours. These aren't absolutes, and procedures as we all know can be longer or shorter than this, but it does give our scheduler an outline. I have heard of places that take the patient off the table if the physician is not there in a timely fashion — currently we don't do this. We just worked with our physicians to have a plan, and work within the plan. — Connie, Meriter Hospital, Madison, WI From October 2008: RCES Exam I am planning on taking the RCES exam and have two questions: 1) Do you know of any review seminars for this exam or review materials? 2) If you have taken the exam, what (if any) compensation did you receive from your place of employment (i.e., increase in pay, step/level increase)? — Janeen Jones, RCIS (To reply to this question, please type “RCES Exam” in your subject line.) Because the RCES exam is relatively new, I know of no organized seminars designed specifically for review and preparation of the exam, like there are for the RCIS exam. I suspect they will be available soon. Cardiovascular Credentialing International (CCI) offers a self-assessment exam, to help measure your preparation to sit for the RCES exam. Information regarding this self-assessment exam can be found on CCI's website at “http://www.cci-online.org”. In our facility, we have offered a 5% pay increase as an incentive for becoming registered as either an Electrophysiology or Invasive Specialist. — Doug Passey, Director, Cardiology Services, Ogden Regional Medical Center I took the RCES exam in April 2008. The materials I reviewed were what was listed in their reading list. I have not seen anyone advertising a review program. Regarding compensation, the hospital paid for the exam once I showed that I passed it. I was able to go to a Level 2 position on our clinical ladder that was developed for EP. This gave me a 5% increase in pay. We have worked very hard on our clinical ladder to work within the lab. — Connie, Meriter Hospital, Madison, WI I had taken the exam in June 2008; at that time I had also been looking for seminars or classes. Unfortunately, I was unsuccessful with finding any. With this being a newer test, nobody has really started any programs or study guides. I basically took the test without any study material and was able to pass it. I did find it helpful to ask our doctors some questions. They are very receptive to us asking them questions. I have been doing EP for approximately 5-6 years. We are located in Wisconsin, and just like the RCIS test, there is no pay differential or bonus. — Jerry Jones First of all, thank you for your consideration in taking the CCI RCES exam and advancing your profession in electrophysiology! Allied health care accreditation and certification is so important, and so few take advantage of the opportunities placed in front of them. In reference to your first question regarding review seminars for the RCES exam, I have not heard of any, more than likely because the certification is so new. What I would recommend is that you take some time to review a few basic textbooks for the EP professional: Electrophysiologic Testing, Fourth Edition by Richard N. Fogoros MD, Practical Electrophysiology (First Edition) by Todd J. Cohen, MD, and Wes Todd’s RCIS review course on CD. These two textbooks and CD program will give you the foundation for most of the questions on the exam. If you have been functioning in the EP setting for a while, the test should not be that difficult. Pay special attention to questions regarding pre-procedural and intra-procedural patient care, and communication issues. This is not a test that just examines your intimate knowledge of EP alone. As far as your second question is concerned, to the best of my knowledge this is not a certification that is currently mandatory anywhere. Pay increases or step incentives are issues you will probably have to work out with your current employer. We were able to negotiate with our institution for compensation for the cost of the exam. Once certifications such as RCIS and RCES become accreditations recognized at the national, state or local levels, then pay incentives may be more justifiable. I took the exam not to increase my pay or move me up the proverbial clinical ladder, but instead to challenge myself to obtain a certification that made me proud to be part of a team of professionals who work in the field of electrophysiology. Best of luck! — James H. Combs, RCIS, RCES, EMTP I believe the SASEAP symposium coming up in September 2009 is planning a session for the RCES review as well as some “hands-on” lab simulations. Our facility compensates RCES and RCIS staff with a $2.00/hour increase in pay. — Kelly Williams, EP Manager