Spotlight Interview: John C. Lincoln North Mountain Hospital

Cesar D. Garcia, BAS, RCIS, RT(R) (CI) (ARRT), Director, Cath/EP/Non-Invasive ardiology/Neurodiagnostics, Phoenix, Arizona
Cesar D. Garcia, BAS, RCIS, RT(R) (CI) (ARRT), Director, Cath/EP/Non-Invasive ardiology/Neurodiagnostics, Phoenix, Arizona

Located just north of downtown Phoenix, John C. Lincoln North Mountain Hospital is a 260-bed, not-for-profit community hospital with a highly innovative cath/EP program on the cutting edge of rhythm management and advancement. North Mountain Hospital is home to John C. Lincoln’s Level I Trauma Center. We were also recently rated as one of the Best Regional Hospitals by U.S. News & World Report

As Arizona’s first hospital to earn Magnet Recognition, we continually strive to serve the community with top-rated cardiovascular care in the midst of a competitive marketplace by specializing in cardiac rhythm management techniques that are unique to only a few hospitals in the country

For example, we were the first hospital in the southwestern U.S. to acquire St. Jude Medical’s MediGuide technology. Since this acquisition, we have demonstrated and incorporated tangible benefits from both clinical and economic standpoints, which we believe will shape the future of cardiac rhythm management programs and the basis as to which they are operated. Structuring our cath/EP program on the MediGuide platform will enable future innovations involving minimal fluoro, while also prompting more aggressive developments in EP and future PCI innovations as well. Our road to achieving this milestone took a collaborative effort from hospital administrators, physicians, the construction/design team, and most of all, our cath/EP staff. 

We are excited to share our story with the electrophysiology community, in hopes that we can inspire other programs as well as to formally offer tribute to everyone that made this possible. To the cath/EP team at John C. Lincoln North Mountain Hospital, this accomplishment is yours, as this wouldn’t be possible without you. 

What is the size of your EP lab facility? When was the EP lab started at your institution? 

The cath/EP department consists of two highly utilized suites for cath/PCI and EP. Our EP program opened in 2006, and has encountered a great deal of transition since the acquisition of MediGuide in April 2014. 

What is the number of staff members? What is the mix of credentials at your lab? 

Currently, we are staffed with six procedural RNs, three admitting/recovery RNs, and four RTs. Staff credentials include RNs, BSNs, MSNs, RT(R)s, and RCISs. 

What types of procedures are performed at your facility? Approximately how many catheter ablations (for all arrhythmias), ICD implants, and pacemaker implants are performed each week? 

Our facility performs general cath/PCI, complex PCI, and diagnostic and complex EP procedures, as well as general peripheral vascular interventions. Per week, we perform five to eight complex ablation procedures and 10-15 device implants, which include BiV PPMs, BiV ICDs, PPMs, and loop recorders. Typically, ablation procedures are performed for atrial fibrillation (AF), supraventricular tachycardia (SVT), ventricular tachycardia (VT), PVC, and multiple morphologies of atrial tachycardia. 

Who manages your EP lab? 

The cath lab director manages the cath lab and cardiovascular services, which includes the EP lab, non-invasive cardiology, and echocardiography. Mark Seifert, MD, our acting EP medical director, champions and pioneers the MediGuide technology. Dr. Seifert also serves as a physician liaison, and aggressively assists in furthering EP innovations and proctorship of St. Jude Medical’s EnSite Velocity System as well as Biosense Webster’s Carto 3. Mayur Bhakta, MD is our physician champion on the coronary side of the MediGuide technology; with extensive knowledge and research insight on the RADI wire FFR system and ILUMIEN OCT, Dr. Bhakta was a principle user in the development of these technologies and how they applied to a future-state MediGuide platform. Our cath lab supervisor is an RN and oversees day-to-day operations while also being highly skilled in EP technologies such as Carto 3, EnSite Velocity, and MediGuide. We are an independently operated lab in which we require minimal company support for our MediGuide and EnSite cases, and no support for our Carto 3 cases. Our RT clinical coordinator serves as the lead tech, radiation safety officer, and technical preceptor for cath and EP.

Is the EP lab separate from the cath lab? Are employees cross trained? 

The EP lab is not separate from the cath lab; the labs are combined. With the exception of two RNs with EP specialization for mapping and stimulating, all employees are cross trained in EP to perform basic functions such as circulating, intraprocedural documentation, and scrubbing. This dynamic gives us the flexibility for better coverage, as well as creates opportunities for all staff to experience and familiarize themselves with the basic principles of EP. 

Our current structure is not necessarily agreeable to having EP separate from the cath lab. Unfortunately, productivity benchmarks are not individually set for EP in our system, which means that benchmarking for EP has to correlate to that of cath or another mechanism similar to surgical services. While EP cases tend to absorb the majority of a shift, using case/day or procedure/day may not accurately reflect the actual demand necessary to have an operational EP lab, unless volume is relatively high to negotiate the lulls in any given reporting period. 

Benchmarking values for productivity coincide with each discipline to yield a daily supply and demand model in which both cath and EP reflect a case per day metric, while appropriate staffing is assigned to the demand. With this model, we find minimal need to flex staff due to volume, and can easily compensate for slower days with the increased volume in EP or cath to keep the staff hours relatively secure (given volumes are not abnormally low). This model allows a great deal of flexibility and opportunity for growth while responsibly managing the staff hours across the board. 

Staff members who express an interest in learning EP are interviewed by the director, supervisor, and RT clinical coordinator, and an “on-boarding” strategy is then devised as to a timeline and level of desired expertise. In some instances, a candidate may simply express interest in learning about the EP study, but not mapping. Those interested in mapping must first demonstrate competency in the diagnostic EP discipline. Preceptorship is overseen by our cath/EP lab supervisor, and progress reports are communicated to the director on a weekly basis. The goal is to have our candidates fully independent, with particular consideration to one’s comfort and confidence with the system. Offering financial compensation for Level I and Level II EP RNs/RTs has allowed us to give incentive for the increased accountabilities as well as generate more interest in EP as a specialization. 

What types of EP equipment are most commonly used in the lab? 

The most commonly used equipment in the EP lab are the EnSite Velocity Mapping (St. Jude Medical), EP-WorkMate Recording System (St. Jude Medical), MediGuide (St. Jude Medical), Zonare Echo Unit (St. Jude Medical), Carto 3 (Biosense Webster), CartoSound (Biosense Webster), Mac-Lab Hemodynamic Recording System (GE Healthcare), and the Artis zee system (Siemens Healthcare) with the MediGuide technology. 

How is shift coverage managed? What are typical hours (not including call time)? 

The EP lab operates from 6:30 a.m. to 5 p.m., Monday through Friday. We generally consider add-on procedures to be worked in and around routine exams. Patients’ length of stay and acuity are factors we consider when performing procedures that may extend after hours. We do try to avoid overtime when reasonable and when it does not compromise patient care or overly extend the patient’s length of stay beyond what is typical for the patient’s admitting diagnosis. 

Ultimately, the best mechanism is focused on the patient’s outcome and all factors associated with it. This being said, it may not be in the patient’s best interest to perform a routine EP case at 8 p.m. with a patient NPO for 14 hours, a physician that is four hours late from scheduled start time, and a fatigued EP team that is projected to work a 15-hour day and scheduled to come back at start of shift the next day. It would be difficult to make a strong case that we are offering our patients the very best care if cases like this are typical. Therefore, we take these values into strict consideration in our day-to-day decision making, and feel we have a relatively manageable system in place. 

What new equipment, devices and/or products have been introduced at your lab lately? How has this changed the way you perform those procedures? 

In April 2014, we became the eight site in the U.S. to implement MediGuide for the EP program. In concurrence with the Artis zee C-arm, this technology enables us to utilize a GPS mapping system embedded into the C-arm to perform all EP studies, ablations, and devices with minimal amounts of radiation. We are performing studies such as AF ablations utilizing zero fluoroscopy as well as implanting PPM devices with just a few seconds of fluoroscopy. Utilizing MediGuide technology has also enabled us to implant BiV ICDs in as little as two minutes of fluoroscopy, significantly reducing cumulative fluoro time. MediGuide also allows for more accurate 3D mapping, which allows for a greater scale of correction to compensate for patient movement without the need for re-mapping. Because of this, we have been able to optimize patient satisfaction, safety, and economic factors by performing complex EP studies (including AF ablations) without the need for general anesthesia, and are minimizing hospital stays by discharging patients same day. 

In July, Dr. Bhakta introduced the first MediGuide coronary wire for patient use in the world — a very big step in the innovative capabilities we provide for our patients by manifesting MediGuide beyond traditional EP. John C. Lincoln North Mountain Hospital became the first site in the country to perform coronary intervention using MediGuide technology. At this point, we have not yet demonstrated a significant reduction in fluoro time compared with conventional PCI, but we are hoping to use this experience to advance the MediGuide technology to specifically address coronary intervention in the near future, with Dr. Bhakta serving as the principle trainer and MediGuide expert in furthering advancements of PCI. 

What imaging technology do you utilize? 

We currently use the Artis zee floor-mounted system (Siemens Healthcare), which is the only system FDA approved for MediGuide technology. Supplementary to the Artis zee system, we also utilize syngo.via (Siemens Healthcare) technology, in which images are “post processed” for an assortment of imaging modalities to measure heart structure such as coronary vessel analysis, vascular vessel analysis, 3D remodeling, and image rendering. 

Does your program utilize a cardiovascular information system (CVIS), picture archiving system (PACS), or cardiology picture archiving system (CPACS)? 

We are currently in the process of implementing the CCW/CCI version of Mac-Lab with GE Healthcare’s Centricity CVIS system. We plan to integrate all cardiovascular imaging within our six-hospital network to a common image management system in which live and discrete data can be remotely reported in a structured setting that is compatible with our EPIC EMR system. This will enable practitioners to utilize the Centricity web-based network to access patient medical records from any licensed device anywhere in the network. In regards to EP, the Centricity network has compatibility with GE Healthcare’s CardioLab system, making EP procedures accessible through the CVIS system. Physicians will have the ability to remotely read and report non-invasive imaging such as ECGs, echos, and caths in a structured report setting that is directed into our EMR. In essence, this will simplify the workflow for physician panel reads, as well as make all imaging accessible in the cath/EP lab for immediate reference through any GE workstation. Our vision for the cardiac service line is to create a platform of “one patient, one record” for more efficient and comprehensive workflow and data acquisition. 

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

Scheduling is handled by our administrative secretary, who is the first line for all inquires. Procedures requiring special accommodations or resources are typically approved by our cath/EP supervisor and/or RT clinical coordinator prior to scheduling. We book procedures through our EPIC EMR system. This enables us to keep the entire patient encounter on one system, including scheduling, order sets, med reconciliation, and procedural charges. We are then able to query a wealth of information using EPIC in regards to generating volume and financial reports. 

What measures has your EP lab implemented in order to cut/contain costs and improve efficiencies in patient through-put? 

The design of the MediGuide suite enables us to quickly transition EP studies, minimizing turnover and creating less idle time, so we can fit in more studies without a significant overhaul of the room before and after each procedure. Having the ability to completely mobilize all EP equipment via the booms allows for more mobility of the EP suite in transitioning to non-EP cases. As the boom systems serve multiple functions within the EP lab, we can utilize them for alternative roles in any particular study. 

We have also worked extensively with other departments in formulating turnover and recovery processes that are conducive to a seamless transition for patient recovery. Creating a department specialized in recovery of outpatients has increased our ability to turn over rooms more quickly, and as a department, we are likely to save on all costs associated with the recovery of patients. 

How does your lab communicate necessary information to staff? 

Through our Daily Management System (DMS), we conduct daily huddles every morning just prior to the start of our day. We dedicate five to ten minutes to discuss our daily metrics that include financial stewardship, quality, patient safety, and growth benchmarks. During this time, cath/EP lab leadership discusses the daily strategy in regards to case mix, and a few minutes are dedicated to open forum to discuss general information from leadership and/or from the staff. Topics that require more discussion are tabled for a more formal venue and added to the staff meeting agenda. Although we do not feel DMS communication eliminates the need for staff meetings, it has helped improve the communication of pertinent information on a daily basis. Our cath/EP lab leadership has found great value and benefit in the level of transparency in the coordination of our day, while also creating a casual roundtable setting for staff discourse. 

How do you ensure timely case starts and patient turnover? 

On-time case starts are a very important metric that we have significantly improved upon over the years. Identifying an actual statistic reflecting the percentage of on-time case starts versus late case starts is what we have used to create measures and countermeasures to address case start times in regards to “staff-controlled” events that contribute to cases being done on time. When first presented, the on-time rate for first case starts was less that 25%, which was overwhelmingly poor. The team responded to this feedback, and within a few weeks, we improved to >90% by creating the appropriate mechanism to enable the team to respond proactively to the initial results.

Although physician tardiness is a common issue amongst most cath/EP labs, we have made significant progress on addressing staff-related factors in room preparedness and daily tasking. Physicians that are routinely late are actively tracked, and administratively supported countermeasures such as a “bumping” policy has given cath/EP lab leadership the discretion to create flexibility in the daily schedule to ensure that patients and other physicians that follow are minimally affected by physician tardiness. One of the more underappreciated benefits of the MediGuide suite is that all EP equipment is located on a specialized boom system in which no wires or cabling touches the floor, but is rather streamed through the boom system. This configuration allows the EP team to simply disconnect the patients from the equipment, relocate the cabling to designated zones on the booms, and electronically relocate the booming systems to vacant parts of the rooms, allowing for quick(er) turnover times and a clutter-free area. Since cabling does not touch the floor, we have eliminated the risk of damaging the fiberoptics by having them stepped on or rolled over by mobile carts that house the EP equipment. Condensing the cabling has also made the room exponentially more presentable for our patients, compared to our previous setup prior to the upgrade. 

Does your EP lab compete for patients? Has your institution formed an alliance with others in the area? 

In Arizona, the EP market is very competitive. The continuation of new innovations and techniques is essential in the marketplace. Recently, the John C. Lincoln Health Network officially affiliated with Scottsdale Healthcare to form a single network of collaborating services and specialties, particularly in cardiology. We feel this affiliation has helped develop some of the more intricate processes in the development of cath/EP structures, and how each campus can exist cohesively with the next. As we explore operational impacts of being a specialization center of rhythm management, we have a responsibility to our cohorts to promote and co-promote each service line in a direct or indirect manner. The collaboration with the Scottsdale Healthcare cath/EP leadership team has allowed us to redefine some of our processes and get invaluable insight on their experiences in moving forward with the direction of this program. 

How is staff competency evaluated? 

Staff competency is evaluated by a series of annual competencies reflecting some fixed cath lab competencies, as well as some that are specifically selected by the cath/EP leadership team. All cath/EP staff is required to achieve these competencies prior to yearly evaluations. We work closely with the companies that support our program in providing our team with regular educational opportunities, which oftentimes is geared to satisfy the staff’s annual competencies. Participation in in-services and sponsored lectures off-site are highly encouraged. 

How do you prevent staff burnout? 

Staff burnout is a rather general term that consists of many moving parts, and therefore is very difficult to manage and impossible to eliminate. One of the many contributing factors to staff burnout is a direct reaction to schedule management. Cath/EP days are relatively hectic to say the least, so a particular attentiveness to daily strategy is oftentimes a major oversight. Staff members want what is best for the patient, and certain concessions predicated around the patients’ well-being are typically agreeable to the staff, even if it means a longer day. Staff generally responds negatively to longer days due to schedule mismanagement if the team doesn’t feel that their time is being considered outside of patient care. This area is especially sensitive because it also involves physician satisfaction, even if/when the physician may not be acting in the best interests of the patient or the staff, but of their own schedules. Staff wants to feel supported, and therefore, processes involved in schedule management should be transparent and consistent across the board. Fortunately, we have strong administrative and physician stakeholder buy-in, supporting the cath/EP department management team in making difficult decisions advocating for patients in regards to schedule discipline. Longer days are often better received because the staff members’ initial perception is that, at minimum, all options were exercised, and all diligence was done. While management strongly supports the team, we have an even stronger support for the patient in having their best interests at the forefront of the decision-making process. 

We have also established an annual peer review process in which staff is given the ability to give feedback to a particular peer in accessing overall performance and individual roles. This process began as an RN tool under the umbrella of Magnet designation. We then took this element and implemented it for all of our staff members. We found that it not only encourages open dialogue amongst peers, but also promotes a team accountability in which problems involving staff are rarely escalated when they arise. The team has operated relatively independent of management in problem resolution under these techniques, and although we are realistic in not believing we can solve all problems, we are confident that our team feels supported and valued within the program. Over the last five years, we have had a turnover rate of less than 2%, with greater than 50% of our team being affiliated with the North Mountain facility for over 10 years and as high as 25 years. 

How do you handle vendor visits to your department? Do you contract with vendors? 

We have great partnerships with our affiliated vendors within the cath/EP program. Vendors schedule a “lab day” with cath/EP lab management, in which they are dedicated one full day to use at their discretion. Only one vendor is scheduled for “lab day”, and we do not allow visits that conflict with a competing vendors’ scheduled day. We encourage the vendors to utilize this time to educate the team, introduce new products, and update new clinical data. Vendors launching new products are given one-week exclusivity to complete stock/consignment as well as educate staff and physicians, while being present during cases to support their product and be an immediate resource for their product. Vendors are required to have updated RepTrax profiles, and all vendors must check in prior to arrival. We do not allow walk-ins unless vendors are associated with an actual procedure upon physician request or CRM implants. Vendors that do not adhere to the protocols are subject to limited access to the department, and eventually, loss of privileges. 

Describe a particularly memorable case that has come through your EP lab. How was it addressed, and what lessons were learned from it? 

We recently performed an SVT ablation using MediGuide in which the aberrancy was originating from the non-coronary cusp of the aortic arch. The mapping catheter was administered retrograde into the femoral artery to the ascending aorta to create a map of the arch, with particular focus on the non-coronary cusp. Prior to generating the map, a coronary angiogram was performed to demonstrate the location of the right and left coronary arteries. Using MediGuide, we were able to utilize the angiograms as reference images for the MediGuide mapping and ablation catheters, to locate the precise point on the non-coronary cusp. The MediGuide-enabled catheters were being displayed in real time on the previously recorded angiograms that were continuously looping at a rate equivalent to the patient’s heart rate, giving the appearance of live fluoroscopy. In doing this, an accurate map of the aorta was obtained with the coronary anatomy being visually referenced, while a 3D map was created with special consideration to the right coronary artery and left coronary artery ostia. The SVT was then treated and terminated. The SVT originating from this location was rather atypical, and these procedures can be somewhat risky and difficult to undertake. Exceedingly high fluoroscopy doses >45 minutes are usually associated with an arrhythmia of this complexity. However, we were able to perform the procedure with 2.5 minutes of fluoroscopy, significantly reducing total dose.  

How does your lab handle call time for staff members? 

We have one call team for the cath/EP lab. We try to discourage routine cases after 5 p.m. to create immediate availability for STEMI call; however, there are occasions that warrant a late EP procedure to be performed, and we provide the service as needed. The call team generally manages all cases after 5 p.m., and on occasion, we would have two rooms operating past 5 p.m., which unfortunately would require non-call personnel to stay until the call team is available or until the procedure is completed. On average, staff takes on 10 days of call per month, and at least one weekend per month; however, at this time we do not perform elective EP studies during the weekend. 

Does your lab use a third party for reprocessing or catheter recycling? How has it impacted your lab? 

Yes, we have partnered with Stryker Sustainability Solutions for the reprocessing of our diagnostic EP catheters and ICE catheters, yielding an average monthly savings of $30,000. 

As the number of products capable of reprocessing has increased over the years, EP programs are tasked with monitoring this very closely, as there may be risks associated with this approach. There is some debate on whether reprocessed catheters are as accurate in creating adequate mapping that is within an acceptable range when compared to new catheters. The impact this has had on our lab is independent of the actual savings we know we can accumulate. We have to manage this relationship very closely, and ensure that we are utilizing the most safe and dependable equipment we can offer, as well as being considerate of costs and accountabilities. 

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

Along with the general rules of radiation exposure, we diligently exercise the ALARA principle as well as time, distance, and shielding. MediGuide has given us the flexibility to perform procedures that historically trend high fluoro times into very manageable dosages of radiation to patients, physicians, and staff. Complex procedures are now being performed with minimal amounts of radiation without negatively affecting outcome. The lesser dependency on fluoroscopy significantly reduces patient dose and also translates into a minimized use of lead worn by staff, which will be shown to decrease neck and back ailments that are commonly reported in the cath/EP lab setting. 

What are your methods for infection prevention?

Along with the meticulous practice of sterile technique, we are diligent in maintaining a clean working environment. For implants, we use the AIGISRx Antibacterial Envelope (TYRX/Medtronic) for patients at a higher risk for infection; this has shown to significantly reduce infections in diabetics, re-implants, and in patients that are immunocompromised. Dermabond is applied for incision management, and this has also shown to reduce infiltration and infection for open procedures. 

We also perform continuous quality assurance on antibiotic stewardship to ensure the appropriateness of recommended IV antibiotics, and that the deliveries are in accordance with AORN guidelines to occur within one hour of incision. This QA tool enables us to actively track the administration of all IV antibiotics and antibiotics pertaining to implants, while also conforming to the core measures of the hospital. 

Is your EP lab currently involved in clinical research studies? 

We have an ongoing trial regarding MRI-safe PPM devices, and we are finalizing a trial design with St. Jude Medical regarding same-day discharge of patients receiving new implant ICDs. We are currently being positioned to be a national training site for MediGuide and for future advancements in MediGuide technology. Our site is also being considered for studies in structural heart disease, renal denervation, and biodegradable stents.  

Describe your city or general regional area. 

Phoenix is ranked the sixth largest city in the United States (U.S. Census Bureau, 2012), and contains over 30 hospitals representing around a dozen hospital systems. The marketplace in Phoenix is extremely volatile and competitive, in which individual hospitals and hospital systems are all vying for advantages in the marketplace by excelling in strategic specializations, with EP being one of those specialties. Larger hospital systems continue to construct freestanding ER facilities around growing communities to serve as filtering and referral centers to the bigger facilities, heightening the race for a larger service area. 

In Phoenix, there are no clearly defined “Center of Excellence” hospitals, which are specifically designed to manage high-risk and complex EP. These procedures are being performed in any hospital with an EP program, regardless of the healthcare system or community standing. Therefore, it can be debated whether Specialty Centers and Centers of Excellence in this region are an actual reflection of innovation and quality while being appraised through the appropriate agencies on key benchmarks and outcomes, or rather a self-appointed title to gain a marketing edge within an already frivolous market. 

Specialty programs are to be designed as centers that possess a greater level of skill and resources than their counterparts in order to yield a more comprehensive treatment plan and better patient outcomes. The Phoenix market does not necessarily operate in this fashion for EP. As a result of this, there is an unwritten mandate that compels multiple hospitals within a service area to be highly competitive and bring something different to the market to appeal to the customer. Unfortunately, this mandate could, and often does, result in hospitals of the same system competing against each other for a desired share of the market based off the needs of the community and of the customer (patients, cardiologists, electrophysiologists, primary care physicians, etc.).

John C. Lincoln North Mountain Hospital is within a ten-mile radius of five major cardiac institutions, all of which cover relatively the same service area. As a community hospital, we have the challenge of staying relevant in this service area by staying competitive in our services and service lines. We feel that beyond the technology and beyond our own skill level, the one main aspect of patient care that is a direct reflection of our care is the patient experience, which no technology can replace or replicate. Our cardiac service line consists of a distinctive group of leaders and stakeholders that support the vision of the cath/EP leaders in our mission to earn a Center of Excellence in cardiac rhythm management as well as in coronary and vascular intervention, by exceeding values in national benchmarks in clinical outcomes and patient experience. The acquisition of MediGuide technology was not designed to be a means to an end for our program, but rather to create a solid foundation for future innovations in years to come. 

Please tell our readers what you consider special about your EP lab and staff. 

The MediGuide product is certainly one that sets the stage for tremendously innovative opportunities in an EP program. Basing a program around a reduction of radiation exposure, while improving clinical outcomes by safely treating complex arrhythmias that would otherwise present significant clinical risk, is a feature most institutions should strive for in all areas of diagnostic medicine, not just EP. MediGuide is a unique technology that is specific to just eight hospitals in the country. 

The one thing that cannot be underappreciated is that EP labs are special because of the people, not because of the technology. Teams are different in all facilities, and while the identity of each facility takes on the identity of the team, the team takes on the identity of its leadership. As team members or leadership change, so can the identity. Programs experiencing high turnover and minimal strength in core staff to uphold a desired identity will find themselves suffering from “identity crisis” within the specialization, making progress and quality very difficult to achieve and sustain. Therefore, operational expectations and the manner as to which those expectations are represented by department leadership are essential in developing this identity. While these expectations remain well defined and consistent, the team philosophy will certainly coincide, and the end result will be a stronger belief system within the team as well as a more confident staff that can deal with daily operational issues on an independent basis, rather than frequently escalating to upper management. 

What makes our lab unique is that our management, clinical leadership, and clinical team are a strong core of individuals who precept new staff into a philosophy that promotes higher learning and a better level of patient care, with a particular emphasis on personal and professional growth. We believe that a team-based approach is the fundamental basis for program development, and protecting this model is the sole purpose and responsibility of all employees. Integration of this ideology during the “on-boarding” process sends a clear and distinct message to new employees that this program is one that demands the absolute best employees and their best efforts to clinically progress throughout their tenure. 

Our leadership model equivalently promotes leadership opportunities between RNs and RTs, and consists of the vice president (RN), cath/EP lab director (RT), cath/EP supervisor (RN), and the cath/EP clinical coordinator (RT). We feel that this model acknowledges both disciplines in the cath/EP setting while also providing growth opportunities for all staff, regardless of their primary accountability. All RNs and RTs are aggressively trained in their respective disciplines, and all staff are trained to scrub assist regardless of discipline. RNs and RTs are required to demonstrate proficiency in the EP lab in all tasks, with the exception of mapping/stimulation, because we feel this makes our staff readily interchangeable, and our staff will have, at minimum, a general knowledge of all procedures involved in the cath/EP lab. The level of accountability and knowledge within our program preceded the MediGuide technology, because we provided an exceptional quality of care and sense of innovation prior to its implementation. The core value of our team is that we share the same vision, and we see each other through change. Each employee is encouraged to emulate the principle that we are the patient experience in all that we do, and we are assessed critically through the eyes of the patient. 

John C. Lincoln North Mountain Hospital’s cath/EP program endured one of most difficult times in our history, but did so with a great sense of dignity and pride. We experienced a lot of growth and a renewed appreciation for the people that we work closest to, as well as those we serve. With the support of our administration, Bruce Pearson, Wayne Gillis, Maggi Griffin, and Rhonda Forsythe, we were able to mobilize our vision and systematically change how we approach electrophysiology and supporting specialties to provide the most innovative care we can achieve. Also, much appreciation to Drs. Seifert and Bhakta for their continued commitment and partnership with our program; they continue to pioneer the MediGuide technology with the blend of EP and coronary intervention. We also want to thank the construction and design team, as well as my predecessor, Glenn King RT(R). During his years of service, he crafted the foundation for a successful program in which future successes could be attributed to and were made possible. This has surely been a humbling learning experience for us all, and we are privileged to have had the opportunity to share our experience. Most importantly, to the cath/EP team, for their vision and continued commitment to excellence: this accomplishment is truly yours. 

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