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Spotlight Interview: Crestwood Medical Center

Anise Black, RN, Manager, Cardiovascular Services
Crestwood Medical Center
Huntsville, Alabama

Anise Black, RN, Manager, Cardiovascular Services
Crestwood Medical Center
Huntsville, Alabama

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

Our EP program is new at Crestwood. Dr. W. Q. Foster and his family relocated to Huntsville in June 2015 to help start our program. The EP lab is separate from the cath lab, with a dedicated EP staff. We chose the Integrated Lab™ (St. Jude Medical) and have been very pleased with every aspect of this partnership, from planning to installation and support for go-live. Dr. Foster began seeing patients the third week of June. By July, we had performed our first implant. To date, he has completed 15 implants and 10 EP studies using both RF and cryoablation, with great success.

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

Our staff includes two RNs and one RCIS with previous EP experience. Those three are a dedicated EP team that work 8+ hours a day. We have a traveler who was brought in and began training staff prior to install. Mike Fritz, CVT, RCES has also been a lifesaver for our staff; with his 35+ years of experience, he brings great knowledge as well as the ability to teach and perform. 

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

We perform implants of pacemakers, ICDs, Bi-V ICDs, S-ICDs, and loop recorders, as well as perform EPS with cryoablation and RF ablation. We are currently performing approximately 5-10 procedures each week.

Who manages your EP lab?

Our EP lab is managed by Anise Black, RN, under the Cardiovascular Services Department. Our EP Coordinator is Ed Ginther, RCIS.

Are employees cross-trained? 

Cross-training to the cath lab occurs as time and caseload allows. EP staff will eventually cross-train to all positions in the EP lab.

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

We are a for-profit, community hospital.

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

In addition to using the Integrated Lab, we use St. Jude Medical’s EnSite Velocity Cardiac Mapping System, ViewMate Intracardiac Ultrasound Console, and WorkMate Claris Recording System. We also use the Arctic Front Advance Cardiac CryoAblation Catheter (Medtronic) and the NRG RF Transseptal Needle (Baylis Medical).

How is shift coverage managed? What are typical hours?

Normal hours are 7 AM to 3:30 PM, or until cases are completed. We currently don’t have call for our EP staff.

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

Our first case normally arrives around 6:30 AM for prep by our pre/post cardiovascular staff, with a start time of around 8:00 AM. After lunch, we begin our afternoon case and work until that procedure is complete. Our patients are generally observed overnight in the cardiac unit.

What imaging technology do you utilize?

We have the GE Innova 2000 radiology equipment.

What is your experience with MR-conditional cardiac devices?

We have implanted two MR-safe devices thus far.

Does your program utilize a Cardiovascular Information System (CVIS), picture archiving system (PACS), or cardiology picture archiving system (CPACS)?

We currently use PACS and CVIS storage for our images and data.

Tell us about your use of travel RNs, RTs or RCISs.

We would normally not use travelers, but since we are a startup lab, we have used Mike Fritz, CVT, RCES to help train staff and set up the lab.

Who handles procedure scheduling? Do they use particular software?

Patients are scheduled by their physician’s office through the hospital scheduling system (HMS).

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

Our EP Lab Coordinator, Ed Ginther, RCIS, manages all inventory and submits equipment purchase requests to the Cardiovascular Services Manager, Anise Black, RN, for approval.

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

We use integrated systems for all studies in order to contain prices and top-tier purchase options.

How does your lab communicate necessary information to staff?

We have morning safety huddles to communicate information and resolve issues.

How do you ensure timely case starts and patient turnover?

Patients arrive approximately 1.5 hours prior to the procedure start time and are prepped in our pre/post area. EP staff checks all lab values and test results, and notifies the MD when the patient is ready to be placed on the table. Patients are returned to the pre/post area for chart completion, and are transported to the receiving unit while the EP staff preps the room for the next patient.

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

We do compete with another local hospital that provides EP services. Our EP physician has networked with many of the surrounding physicians to offer our services and get referrals.

How are new employees oriented and trained at your facility?

All new staff undergo hospital orientation as well as extensive area-specific training.

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

Education is handled via online; St. Jude Medical has also provided classes. In addition, educational blocks for beginner, intermediate, and advanced learning are available. Attendance at Heart Rhythm Society functions will be made available in the future. 

How is staff competency evaluated?

All staff is given written and performance-based annual competency evaluations on all procedures and equipment used in their area.

What committees, if any, can staff members serve on in your lab/hospital?

We have one staff member serving on our Hospital Safety Committee, which focuses on efficiently improving workflow while recognizing that employees use safe work practices.

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

Yes, vendors check in with the Reptrax system after scheduling appointments through our EP lab coordinator. 

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

Use of mapping systems and low-dose settings are used to minimize radiation exposure to patients and staff.

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