Spotlight Interview: Lancashire Cardiac Centre

Dr. Scott Gall, MBBS, MRCP (UK)
Dr. Scott Gall, MBBS, MRCP (UK)

The Lancashire Cardiac Centre is part of a large teaching hospital, based in Blackpool in the Northwest of England in the UK. The Cardiac Centre serves a referral population of just under two million for specialist tertiary cardiac services, which includes EP. 

What is the size of your EP lab facility? 

We have one dedicated biplane lab for EP within the Lancashire Cardiac Centre. There are two other biplane labs and one single plane lab that are used for other cardiac procedures including device implantation.

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

We have two consultant electrophysiologists, and a large team of specialized cardiac physiologists, cath lab nurses and radiographers, some of whom cross cover with other labs for interventions, devices, etc.

When was the EP lab started at your institution?

Our EP program was started in November 2010 by Dr. Scott Gall; our second electrophysiologist, Dr. Shajil Chalil, started in mid 2011. Prior to this, the centre was already established in simple and complex device implantation.

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

Ablation of all arrhythmias is performed on a regular basis, with up to 20 ablations performed each week. Per year the centre currently performs about 800 device implants, of which approximately 50% are complex devices.

What is the primary goal of your program?

The goal is to provide a comprehensive service to patients within our region. We have seen a large increase in the number of ablation procedures and device implantations over the past few years.

Are employees cross-trained?

There is a degree of cross training for some staff who also cover other cardiac procedures, but many are specifically trained in cardiac rhythm management.

What new equipment, devices and/or products have been introduced at your lab lately? How has this changed the way you perform those procedures?

We have recently introduced the CardioFocus HeartLight endoscopic ablation system to treat patients with atrial fibrillation (AF). We hope that this will reduce the need for redo procedures in our patients with paroxysmal AF.

Have you recently upgraded your imaging technology?

No, we currently have a Philips biplane lab, which was installed in 2008.

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

We currently utilize a consultant and secretary collaboration when booking patients for procedures. Only the local hospital’s booking system is required for this.

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

We have a procurement team that negotiates purchasing on our behalf, with close engagement with the clinical team. The technical team manages the EP inventory with a stock management system called ScanTrax.

Has your EP lab recently expanded in size and patient volume, or will it be in the near future? 

Over the last three years the service has expanded considerably. We have developed a business case in order to further expand the service. 

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 aim to provide the cost of any given case as per a given tariff in order to control spending. In addition, we purchase bulk deals in order to obtain stock at the lowest possible prices.

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

Being the tertiary center in the area, we receive patients from outside the local area for all types of procedures, so alliances with these hospitals are already in place.

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

All staff are asked to maintain their own continuing professional education. They are encouraged to attend meetings around the UK and internationally. We hold weekly meetings to discuss interesting EP and device cases, and monthly educational mornings are held for interested staff.

How is staff competency evaluated?

Staff members are assessed for medical device competencies and are encouraged to take the Heart Rhythm UK or IBHRE exam, as well as complete a logbook of the cases they cover.

Do you encourage your clinical staff members to take the registry exam for Registered Cardiac Electrophysiology Specialist (RCES)? How many members of your lab have taken the exam? Does staff receive a pay incentive upon passing the exam?

We have one member of the team with this certificate, and others are encouraged to take this or the UK equivalent. There are no performance-related pay incentives.

How do you prevent staff burnout? In addition, do you practice any team-building exercises?

The team gets on very well, and ‘nights out’ are a regular feature for team building.

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

All representatives are contacted via the operating consultant or technical team. We are part of a procurement hub and do have contracts with our main suppliers.

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

Background music is played in the lab to help create a calming atmosphere.

Approximately what percentage of your ablation procedures are done with cryo? What percentage is done with radiofrequency? 

Very few procedures are currently performed with cryo — the vast majority are still performed with radiofrequency, although the percentage of cases performed with laser are increasing and now at about 10%.

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

Lead shielding and aprons are used at all times within the lab, and radiation doses are monitored on a monthly basis. New technologies such as the CardioFocus HeartLight system, which uses endoscopic visualization, have significantly reduced fluoroscopy times and continue to minimize radiation exposure.

Do your nurses/techs participate in the follow up of pacemakers and ICDs? If so, how many device visits per week do they handle? Do you use any particular software for follow up? How many of your ICD/pacemaker patients require a doctor for their visits?

The Pacemaker/ICD clinic is run by a highly specialized cardiac physiologist. We run 7 clinics a week and each clinic sees around 20-25 patients. Only a very small amount of patients need to see a doctor usually for medication changes or wound problems.

What innovative EP techniques are being utilized in your lab?

The CardioFocus HeartLight laser balloon is now used routinely for paroxysmal AF ablations. We are the only centre in the UK to use this technology under conscious sedation, and have recently become the first recognized Centre of Independence using this technology. Initial outcomes are very promising, with low procedure and fluoroscopy times.

Is your lab doing web-based/transtelephonic device follow-up?

Yes, we offer all our ICD patients web-based/transtelephonic device follow-up. We have three different manufacturers’ remote follow-up systems, which are monitored daily by the CRM team. We encourage two routine scheduled remote follow-ups per year, as well as any urgent follow-ups. 

Is your EP lab currently involved in any clinical research studies or special projects? Which ones?

We are currently taking part in the REM-HF study, which is evaluating the effectiveness of automatic remote monitoring using implanted device technology for the management of chronic heart failure. We are also involved in a number of registry studies and planning a number of clinical research studies awaiting formal ethical and R&D approval.

Describe your city or general regional area. 

The regional area covered by our centre is quite varied. The surrounding area is quite rural with many small towns and villages, although the centre itself is based in a popular English seaside town.

For more information, please visit http://www.lancashirecardiaccentre.nhs.uk/