EP Labs in Florida

Spotlight Interview: Baptist Heart & Vascular Institute

Steve Pala, MBA, RCIS, RCES,
Director of Cardiac Cath and Electrophysiology 
Baptist Health Care
Pensacola, Florida

Steve Pala, MBA, RCIS, RCES,
Director of Cardiac Cath and Electrophysiology 
Baptist Health Care
Pensacola, Florida

Baptist Health Care (BHC) is a community-owned, not-for-profit health care organization that serves the Northwest Florida and South Alabama region. It is comprised of three hospitals, four medical parks, a behavioral health facility, two ambulatory surgery centers, an institute for orthopedics and sports medicine, and an institute for heart and vascular care. BHC has over 300 providers in its physician enterprise. In addition, the organization provides behavioral health, vocational, and child protective services for the region. BHC is a proud member of the Mayo Clinic Care Network, and partners with CVS’ minute clinics.

The Baptist Heart & Vascular Institute is the trusted partner for comprehensive cardiovascular care in the region. The team consists of 35+ cardiology providers, with over 600 combined years of service, that serve the northwest Florida and south Alabama area.

The Institute is renowned for its dedication to pioneering innovative techniques and advancing the level of heart and vascular care.

What is the size of your EP lab facility? 

We have four procedure rooms in our system: three are fully equipped EP labs and one is a device room. EP procedures are performed at Baptist Hospital, our flagship facility, and Gulf Breeze Hospital, our sister facility. 

When was the EP program started at your institution? 

EP has been part of our services since 1983.

What is the number of staff members? 

We have a total of 33 team members that work in EP, with eight dedicated to EP. All dedicated EP team members are RCES certified.  

What is the mix of credentials at your lab? 

Our team is comprised of a mixture of RNs, RTs, and paramedics. 

What types of procedures are performed at your facility? 

We perform all types of EP procedures, including atrial fibrillation (AF) ablations, cryoablations, ventricular tachycardia (VT) ablations, epicardial ablations, WATCHMAN device (Boston Scientific) implantations, Reveal LINQ (Medtronic) insertions, and all other types of device implants. 

Approximately how many catheter ablations (for all arrhythmias), ICD implants, and pacemaker implants are performed each week? 

We perform approximately 20 device implantations and 15-20 ablations each week.

Who manages your EP lab? 

We have two EP clinical coordinators who manage the day-to-day operations and throughput of the lab. We have one manager who focuses on quality, service, and other process improvement initiatives at both Baptist Hospital and Gulf Breeze Hospital.  

Are employees cross-trained?

Cath and EP lab staff are cross trained to work in both departments. In January 2015, we made the decision to require all staff to become either RCES or RCIS certified. We are very proud to say that all staff who are eligible have successfully passed the RCIS or RCES exam, and we are 100% certified. Some team members are even planning on taking both exams.  

Do you have cross training inside the EP lab?

Yes, we are very proud of the investment in our staff to train in cath, EP, and peripheral procedures. Many of our team members are cross trained to monitor, circulate, and scrub. This cross training has been very successful in further developing our team, improving efficiency and throughput, as most team members can work in multiple roles within our team. 

What type of hospital is your EP program a part of? 

Our EP program is part of the Baptist Heart & Vascular Institute, which is one of the largest service lines within the Baptist Health Care System. We provide EP services at both Baptist Hospital and Gulf Breeze Hospital. Both are non-teaching facilities.

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

We use both CARTO (Biosense Webster, Inc., a Johnson & Johnson company) and EnSite Velocity (Abbott) for our 3D mapping procedures. We implant devices from Medtronic, Boston Scientific, Abbott, and BIOTRONIK. 

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

We have 10-hour and 12-hour shifts. One team is assigned call as a late team to finish procedures for the day. We run 7 am to 7 pm for elective procedures. Procedures after hours and on the weekend are performed in the OR.  

Tell us what a typical day might be like in your EP lab. 

We have a wide variety of procedures that can be scheduled during the day. We can vary between doing implants and ablations, or have a heavy focus on structural procedures such as the WATCHMAN device implant. Each day is a little different, and that variety is enjoyable.  

What new technology has been recently added to the EP lab? How have these technologies changed the way you perform procedures? 

We recently added the WATCHMAN device to our list of procedures. We are the only facility within the region offering this service. We also recently opened a new EP lab that is fully equipped with OR capabilities to perform complex EP procedures such as lead extractions and Convergent procedures. We have new CardioLab Recording Systems (GE Healthcare) in all three EP labs. Each lab also has the CARTO 3 system (Biosense Webster, Inc., a Johnson & Johnson company). 

What imaging technology do you utilize? 

We use Philips for our imaging, and the Vivid i (GE Healthcare) for our transseptal punctures and ultrasound. 

Do you implant MR conditional pacemakers or ICDs? What about subcutaneous or leadless devices? 

Yes, we implant MR devices and subcutaneous ICDs. Two of our physicians have trained on the leadless pacemaker system, although they have not yet started implanting it.  

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

Our scheduling department uses a system called the Schedule Maximizer (SCI Solutions). The EP physicians have dedicated procedure schedulers in their office to assist with accurately booking procedures. 

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

We have a governance structure in place with our physicians that are focused on many quality metrics. In addition, we have recently achieved accreditation through the Intersocietal Accreditation Commission (IAC) in testing and ablation, device implantation, and chronic lead extraction. This accreditation has a strong focus on quality and our quality improvement program. This is chaired by Dr. Thabet Alsheikh, our EP lab Medical Director. We are one of the first eight facilities nationwide to have achieved this accreditation. Baptist Health Care was also awarded IAC Cardiovascular Catheterization accreditation in Fall 2017, so we are now the only hospital in the country to hold both the IAC Cardiovascular Catheterization and the IAC Cardiac Electrophysiology accreditation. We are very proud of this accomplishment.

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

We have a dedicated buyer for our EP and cath labs. We use Apollo Advance (LUMEDX) to manage our inventory and equipment, as well as barcode our inventory into the system for billing. 

Has your EP lab recently expanded in size and/or patient volume? 

We have seen steady growth in procedural volume over the past four years, as our program opened additional labs. We’ve had to streamline our processes to better meet the demands of our busy physicians. 

Have you developed a referral base? 

Yes, our program serves the entire region of Northwest Florida and South Alabama. Our physicians have remote offices in our outreach areas.

In what ways have you helped to cut/contain costs and improve efficiencies in the lab? 

With physician involvement, our team has been able to establish vendor partners for device and ablation contracts. Physician compliance with vendor selection has yielded significant savings year over year. In addition, we also do many device implants as same-day discharges. We are currently over 80% OP procedures with same-day discharge. Our service line is supported by a fantastic financial analyst that identifies cost-saving initiatives and works with our team to capitalize on these opportunities. Our group purchasing organization (GPO) is Vizient, and that relationship has yielded many cost-saving initiatives as well.  

How do you ensure timely case starts and patient turnover? 

We have a daily management process to track various quality initiatives. The most recent initiative was tracking time starts. This allowed for a dramatic improvement on time starts. We also had a position recently approved to help with housekeeping and transport. We expect this position to increase efficiency and further improve turnover. Also, our pre- and post-team works to clip patients prior to the procedure and pull sheaths post procedure, which allows our lab to quickly turn over in between procedures. 

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

We are the leading and largest EP program in the region; however, there are a number of competing programs. Because of the array of procedures, services, and the quality of our program, we have had the opportunity to work with other programs for referrals, specifically in the outreach.

How are new employees oriented and trained at your facility? 

Our department is supported through a cardiovascular educator who facilitates orientation for new staff and continuous training. Each new hire is assigned a preceptor to ensure checkoff on procedures and processes. This is in addition to our standard hospital orientation process. 

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

In addition to continuous training from our cardiovascular educator, Dr. Alsheikh provides a biweekly educational class (30-60 minutes) on EP procedures, anatomy, EKGs, and many other topics. This ensures our staff is current on their skills and knowledge. It also aids in preparing them for the CEPS Exam. We also work with our industry partners to provide educational material and hands-on resources such as heart dissection labs, access to websites (such as www.medtronicacademy.com), and many others. Our latest achievement was the introduction of an annual cardiovascular symposium that provided six CEU hours. The labs were closed for the day, and all staff had the opportunity to attend the conference. This shows the commitment our administration places on ongoing education and training for our team.

How is staff competency evaluated? 

Annually, each staff is evaluated based on competencies. 

Have members of your staff taken the registry exam for the Registered Cardiac Electrophysiology Specialist (RCES)? Does staff receive an incentive bonus or raise upon passing the exam? 

Yes, we are 100% RCES certified for all staff who are eligible (>1-year employment). The cost of the exam was reimbursed and a pay increase was provided upon achieving the certification. We have many staff studying for the CEPS Exam. 

How do you prevent staff burnout? Do you also practice any team-building exercises? 

We work very closely in the lab, and frequently have celebrations and team-building opportunities to help avoid burnout and create team morale. After each team member passed the RCES exam, we celebrated with a cake in their honor. In addition, we have their name engraved on a plaque that is displayed. We have pool parties and other after-hours social gatherings. By far, the most enjoyable event was when our team entered into a dragon boat race for charity, and took third place overall! 

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

We have a closed lab to vendors unless the vendor is there to support a particular procedure. Within the organization, we have a registration and check in/out process through the materials management department. Many of our contracts are handled through Vizient. 

Does your lab utilize any alternative therapies to help patients in the EP lab?  

Our labs have music in each lab, Bair Huggers (3M), and warm blankets to make patients comfortable. We also partner with anesthesia to provide sedation throughout the procedure. 

Describe a particularly memorable case from your EP lab and how it was addressed. 

Our most memorable cases involve some of the most difficult procedures and our team’s ability to rally around the patient, using all possible resources to achieve the best possible outcomes.  

How does your lab handle call time for staff members? 

Our EP team is on call 2-3 nights a week to finish late procedures. 

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

We use Sterilmed as our reprocessing company. This has become the norm over the past five years. Each year, it allows us to keep our costs down and continue to stay financially competitive. 

Approximately what percentage of ablation procedures are done with cryo vs radiofrequency?

Our current mix is around 75% radiofrequency for AF procedures, with the rest being cryoablation. 

Does your lab use contact force sensing technology during radiofrequency ablation of atrial fibrillation? 

All three labs are equipped with the latest version of CARTO 3 and software, which allows us to use this technology on all of our AF procedures. 

What are your thoughts on the use of the new oral anticoagulants (NOACs) in patients with non-valvular atrial fibrillation? 

We have a great partnership with our pharmacist, and work very closely to use evidence-based guidelines to treat patients. 

What are your techniques for left atrial appendage (LAA) occlusion? 

Our current process is to utilize the WATCHMAN device, but we have also performed the LARIAT procedure (SentreHEART, Inc.) in the past. 

What other innovative EP techniques are being utilized in your lab? 

We have performed many AF ablations without any fluoroscopy. By utilizing the low fluoro or no fluoro guidelines, we have seen a dramatic reduction in radiation exposure for our staff and physicians. We use the figure 8 suture method to remove many venous sheaths in the lab. We have moved away from femoral arterial lines and have begun using radial artery lines for our AF patients. 

What measures has your lab taken to reduce fluoroscopy time? In addition, what types of radiation protective shielding and technology does your lab use? 

Our physicians and staff have been very aggressively working to reduce our fluoro time during procedures using ultrasound catheters. We have performed many AF ablations with zero fluoro. This has resulted in a reduction of radiation exposure and an increase in safety to our patients, staff, and providers. 

What are your methods for device infection prophylaxis? 

Our physicians use the CanGaroo ECM Envelope (CorMatrix/Aziyo Biologics) and the TYRX Antibacterial Envelope (Medtronic), in addition to standard antibiotics. 

How do you use the NCDR Outcome Reports to drive QI initiatives at your facility? 

These results are part of our co-management agreement and are tied to our physicians’ compensation. Results and action plans are reviewed and discussed monthly.

Do you participate in the LAA occlusion registry? 

Yes, we participate in the LAAO registry for all of our WATCHMAN procedures. 

What are your thoughts on EHR systems? Does it improve your quality of care? 

Our system is transitioning to Allscripts for our EHR. We have high expectations for improvement of data collection and our ability to use that to drive results and standardize best practices.   

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

MRI devices will become the norm in a few years. More physicians are tackling even more challenging AF and VT ablations as our patients age and their disease progresses.

How does your lab handle device recalls? 

Our quality department works closely with our physicians on all recall devices. 

How is outpatient cardiac monitoring managed? 

This is being managed by the non-invasive department. They work closely with our EP physicians to monitor these patients and interpret reports. 

Describe your city or general regional area. How is it unique from the rest of the U.S.? 

Pensacola is home to a large U.S. naval base, and many residents are either military or former military personnel. Being located in the Gulf Coast, we are a beach town with a southern feel. 

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

Our staff is what separates us from all other programs. Each team member is dedicated to delivering the highest quality of care. They are extremely professional, hardworking, and extremely compassionate to those in need. An example of this is becoming 100% RCES certified and IAC accredited, and the effort and commitment it took to achieve these goals.