Spotlight Interview

Spotlight Interview: IU Health-Ball Memorial Hospital

Angela Miller, MBA, BSN, RN and Antonio Navarrete, MD, FACC, FHRS, CCDS

Muncie, Indiana

Angela Miller, MBA, BSN, RN and Antonio Navarrete, MD, FACC, FHRS, CCDS

Muncie, Indiana

IU Health-Ball Memorial Hospital was founded in 1929 as both a teaching hospital and regional tertiary referral center. It is accredited by the Commission on Accreditation of Rehabilitation Facilities. We are also affiliated with the Indiana University School of Medicine.

What is the number of staff members in your EP lab? 

We have three full-time, dedicated staff members (Spencer Davis, RN, Karen Wallace, RT, RCIS, and Tim Schepman, RN) and two part-time staff members (Amy Roby and Angela Miller, MBA, BSN, RN).

Approximately how many catheter ablations, ICD implants, and pacemaker implants are performed each week? Annually?

On average, we perform 4 atrial fibrillation ablations and 4-6 device implants a week. On an annual basis, we perform over 200 ablations (>100 atrial fibrillation ablations) and place >240 cardiac electronic devices (pacemakers, ICDs, CRTs, and loop recorders). 

Who manages the EP lab? 

Angela Miller, MBA, BSN, RN.

Is the EP lab separate from the cath lab? 

Yes.

Are employees cross trained? Do you have cross training inside the EP lab? 

We are minimally trained in the cath lab. We do have cross training inside the EP lab.

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

Academic.

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

Shift coverage is from 7am-5:30pm, 4 days/week. Our EP staff members are not required to take call; instead, they generally will stay after 5pm several days a month to provide EP coverage when needed.

What new equipment, devices, and/or products have been introduced at your lab lately? 

We utilize St. Jude Medical’s TactiCath Contact Force Ablation Catheter, Medtronic’s PEAK PlasmaBlade System and Reveal LINQ Insertable Cardiac Monitoring System, and Boston Scientific’s S-ICD System. We are in the process of acquiring the Topera (Abbott) 3D Mapping System. 

What imaging technology do you utilize? 

We use Philips fluoroscopy for imaging. We use intracardiac echo for any complex ablation procedure. We have both Biosense Webster’s Carto and St. Jude Medical’s EnSite NavX velocity electroanatomical mapping systems. 

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

Scheduling is mainly performed using Cerner by the cath lab secretary.

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

Inventory is reviewed daily by the EP/cath lab staff, and ordered accordingly. The entire cath lab has one person in charge of ordering for all rooms.

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

All of our catheters, cables, and some specialized sheaths are recycled. All new inventory is approved though a system-wide supply chain. We have two suppliers in the IU system that we can choose from for EP products.

How are new employees oriented and trained at your facility? 

New employees are immediately placed with a preceptor for a usual period of about 3 months. They also take ECG and basic intracardiac courses online, and attend several EP courses sponsored by the Heart Rhythm Society and industry. 

Does your lab utilize any alternative therapies? 

Yes, patients have the option to choose the desired genre of music to be played if they request it.

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

Yes, we have used different companies over the past years. Recycling certain equipment gives the lab a chance to earn additional revenue available for education and other purposes deemed necessary. 

What are your methods for infection prevention during device implants?

OR standards and protocols are followed during these procedures — the EP lab follows the same guidelines as the OR. It was designed as an OR when it was built. Our infection rate is below the national standards for pacemaker and ICD implants. Either cefazolin or vancomycin IV is given to patients within an hour of the surgical incision. We do not routinely give oral antibiotics post procedure.

We work very closely with the infectious disease department and the preventive medicine team.

Any new employee in the EP lab undergoes careful training in aseptic techniques. 

Is your EP lab currently involved in clinical research studies? 

Yes. We are participating in the Boston Scientific NAVIGATE X4 Clinical Study utilizing quadripolar LV leads, and the IBAD-AFIB clinical trial (Atrial Fibrillation Mechanism Analysis Through Ibutilide Administration During Pulmonary Vein Ablation). We are in the process of starting a new trial using Pradaxa uninterrupted during atrial fibrillation ablation, and are starting a new trial using the subcutaneous ICD.

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

Our amplifier and EP recording station are by Bard. All of the EP studies are stored on a server and can be viewed remotely. Selected figures created with the electroanatomical mapping systems are stored on CPACS.

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

We are very careful about using fluoroscopy in our lab. Relying heavily on intracardiac echo and electronatomical mapping, we have significantly decreased fluoroscopy usage. We have done several completely fluoroless ablation procedures. We recently presented a poster at the ACC conference reporting a mean fluoro time of 5 ± 7 minutes for atrial fibrillation ablation. Wearing lead aprons can put our EPs and interventional cardiologists at risk for chronic back injuries, so we try to remove our lead aprons very early on during ablation procedures. For example, during atrial fibrillation ablation, fluoro is disabled and our EP staff removes their lead aprons after the transseptal puncture is performed. 

Does your hospital offer a cardiac device support group for patients?

We have an ICD support group that meets quarterly. A brief topic is presented by a guest speaker, and there is time for a question and answer session. ■ 

For more information, please visit http://iuhealth.org/ball-memorial/.