Genesis HealthCare System

M. Magdy A. Migeed, MD, FACC, FHRS, Tabitha McKenzie, RN, BSN, and Ravin Miller, RN, MSN, Zanesville, Ohio
M. Magdy A. Migeed, MD, FACC, FHRS, Tabitha McKenzie, RN, BSN, and Ravin Miller, RN, MSN, Zanesville, Ohio

Genesis HealthCare System is an integrated health care delivery system based in Zanesville, Ohio. The system includes a 334-bed, not-for-profit acute care hospital that operates at two Zanesville sites — Genesis-Bethesda and Genesis-Good Samaritan. The system also includes an extensive network of more than 300 physicians and multiple outpatient care centers throughout the region. The Genesis mission is to provide compassionate, quality health care, and the system continually strives to meet the needs of the community. The EP lab is located at the Genesis-Good Samaritan Campus.

Genesis was the first organization in the nation to receive Atrial Fibrillation (AF) Certification by the Society of Chest Pain Centers (SCPC) in 2011.

Genesis is in the planning stages of a new, expanded medical center to support its ongoing commitment to provide the highest quality care at the lowest cost and to meet the growing needs of the community. The new facility, which is scheduled to open in 2015, will include two new hybrid OR suites. 

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

In our EP lab, there are eight staff members, including four RTs and four RNs, as well as one electrophysiologist. 

When was the EP lab started at your institution? 

The EP lab opened in September 2009.

What types of procedures are performed at your facility? Approximately how many are performed each week?

We offer a full spectrum of EP procedures, ranging from EPS to AF and VT ablations. The EP lab uses Biosense Webster’s Carto, St. Jude Medical mapping systems, and ICE. We perform implantation of cardiac devices such as loop recorders, pacemakers, ICDs, CRT-P, and CRT-D devices. Documentation and hemodynamic monitoring are completed in the Bard system. We also have three cath labs, one of which can accommodate device implants. 

We perform an average of 95 procedures a month and between 15–20 each week in the EP lab.

Who manages your EP lab? 

Magdy Migeed, MD, FACC, FHRS is the Director of Electrophysiology, Tabitha McKenzie, RN, BSN is the EP Lab Clinical Nurse Manager, Abdulhay Albirini, MD, FACC is the Director of Interventional Cardiology, Ravin Miller, RN, MSN is the Cath Lab and EP Lab Operational Nurse Manager, and Cheryl Jorge, RN, MSN is the Director of Heart and Vascular Services.

Are employees cross-trained? 

All EP lab employees have cath lab experience, but are exclusively dedicated to the EP lab. 

Do you have cross training inside the EP lab? 

All RNs and RTs are cross trained. 

What new equipment, devices and/or products have been introduced at your lab lately? 

The EP lab is equipped with Siemens biplane imaging, Biosense Webster’s Carto 3, St. Jude Medical’s EnSite, ICE, Bard EP, Micropace technology, and Anesthesia services. 

Have you recently upgraded your imaging technology? 

The EP lab was new in 2009; therefore, we are continuing with upgrades as they are released.

Who handles your procedure scheduling? 

The administrative assistant uses Op-Time (EPIC).

What type of quality control/quality assurance measures are practiced in your EP lab? 

Internally, we hold monthly M&M meetings to review complications. We participate in the ICD Registry in order to benchmark data with facilities nationwide. HFAP and ODH are regulating the bodies.

How is inventory managed at your EP lab? Who handles the purchasing of equipment and supplies?

EP lab nurses work directly with the Purchasing Department to replace all diagnostic equipment and ablation catheters. Cardiovascular Purchasing handles the purchasing of equipment and supplies.

Has your EP lab expanded in patient volume? 

Our EP lab services are still a new service line within Genesis HealthCare System and the southeastern Ohio region. Most physicians are still not familiar with the indications for EP and device implantation. Despite this fact, we have significantly grown our volumes since the inception of the program. 

Have you developed a referral base? 

The majority of referrals are through general cardiology and internal medicine specialists in the community and surrounding areas. We continue to make efforts to reach out to PCPs and other specialists to educate them on the services available within our community at Genesis. 

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

The EP lab and Interventional Heart Services have partnered in an umbrella contract dedicating market share in order to cut costs, as well as continually reviewing and negotiating vendor contracts including annual renewals. 

In what ways have you improved efficiencies in patient through-put? 

All elective cases arrive early to the Interventional Recovery Unit (IRU), and there is a standardized process for prepping patients. All IRU staff members are aware of physician and Anesthesia requests, and are able to meet them in an efficient manner.

Does your EP lab compete for patients? 

The competing institution is approximately one hour away. Therefore, this program has the benefit of providing exceptional care and assertive management of CRT and arrhythmias while keeping patients close to home. 

How are new employees oriented and trained at your facility? 

There is a standardized orientation process. The new hire is given an orientation guide list and designated to a preceptor specific to their discipline (RT to RT). A weekly meeting is then set up with the nurse manager with orientee and preceptor to receive feedback on progression. The physician is involved in the orientation process of all new hires.

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

The EP staff is encouraged to attend local, state, and national conferences on an annual basis, gaining exposure to new state-of-the-art technology and networking opportunities. 

How is staff competency evaluated? 

Staff competency is evaluated by completion of orientation guide list, annual department-specific education day, and bi-annual management evaluations. 

How do you prevent staff burnout? 

Opportunities are provided to flex in and out of case rotation due to the high competency level and tenureship of the EP staff. 

What measures has your lab taken to minimize radiation exposure to physicians and staff? 

We make every effort to decrease radiation exposure to everyone in the lab including the patient. Radiation exposure is monitored by the ODH and through monthly reports taken from the dosimetry badges for each individual staff member and physician. These efforts for every case include minimal frames/sec, lead aprons, lead shields, use of the RADPAD® (Worldwide Innovations & Technologies, Inc.), and radiation protection gloves worn by the operator.

Does your staff participate in the follow up of pacemakers and ICDs? 

Genesis offers services on site at the Heart Failure and Device Clinic with the assistance of nurses, techs and nurse practitioners. 

What are some of the dominant trends you see emerging in the practice of electrophysiology? 

With new indications emerging and an increase in technology, the overall volume will increase. To meet the demands in the field of electrophysiology, continuing to build a strong relationship with referring physicians is essential to providing exceptional patient care.

 How does your lab handle device recalls? 

Genesis works closely with most device vendors. The equipment and/or device implants are chosen by the electrophysiologist based on the indication to achieve the best outcomes for an individual patient. The electrophysiologist uses multiple vendors in an effort to decrease the effect of recalls. 

Is your EP lab currently involved in any clinical research studies or special projects? 

Yes; studies with device (CRT) and ablation (irrigation catheters) areas are currently ongoing. 

Does your staff provide educational materials for patients? 

Yes, our patients are provided with device educational brochures. The EP team (EP lab staff and office staff) has expanded to provide our EP patients and their families with pre-and post-procedure education. 

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

Genesis is an integrated healthcare delivery system that offers a level of care not typically found in a community of its size. Genesis offers patients a broad continuum of care and the most comprehensive scope of services available in southeastern Ohio. Genesis is the primary setting for acute care with 80.7% market share in Muskingum County. Genesis’ primary service area is the following six counties: Coshocton, Guernsey, Morgan, Muskingum, Noble, and Perry; the secondary service area includes portions of the following six adjacent counties: Licking, Athens, Washington, Monroe, Belmont, and Tuscarawas.

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

The EP lab at Genesis is unique due to the market served and the comprehensive, complex procedures performed. This program benefits the patients through receiving care close to home. We continue to strive to perform innovative procedures using cutting-edge technology.