Spotlight Interview: Adventist Hinsdale Hospital

Medical Director Chad E. Bonhomme, MD and Regional Executive Ted Paarlberg, Hinsdale, Illinois

Medical Director Chad E. Bonhomme, MD and Regional Executive Ted Paarlberg, Hinsdale, Illinois

When was the EP lab started at your institution? We’ve been doing device implants and EP studies for years, but we did not have a dedicated EP lab when Dr. Bonhomme joined us in December of 2006. With Dr. Bonhomme’s guidance, we developed a vision, needs assessment and strategic plan in January of 2007. An educational curriculum was designed with Dr. Bonhomme, C. R. Bard, Inc. and some of our device vendors. In February of 2007, a recording system was purchased from C. R. Bard, Inc. and the first EP study/ablation was performed a few weeks later. Prior to initiating left-sided procedures, the staff received training at Aurora Sinai Medical Center in Milwaukee. Transseptal, anticoagulation, and patient preparation protocols were borrowed and established. We started left-sided procedures in July of 2007. By September our procedure volume had grown so dramatically that we went to the Hospital Board with a proposal to build a dedicated EP lab. The request was approved and the new lab will open this summer (July 2008). What is the size of your EP lab facility and number of staff members? What is the mix of credentials at your lab? The new lab will be approximately 900 square feet, with the procedure room accounting for 720 of that…it’s a converted CV OR, so it’s very spacious. In terms of credentials, we have a pretty even mix of RNs, CV techs and radiology techs. Will the new EP lab be separate from the cath lab? We currently operate two labs in a contiguous space, one of which serves as a shared EP lab with interventional cardiology. The new, dedicated EP lab is located in the same geographic area as the existing labs so we’ll be able to gain some space and staffing efficiencies within the interventional suite. What types of procedures are performed at your facility? Approximately how many are performed each week? We perform implantation of all available devices including biventricular devices with echo-guided optimization. All ablations are performed, including those for atrial fibrillation and ventricular tachycardia. We currently perform between 15 and 20 EP procedures per week. What is the primary goal of your program? Our primary goal is to apply state-of-the-art ablation practices and device therapy for the Chicagoland area. This includes 24/7 availability for device therapy to avoid temporary pacing prior to permanent implantation. Our ultimate goal is to gain national recognition as an EP Center of Excellence. Who manages your EP lab? Chad E. Bonhomme, MD is the Director, and Christine M. Anna is the EP Lab Manager. Who are the primary stakeholders in your program and how do you communicate with them? Certainly our cardiology groups — and the EP’s in particular — are key partners in the program. Each of them contribute something unique and they are never at a loss to let us know how they feel things are going! The support from the Hospital Executive Team and Board has been tremendous — they shared the vision of building this program with the medical and clinical team from the start. Also, we are blessed with a very active Foundation, which has been a strong supporter of the Cardiology Program for many years. When they learned about what a comprehensive EP program means to the residents of our community, the Hinsdale Hospital Medical Staff Auxiliary responded with a very generous donation that was totally unexpected! The offices of the Regional Executive, Cardiology Director and Cath Lab Manager are all literally within 50 feet of the EP lab, so we’re in constant contact with the physicians. We’ve done presentations for the Foundation Board and the Hospital Leadership Council and we have monthly Executive Team review meetings. We will be hosting a variety of promotional activities for the new lab and have actually invited Foundation Board and Executive Team members to view a case in the new lab. Do you have cross training inside the EP lab? We do. We have dedicated EP staff as well as staff members from the cath lab who are cross-trained.  What new equipment, devices and/or products have been introduced at your lab lately? Due to the development of a new program, we have had many purchases, including two C. R. Bard, Inc. recording systems with Micropace, a GE Innova® 2100IQ, the ACUSON AcuNav catheter with the ACUSON Sequoia system, CartoMerge and CartoSound, EnSite with CT fusion, a fluoroscopy upgrade to allow 7.5 fps in the shared lab, and Maestro and Stockert RF generators. The AcuNav has been particularly helpful logistically, reducing our need for TEE scheduling. Adventist Hinsdale Hospital was one of only twelve facilities in the country with the CartoMerge and CartoSound technology at the time. What type of quality control/quality assurance measures are practiced in your EP lab? Complication rates are formally tracked and reported at a monthly Cardiology Patient Care Committee. Fluoroscopy times and radiation doses are monitored and recorded daily. How is inventory managed at your EP lab? Who handles the purchasing of equipment and supplies? The EP Lab Manager is primarily responsible for inventory management. Because some of our supplies are bulk purchases and allocated between several campuses, the Regional Cardiovascular Executive and Regional Purchasing team are very involved.  Has your EP lab recently expanded in size and patient volume, or will it be in the near future? Adventist Hinsdale Hospital has the fastest growing EP program in the Chicago metropolitan area. We have five electrophysiologists on staff — four of whom joined us within the past 18 months. We saw a 556 percent increase in volume between 2006 and 2007. With the opening of the dedicated suite, we are projecting a 125 percent increase this year. Has managed care affected your EP program and the care it provides patients? Not at all. We apply the same medical necessity and patient care standards to every patient who comes through the door, regardless of payor. Many of the procedures are performed on an outpatient basis and our inpatient length of stay is substantially below the national average for like-facilities. Have you developed a referral base? Yes, there is a core referral base in the western and southern suburbs of Chicago through the existing cardiology groups. We have a very strong primary care liaison program and extensive community outreach and educational programs that our EPs actively participate in to educate the medical staff on how the available therapies and technologies can benefit their patients. What measures has your EP lab implemented in order to cut or contain costs? In addition, in what ways have you improved efficiencies in patient through-put? We’re very fortunate to have a cadre of young and astute EPs whose main objective is a superior patient experience. They also understand that we work in an industry with shrinking margins, so they are very sensitive to the cost structure of the program. We share financial data, including equipment and supply costs, with them on a regular basis. While we continually reinforce that they make the clinical decisions, they appreciate having the financial information and we feel it strengthens the partnership between the physicians and the hospital administration. We also do bulk buys of our CRM devices and recycle catheter tips — the proceeds of which help fund some of the staff celebrations! We also stagger the times that outpatients come to the hospital in order to reduce wait times and improve staff productivity. We focus heavily on patient and lab turnaround times. Does your EP program compete for patients? Yes. Chicago is a highly competitive healthcare market, and there are several well-established EP programs — primarily at the academic centers — with whom we compete. We’ve been successful in moving market share (as well as physicians and lab staff!) away from our competitors over the past 12 months. How many procedures are performed on an outpatient basis? In 2006 approximately 31 percent of procedures were outpatient; that grew to 47 percent by the end of 2007. How are new employees oriented and trained at your facility? We feel that it takes two years to fully train a new member of the EP team. As our program has grown and gained regional notoriety, we’ve been fortunate to recruit several staff with strong EP backgrounds from other area hospitals. These people serve as mentors to our less experienced staff. Our electrophysiologists are also very involved in training of the staff. What types of continuing education opportunities are provided to staff members? So far, primarily vendor-sponsored CE modules have been offered. Our new lab has an Internet- and satellite-linked audiovisual system to provide webcasts and symposium-based CEs. The staff has also trained with Carto in Cincinnati and AcuNav in Chicago. How is staff competency evaluated? We are currently developing separate competencies and evaluation tools specific for the EP staff. How do you prevent staff burnout? In addition, do you practice any team-building exercises? The EP team — inclusive of the physicians — has united over their enthusiasm about learning new skills and growing the program together. We continue to recruit dedicated EP staff to alleviate some of the other cath lab responsibilities, and they are not required to take call as cases tend to go longer into the evening. Finally, the team enjoys a social night out on the town together every once in a while! What committees, if any, are staff members asked to serve on in your lab? The manager participates in a monthly Patient Care Committee. How do you handle vendor visits to your department? Vendors must register each visit with the hospital. All sales calls are scheduled in advance. Since the lab has become so incredibly busy, we don’t allow impromptu visits. Does your lab utilize any alternative therapies? In the morning we let the patients choose a radio station; in the afternoon we listen to the Cubs games! Does your lab use a third party for reprocessing? We did initially, but we were disappointed with the condition of the returned catheters, so we discontinued the program.  Do you perform only adult EP procedures or do you also do pediatric cases? We do perform ablations on patients in their teens, but our primary patient populations are the elderly and the aging baby boomers. What measures has your lab taken to minimize radiation exposure to physicians and staff? Our fluoroscopy has been upgraded to allow 7.5 fps. We use the RADPAD® radiation protection products on all cases and have lead skirt barriers on both sides of the table. Do your nurses/techs participate in the follow up of pacemakers and ICDs? No, device follow up is done either with the physician’s practice or device rep. What are your thoughts about non-EPs implanting ICDs? We believe that only EPs should implant, program and follow ICDs. What about device recalls? How has your lab handled these? Recalls are handled through the cardiology practices. Is your lab doing web-based/transtelephonic device follow-up? No. The physician practices provide this independently. Is your EP lab currently involved in any clinical research studies or special projects? We are currently not involved in research, as our priority for the past 18 months has been to build the staff and launch the new lab. However, becoming involved in research is an important part of our long-term strategic plan. When was your last inspection by the Joint Commission? The last inspection was in January of 2007 when our EP program was very much in the embryonic development stages, so the survey was largely a non-issue for the EP program. Does your lab provide any educational or support programs for patients who may have additional questions or those who may be interested in support groups? Yes, we use patient education/information material available from the Heart Rhythm Society’s Web site. We have also created a device care instruction sheet. We do not currently hold a device support group, but this is a future program development objective. Give an example of a difficult problem or challenge your lab has faced. How it was addressed? Our biggest challenge was building a lab from scratch, including creating and sustaining an EP interest within a veteran interventional cardiology staff. We started off with shorter implantation and simpler ablation cases, exposed some of our staff to an enthusiastic dedicated EP staff in Milwaukee, and scheduled some off-site educational sessions. We had C. R. Bard, Inc. and Biosense Webster available to help with some of the initial connectology challenges. Within four months, some staff members showed greater interest, and we started left-sided work shortly thereafter. Describe your city or general regional area. How does it differ from the rest of the U.S.? Adventist Hinsdale Hospital is a 427-bed community hospital located in the western suburbs of Chicago. This area is one of the top competitive healthcare markets in the country and has many reputable, long-standing cardiology programs — many of which are in the academic centers. There is limited population growth in our service area as many of the communities are basically “land-locked.” This reality has forced us to be more aggressive in competing for market share outside of our traditional service area and with the academic centers in order to grow volume . We love a good “David and Goliath” story! Please tell our readers what you consider unique or innovative about your EP lab and staff. We made the decision two years ago to make EP a central growth strategy for our cardiology program. We felt we weren’t serving our community adequately without this service, and up until very recently, virtually all of the EP business left the community to seek treatment at competitor hospitals. It has been very rewarding to see this trend reversing, as we’re now able to offer state-of-the-art technology, clinical excellence and post-procedure follow-up right here in a community hospital setting. Also, our lab has established a culture of “willing to start early” and “willing to stay late” — that is not always easy to find. It is this mentality that allows us to be flexible in our scheduling of routine cases, add-ons, weekend cases if needed, and in-services when the working day is finished. Most importantly, we have established an unbreakable lab law — after every 100 implants, we celebrate with a nice dinner out for the entire staff! Finally, as a faith-based organization, our philosophy at Adventist Hinsdale Hospital is to treat the mind, body and spirit. Each department of the hospital, including the EP lab, develops a “Spiritual Life Plan” as part of its strategic plan each year to help us live out this philosophy of “whole person care.” We feel that this focus is essential to fulfilling our mission and truly sets us apart in the market. For more information on Adventist Hinsdale Hospital, please visit their website: www.keepingyouwell.com/