Mission Hospital is a 407-bed, acute care, full-service facility, and one of only three trauma centers in the area. This non-profit organization, which is part of the St. Joseph Health System, commits ten percent of its net income to programs that benefit the community.
Mission Hospital continues to expand its services to accommodate the needs of a growing community. In June 2011, we became the only hospital in Orange County to provide state-of-the-art Stereotaxis technology to cure heart arrhythmias.
What is the size of your EP lab facility and number of staff members? What is the mix of credentials at your lab?
We have two EP labs: our primary EP lab uses Stereotaxis, Biosense Webster’s Carto mapping system, and St. Jude Medical’s EP monitoring system. The second EP lab is limited to the Carto and St. Jude Medical systems, and accommodates overflow EP studies as well as device implants. We also have two cath labs that can accommodate device implantations, but are mainly used for coronary angiography. We currently have 17 staff members within the cardiovascular lab: seven are radiologic technologists (RT) and ten are registered nurses. We have a core EP team of seven members; however, everyone in the department is cross trained.
What types of procedures are performed at your facility? Approximately how many are performed each week?
We do a full spectrum of EP procedures ranging from basic EPS to VT ablations. On average, we perform about eight atrial fibrillation (AF) ablations per week with the use of Stereotaxis. Our physicians will typically do two AF ablations a day. We also perform device implants, permanent pacemakers, and ICDs. We can accommodate anywhere between 5–15 device cases each week. In addition, our center performs laser lead extractions.
What new equipment, devices and/or products have been introduced at your lab lately?
Stereotaxis has been in our lab for about a year and a half. With use of this technology, we had to develop new policies and procedures for the hospital. This new equipment has helped to cut down on radiation exposure and procedure case times. Another added benefit with Stereotaxis is that the physicians utilizing the technology now do not have to be standing at the bedside for extended lengths of time, thereby allowing them to be less physically strained not having to stand and wear protective aprons. This allows them to be more productive in their practices.
Who handles your procedure scheduling? Do they use particular software?
Currently we do not use a particular computer software to do our scheduling, but in the near future will be moving in that direction. The charge nurse is primarily responsible for scheduling cases and coordinating staffing to accommodate the needs of the department.
Have you recently upgraded your imaging technology?
With the addition of Stereotaxis, we have a new Siemens fluoroscopy system.
What types of continuing education opportunities are provided to staff members?
We have worked with various vendors to teach classes related to their products and equipment. For example, we provided a four-week class on basic EP six months ago via one of the vendors providing continuing education hours. Our hospital also encourages staff to obtain certification related to one’s area of expertise and provides the incentive of an annual bonus to staff who successfully complete their certification.
What committees are staff members asked to serve on in your lab?
We have a number of committees at Mission Hospital and we encourage staff to become involved. The house-wide committees consist of Quality, Education, Leadership and Practice. The committees meet monthly, and attendees range from the head mangers of departments to the bedside nurse. At Mission Hospital we recently achieved Magnet Accreditation, and are very proud of this recognition.
We also have a unique rhythm management team that meets every month to discuss issues and ways to improve the EP lab. It is a very efficient way to communicate about EP concerns and to discuss ways in which to improve the current systems. This management team consists of specialized EP physicians, the director and manager of cardiovascular services, EP staff members, advanced practice nurses, and can also include purchasing, infectious disease and radiology, depending on the topic of the meeting.
How do you handle vendor visits to your department? Do you contract with vendors?
We have designated vendor scheduling, which restricts one vendor in the department per day. We have some products on consignment within the department.
How does your lab handle call time for staff members? How often is each staff member on call? How frequently do they have to come in, on average? Is there a particular mix of credentials needed for each call team?
Our call team consists of four team members. Two of the team members are nurses and two members are RTs or another nurse. Full-time staff must take eight days of call per month, which includes one weekend a month. The part-time staff must take five days of call, which includes one weekend a month. Typically, call starts at 1730 and lasts until 0700 the next day. The call team covers call for the EP lab as well as the cardiovascular lab. We are a STEMI-receiving hospital; thus, we are called in on average three to four times a week during off hours. On weekends we tend to do an average of two to five cases.
Does your lab use a third party for reprocessing? How has it impacted your lab?
We currently use Stryker for recycling our catheters within the EP lab. It has significantly cut down on costs to the department. Recently we were recognized for the Stryker Award, which provides a donation to the hospital for our diligence with reprocessing.
Approximately what percentage of your ablation procedures is done with cryo vs. radiofrequency?
We currently do not have cryo; thus, all of our ablations are done with radiofrequency.
Do you perform only adult EP procedures or do you also do pediatric cases?
The main population we care for is that of adults. We have performed a few ablations on patients between 15 and 18 years of age. All of our EP physicians have training with the pediatric population, but refer them to the pediatric physicians within our hospital system.
What measures has your lab taken to minimize radiation exposure to physicians and staff?
The use of Stereotaxis has significantly lowered the amount of radiation exposure to staff and physicians. Staff continues to practice radiation safety using shielding and distance to protect oneself from the radiation source. The director of radiology also is actively involved in making sure the RTs are practicing the best means to ensure everyone in the room is safe.
What about device recalls? How has your lab handled these?
With the recent Riata lead recall, we needed to develop a system to fluoro the lead in this population. We worked closely with the physicians, representatives from St. Jude Medical, and staff to make the process efficient and less impactful on the patients affected.
Is your lab doing web-based/transtelephonic device follow-up?
Currently, all follow-up is being done in the implanting physician’s office. We currently use various device companies to interrogate devices within the hospital setting and do not have a designated employee to fill this role.
Does your staff provide educational materials for patients? Does your hospital also offer a device support group?
In January 2013 we will be implementing a support group for patients with devices as well as arrhythmias within the community setting. The group will meet once a month for an hour with a specific topic, and have the opportunity to network with others. We have several support groups that exist at Mission Hospital, and we are excited to add a device support group to the list in order to meet the needs of this unique population.
For more information, please visit: http://www.stjhs.org/