Spotlight Interview: Main Line Health - Lankenau Medical Center

Chris Dearing, BSN, RN, BS, RRT, Nurse Manager,
Invasive Cardiology, Interventional Radiology
Wynnewood, Pennsylvania

Chris Dearing, BSN, RN, BS, RRT, Nurse Manager,
Invasive Cardiology, Interventional Radiology
Wynnewood, Pennsylvania

What is the size of your EP lab facility and number of staff members?

There are six board-certified electrophysiologists who routinely perform procedures at Main Line Health’s Lankenau Medical Center in Wynnewood. We have three dedicated EP labs and two noninvasive procedural rooms within the Invasive Cardiology Department. The two main EP labs, which were built in 2010, utilize a shared control room and are approximately 2,000 square feet total.

The third EP lab, built in 2008, is equipped to function as a swing lab for angiography as well as handle diagnostic and interventional EP services. The two noninvasive rooms are 160 square feet each, and are equipped with physio-monitoring and information systems as well as anesthesia services. Lastly, we have a fully integrated EP lab in one of the main cardiothoracic operating rooms.

The EP staff consists of 6 registered nurses, 3 EP technologists, 1 nurse practitioner, 2 physician assistants, and 3 fellows. We often require the need of the anesthesia department for complex cases and device implants that require defibrillator testing.

What is the mix of credentials at your lab?

In the EP lab we have 6 registered nurses, of which two are RCES certified and one RCIS certified, 3 EP-CV technologists, of which two are graduates of an accredited cardiovascular technologist program, and 3 advanced practitioners (1 nurse practitioner who is a board-certified acute care practitioner with IBHRE competency, and 2 certified physician assistants, one of which is IBHRE competent). All staff are certified in basic life support and advanced cardiac life support. The Invasive Cardiology Department has a total of 54 staff members (22 RNs, 5 CVTs, 2 CRNPs, 2 PAs, 6 fellows, 14 physicians, 1 medical secretary, and 1 cath lab aide).

When was the EP lab started at your institution?

The EP lab at Lankenau Medical Center was first established in 1990, as an offshoot of the cardiac cath lab. The initial EP team was comprised of cath lab staff who showed interest in this new field of cardiology. The EP lab started its journey utilizing a mobile c-arm for its imaging technology and an E for M Cath Lab system with an EP module for its hemodynamic recording system.

What types of procedures are performed at your facility?

Our EP labs offer all levels of interventional EP care and services. We routinely perform all EP diagnostic services and basic noninvasive procedures as well as percutaneous or surgical atrial fibrillation (AF) ablations, and endocardial and epicardial ablations for complex arrhythmias. Procedures include EP studies, radiofrequency catheter ablations, cryoablations, cardiac implantable electronic devices, cardioversions, noninvasive program stimulations, and head-up tilt table testing (HUTT).

Approximately how many are performed each week?

We average 30 cases per week.

What is the primary goal of your program?

The primary goal of our EP medical program is to promote superior patient outcomes in a safe practice venue. We specialize in optimizing technology-based data and extracting meaningful information to improve patient care. Our program is the foundation for community outreach in an effort to form a partnership to provide leadership, technical assistance, and recommendations for program development. We strive to provide the highest quality, compassionate cardiovascular care to Main Line Health patients in a professional environment that respects the contributions of each employee and emphasizes not only the expertise in clinical practice, but supports the commitment to clinical research and education.

Who manages your EP lab?

Chris Dearing, BSN, RN, BS, RRT is the Nurse Manager who, since 2007, has managed the day-to-day operations for the Invasive Cardiology Department, which is comprised of Interventional Cardiology and Electrophysiology. Mark Heimann, ACNP-BC is the EP Clinical Lead, and Elizabeth Ragan, BSN, RN, RCIS is the Scheduling Coordinator for Invasive Cardiology.

Lankenau Medical Center’s EP lab is under the medical direction of Dr. Dusan Z. Kocovic, MD, who is Chief of Staff for Electrophysiology at Main Line Health. Dr. Steven A. Rothman, MD is Lankenau Medical Center’s Chief of Staff for Cardiovascular Disease, and Dr. Douglas B. Esberg, MD, is Director of the Electrophysiology Fellowship Program at Lankenau.

Is the EP lab separate from the cath lab?

Since 2007, the EP and cath labs have been separate specialties under the umbrella of Invasive Cardiology; however, cross coverage is requested at times. The EP-CVT staff is rarely asked to monitor a case in the cath lab due to the infrequency of their presence. The same holds true for the cath lab-CVT staff in the EP lab. The present technologies in EP are so complex to operate and troubleshoot that it is essential to have highly trained individuals whose proficiency is a result of consistently working in that environment. The EP staff serves as an extension to the electrophysiologist, which results in a team approach with each case. It’s a harmonious collaboration of professionals with a common purpose of providing superior patient care and outstanding clinical outcomes. The cath lab RNs will be asked to provide conscious sedation during device implantation if staffing is needed due to increased volume or staffing issues. They will also be utilized for noninvasive procedures such as cardioversions and HUTT tests. All RNs have a critical care background and have been deemed competent to provide conscious sedation following a rigorous 3-month initial orientation. All performance is monitored via yearly competencies.

Do you have cross training inside the EP lab?

Yes. The EP-CVT staff and EP nurses can basically perform all tasks, with the exception of nursing being the only staff members that can administer medications. The other exception is the cardiac mapping systems. Currently our EP-CVT staff are the only members of the EP team trained to operate St. Jude Medical’s EnSite Velocity System and Biosense Webster’s Carto 3 Navigation System. Nursing and EP-CVTs can operate Bard’s LabSystem PRO EP Recording System, Boston Scientific’s EPT-1000XP Cardiac Ablation System, Biosense Webster’s Stockert 70 RF generator, and both Fischer Bloom DTU-215B and Micropace EPS320 cardiac stimulators.

What are the regulations in your state?

In a hospital in which EPS is performed in Pennsylvania, each physician performing EPS shall be either board certified or have attained pre-board certification status in cardiovascular diseases and shall also be either board certified or have attained pre-board certification status in clinical cardiac electrophysiology. Therapeutic electrophysiology, including ablation and the implantation of automatic implantable cardiovertor defibrillators, shall be performed in a hospital with an open-heart surgery program, and not in any other facility. Implantation of routine permanent pacemakers may be performed in hospitals that do not have an open-heart surgery program onsite.
There is one registered nurse, assigned to provide nursing care for patients in the EP lab area at all times, who has intensive care or coronary care experience, knowledge of cardiovascular medications, and experience with cardiac catheterization patients.

There are nursing service goals and objectives, standards of nursing practice, procedure manuals, and written job descriptions for each level of personnel, which shall include the following:

  • A means for assessing the nursing care needs of the patients and determining adequate staffing to meet those needs.
  • Staffing patterns that are adequate to meet the nursing goals, standards of practice, and the needs of the patients.
  • An adequate number of licensed and unlicensed assistive personnel to assure that staffing levels meet the total nursing needs of the patient.
  • Nursing personnel assigned to duties consistent with their training, experience, and scope of practice, where applicable.

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

We have experience working with companies in all levels of technological creation and development. Presently, we have been working with a company attempting to bring intracardiac visualization technology to the marketplace (Voyage Medical). We are a partner to Siemens Medical for fluoro systems in EP lab development and a show site on a national basis for Artis zee and for DYNAVISION. Some examples of our recent technology acquisitions include:

  • The ScottCare OneView CRM for device implantation transcription and database registration in our EP lab, along with available export of ACC NCDR registry data
  • St. Jude Medical’s ViewMate ‘Zonare’ for intracardiac echocardiography evaluation
  • Baylis Medical’s NRG™ RF Transseptal Needle
  • Biosense Webster’s ThermoCool SF Ablation System
  • St. Jude Medical’s Quartet Quadripolar LV Pacing Lead
  • Terumo Medical’s TR Bands for radial artery hemostasis

How has this changed the way you perform those procedures?

The technologies have varying degrees of impact on procedural performance. The most recent example we share is the Siemens Medical Artis zee with DynaCT and the Syngo platform for image reconstruction. For our population referred for AF ablation, this allowed us to perform a CT directly on the table in our lab at the time of the EP procedure. Our CRNP or PA has been trained to then do a three-dimensional reconstruction, whereby registration with fluoro and/or with a mapping system is performed. The technology-based impact on our procedural performance varies from technology to technology, and may be as little as no impact or, as in our example, significant impact.

Have you recently upgraded your imaging technology?

We recently upgraded our EP labs in March 2010 by installing two Siemens Artis zee biplane fluoro systems and two Artis zee 60-inch large monitor displays, along with maintaining intracardiac echo at tableside.

Who handles your procedure scheduling?

The Surgical Scheduling Department at Main Line Health handles all intake of cases for the EP physician offices at Lankenau. The Cath/EP Scheduler for Main Line Health’s three EP labs (Lankenau, Bryn Mawr, and Paoli) will input relevant data regarding cases into a scheduling software system, which will be reviewed and manipulated by Lankenau’s Invasive Cardiology Scheduling Coordinator. We will then adjust the start times according to the physicians’ activities and staffing mix for that next day.

What software is used?

We use the Operating Room Scheduling Office System (ORSOS) patient scheduling software.

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

We maintain several core measures and are required to have Evidence Based Practice Teams that examine antibiotic timing and incision time for implanted cardiac devices to vascular access site surveillance. We monitor as many metrics as we have labor support, including resource utilization for cases, procedure start time, and anesthesia utilization. We also measure practices such as labeling of bowls/syringes, patient identification, time-out checks, lead apron checks, dosimeter readings, radiation exposure, and handwashing audits.

How is inventory managed at your EP lab?

Inventory Control is a function that is jointly shared between the Nurse Manager and the Inventory Control Coordinator.

Who handles the purchasing of equipment and supplies?

There is a steering committee in place under the direction of our institution’s multidisciplinary team. If a vendor is proposing a trial for a new technology, it must be accompanied by the FDA approval and undergo biomedical inspection if necessary or product use approval prior to trialing the product. If a product is requested by a physician or allied professional, the product proposals and requests must be made to the committee and be approved unanimously by the committee prior to introduction into clinical service lines. All providers are encouraged to attend the routinely scheduled committee meetings and present information.

Tell us about your recent lab expansion.

The three dedicated EP labs and two non-invasive procedural rooms were built in 2010 and share a control room which total approximately 2,000 square feet. The design was based on the concepts of multidisciplinary procedure performance and transparency. All providers are able to share information during the procedure, whether with individuals on site or utilizing remote desktop connection. We have found that this form of ‘open architecture’ and transparency has resulted in improved procedural safety and clinical outcome. We have found the size of our lab to be quite adequate to accommodate excellence in our clinical service line.

Is your EP lab part of a separate heart hospital?

No. Lankenau Medical Center is part of the Main Line Health System. Main Line Health is a network of hospitals and health centers in the Philadelphia area. The Lankenau Medical Center serves as the largest educational facility for advanced medical and allied professional training. The cardiovascular service division and EP lab are operated within the Medical Center.

How has managed care affected your EP lab and the care it provides patients?

The growth of managed care in the U.S. was spurred by the enactment of the Health Maintenance Organization Act of 1973. While managed care techniques were pioneered by health maintenance organizations, they are now used by a variety of private health benefit programs. Managed care is now nearly ubiquitous in the U.S., but has attracted controversy because it has largely failed in the overall goal of controlling medical costs. Proponents and critics are also sharply divided on managed care’s overall impact on the quality of U.S. health care delivery.

Despite the controversy surrounding managed care, our facility has focused in the past decade on the importance of multidisciplinary provider awareness of health care costs. The Invasive Cardiology Department recognizes the high cost to society for the technology-based subspecialty care in electrophysiology. We vigorously work to avoid unnecessary health care costs by allowing physicians to participate in negotiating the costs of the technologies, encouraging case review for medical necessity and treatment options, and increasing awareness of service line revenue and costs. We actively promote patient education in the department prior to and after all procedures or diagnoses to increase the patient discharge preparation and reduce length of stay. Our laboratory recognizes the high cost of health care cases and works routinely with the industry and the administration to promote affordability in service delivery while promoting excellence in interventional care.

Have you developed a referral base?

Our referral base remains a dynamic challenge; we have established it to focus on the geography of our health network and community access to services. We strive for excellence in multidisciplinary service lines in the field of cardiology, and by supporting the finest multidisciplinary team with the most advanced technologies to promote excellent patient outcomes. Our health system recognizes the value of community outreach and programs that traverse the line of inpatient and ‘at-home’ patient care.

What measures has your EP lab implemented in order to cut or contain costs?

Cost containment is a component of our program’s mission and is constantly considered as we manage the service line. All technologies and clinical decisions are subject to transparency of presentation and discrimination. We pay close attention to increasing cost of technology and repeatedly consider the benefit to cost ratio. We recognize a need to remain at state-of-the-art level balancing practicality and societal cost.

In what ways have you improved efficiencies in patient through-put?

We attempt to assign our staff nurse to follow the patient from the point of initial contact, through pre-procedural preparation, followed by the intervention, and back to the holding area for either in-hospital stay or discharge. We feel that promotes efficiency while displacing the feeling the patient may get when being ‘passed off’ from provider to provider within a department. The assigned nurse is assisted by various support team members, from housekeeping to turn over the room, dietary to provide nourishment, and technologists to assist with various components of the procedures.

The greatest impact for procedural performance time and through-put is our utilization of a nurse practitioner and physician assistant to promote stability in the medical education program, expertise in procedural performance, and a true commitment to focus on patient safety and optimal procedural outcome. In prior comparison of procedure time, radiation exposure, and complications, these providers exceeded unequivocally as compared with the annual rotation of medical training staff. We have combined this to create this optimal scenario to promote procedure efficiency.

Has your institution formed an alliance with others in the area?

Our institution is part of the Jefferson Health System. This entity is the corporate parent of Main Line Health, Thomas Jefferson University Hospital System, and Magee Rehabilitation.

How are new employees oriented and trained at your facility?

Once employees complete the mandatory hospital orientation program, subspecialty unit orientation begins. A booklet is provided to each team member outlining the three-month orientation process, which takes place with our most experienced staff acting as preceptors and ultimately mentors. During the orientation process, the individual rotates through our Cardiothoracic Surgery Department for OR experience and competency, followed by evaluation of the performance responsibilities in the multiple aspects of peri-procedural support. Finally, competencies are performed for all major technologies allowing for detailed orientation and comprehensive sign-off on staff capabilities.

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

Staff participates in hospital in-services and continuing education programs, as well as training provided by physicians and vendors. Four EP staff members were able to earn CEUs at this year’s Heart Rhythm Society Annual Scientific Sessions in Boston.

How is staff competency evaluated?

The EP staff has yearly competencies which involve the Clinical Lead and support staff evaluating the proper use of various technologies and procedures via direct observation and return demonstration.

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

Staff burnout is a real issue in electrophysiology due to the critical nature and complexity of the cases, which involve long hours and intense concentration. Also, trying to operate the EP lab at peak efficiency means there is little room for extra staffing. Thus, it is important to focus on the little things one can provide to ease the tense nature of this profession. The following are measures we use to prevent staff burnout with team-building exercises:

  • We have specific departmental goals that pertain to the EP lab, such as infection control with device implants or ways to minimize vascular complications. We routinely clarify our goals in order to streamline our staff focus.
  • Our scheduling is flexible and we try to accommodate everyone’s requests for time off. We do this for the full-time staff by utilizing per diem staff with EP experience. 
  • We reward hard work and performance as often as possible with off-site educational conferences, merit increases during yearly evaluations, and something simple as a gift card with a ‘thank you’ or ‘you’re the best.’ 
  • The entire team works collaboratively with mutual respect for each other. This is probably one of the most important reasons why our staff is so energetic and engaged. It is paramount for a successful program. No one person is bigger or more important than the next. We are all essential components of the team. 
  • We make every effort for staff to attend EP in-services, both on site and off campus. Scott Cox, PA-C gives monthly in-services to the EP staff on topics including case reviews and technology-based discussions. 
  • Several years ago we established a Retention Committee, which is headed by one of our EP staff nurses, Adrienne DeFay, BSN, RN, RCIS. She helps organize the celebration of birthdays and is especially great at getting the staff together to celebrate all holidays. Thanksgiving in the department is the best. Mary Benvenuto, RN, RCIS had the department’s holiday party at her house this past Christmas. 
  • We get the team involved in any hospital events such as the annual hospital Health Fair, the AHA’s Heart Walk in Philadelphia, the Magnet nursing conference, or the HRS annual sessions.

What committees, if any, are staff members asked to serve on in your lab?

The Clinical Ladder program at Lankenau Medical Center recognizes and rewards staff nurses for clinical expertise in delivering direct care to patients. It is a voluntary program in which nurses demonstrate expertise in the areas of clinical management, educational activities, and research. One example of activities in these areas includes serving on unit and hospital committees. Several of our EP nurses have maintained Clinical Ladder status for years. Two important departmental committees our EP lab staff are involved with include the Infection Control Committee and Vascular Access Committee. Our Infection Control Committee is responsible for maintaining and analyzing data collected for antibiotic tracking of device implants. This data is collected by Trish Fingo, RN, RCES, who is one of our EP staff nurses. It is then reviewed and shared with the team in order to ensure we are 100% compliant with antibiotic administration and incision time. Our Vascular Access Committee closely monitors vascular complications and reports findings to our Quality Assurance team. Other committees our staff are involved in include the Procedural Patient Safety Committee, Dermal Defense Team, and UTI Committee.

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

Hospital policies and procedures indicate a need to effectively communicate and enforce vendor policies and management of vendor credentials. This platform is done through Reptrax and is jointly handled by our Inventory Control Coordinator and the Nurse Manager. We routinely do business with many medical device and pharmaceutical companies. We can have anywhere from 3 to 10 vendors in our EP lab each business day.

Describe a particularly memorable case that has come through your EP lab.

We feel that every case has memorable components. Whether it is noninvasive ICD testing, a VPD ‘trigger’ ablation for VF, or acute hemodynamic optimization of an individual undergoing biventricular lead implantation with complex anatomy, they are all memorable. In our staff lounge, we post letters written to administration by thankful patients for the wonderful care they received. It’s in those letters where the staff has an opportunity to recall how much of an impact they had on a patient’s life. In these letters you often find memorable stories that stick with you.

How does your lab handle call time for staff members?

In the Invasive Cardiology Department, our EP lab staff does not take call. Lankenau Medical Center is an accredited chest pain center with PCI through the Society of Chest Pain Centers. Our cath lab staff takes on-call to rapidly respond to and effectively treat heart attacks. They also take call for emergent complete heart block patients and will assist in permanent pacemaker implants. Late cases in the EP lab are handled by the EP team, and each day we assign two or three EP staff members to stay until the cases are finished. This usually means that two times per week you would be assigned ‘late days’ or what we call ‘triangles.’

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

Presently, less than 1%.

Do you perform only adult EP procedures or do you also do pediatric cases?

We do not perform cases on pediatric patients.

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

To minimize staff and physican radiation exposure, the EP recording system and mapping systems are used in the control rooms. For the majority of our ablations, the team routinely utilizes 3D anatomical mapping. The Siemens Medical Artis zee biplane systems have been programmed to default to an extra-low fluoroscopy dose. We provide lead aprons and eyewear to all staff, and have our physicist check the aprons and collars annually for defects.

Do your nurses/techs participate in the follow-up of pacemakers and ICDs?

The nurses and technologists are encouraged to participate in every aspect of clinical and interventional EP care. Because of staffing and administrative burden, we rarely have time or the opportunity to perform complete device interrogation and reprogramming on a staffing level. Presently, our organization allows the industry representative to support cases in the interventional and clinical environment. This is used as a vehicle to support medical training, leaving the staff to attend to patient care in the peri-procedural milieu. One of our PAs, Brighid Donegan, PA-C, is designated to provide clinical EP support outside of the interventional environment, further allowing the EP staff to concentrate in the direct peri-procedural care of the patient.

What innovative EP techniques are being utilized in your lab?

Presently, our medical providers are committed to medical training that focuses on understanding concepts of signal analysis first, followed by imaging and mapping system enhancement to establish the mechanisms of arrhythmias. We are slower to adapt ‘EP techniques’ as a result. Presently, for pulmonary vein isolation procedures we do not use sheaths in the left heart unless we determine an absolute need (<1% of time) for anatomic access. We have been using adenosine protocols, though, to assess ‘dormant’ conduction that may be masked by the heating effect on elevated resting membrane potential, both in our surgical OR for atrial fibrillation ablation and in our percutaneous lab. Under Dr. Kocovic’s direction, we have historically performed cardiac resynchronization therapy utilizing efforts to obtain an acute understanding of LV lead placement effects and timing effects of pacing therapy. This is done using catheters placed in the left circulation that either directly measure or infer LV pressure and volume measurements along with additional metrics.

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

We would like to think the most dominant trend is to optimize technology-based data management to provide clear and meaningful information for our providers. Technology is advancing at such a stride in EP care, we feel it is necessary to take our time in evaluating the ‘trend’ of the technological use or the technique used during the procedure.

How is your lab preparing for these future changes?

Our belief is that we will remain prepared for any and all future changes by reviewing the literature daily, incorporating the suggestions of providers and industry personnel with care and caution, and demonstrating proficiency with which we perform these procedures.

What are your thoughts about non-EPs implanting ICDs?

We do not support the concept, and require board certification in EP to implant ICDs in our health system.

What about device recalls? How has your lab handled these?

We maintain a comprehensive database (ScottCare’s OneView CRM) for our health system’s registry of CIEDs at the Lankenau Medical Center. This database is able to be queried for any information regarding device information, trends of any elements regarding device management, or the results of testing and diagnostic information. Typically, we will request the manufacturer’s registry information as well for comparison. Depending on the type of issue, our multidisciplinary management team will join together to review industry recommendations and create a clinical implementation protocol if and as needed.

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

Yes, we presently are participating in the following studies/projects:

  • LAPTOP HF – St. Jude Medical - To evaluate the clinical effectiveness of St. Jude Medical’s Left Atrial Pressure (LAP) Monitoring System in ambulatory patients with advanced heart failure.
  • HARMONY – Gilead Sciences - The primary objective of this study is to evaluate the effect of ranolazine and of low-dose dronedarone when given alone and in combination at different dose levels on AF burden over 12 weeks of treatment.
  • EVOLVE – St. Jude Medical - Patients indicated for a BiV ICD are screened. The 6-month response to cardiac resynchronization (CRT) in heart failure (HF) patients with standard V-V (right ventricle and left ventricle) timing versus hemodynamic optimized V-V timing (checking pressures to find the optimal location for the lead) lead placement will be compared.
  • CARE – Boston Scientific - To investigate prospective means of increasing the responder rate to CRT, specifically in medically-refractory ischemic heart failure patients. Six-month response to CRT will be compared in heart failure patients with standard LV lead placement versus hemodynamically optimized lead placement.
  • CABANA – National Institutes of Health – A 6-year mortality trial designed to test the hypothesis that the treatment strategy of percutaneous LA catheter ablation for the purpose of the elimination of AF is superior to current therapy with either rate control or AA drugs for reducing total mortality in patients with recent-onset AF requiring treatment.
  • SHIELD 2 – Forest Research Institute, Inc. – The primary objective of this study is to assess the impact of 75 mg azimilide versus placebo on the occurrence of unplanned (non-elective) cardiovascular hospitalizations, unplanned cardiovascular emergency department visits, or cardiovascular death in patients with an ICD.
  • CADENCE  – Otsuka Pharmaceutical Development & Commercialization, Inc. – To determine the safety, tolerability, pharmacokinetics and efficacy of an investigational drug (OPC-108459) following infusions in adult subjects diagnosed with paroxysmal or persistent AF.
  • RAID – National Institutes of Health – To determine whether ranolazine administration will decrease the likelihood of a composite arrhythmia endpoint consisting of ventricular tachycardia or ventricular fibrillation (VT/VF) requiring anti-tachycardia pacing (ATP), ICD shocks, or death.

Additional projects include persuing Chest Pain Center Accreditation as an AFib Center, and utilizing ScottCare’s OneView CRM platform as the single conduit for our institution to manage all of its ambulatory electrocardiographic monitoring and remote device management. The interventional environment has taken on all forms of CIED registration into our health system database, beginning with remote follow-up from the time of implant of the device, along with avoiding redundancy when the patient shows up in the office (the operative report and implant testing results and all information are accessible in the same ScottCare OneView CRM database).

Are you ACGME-approved for EP training?

Yes.

What do you think about 2-year EP programs?

We feel strongly that a 2-year EP fellowship should be mandatory. The advanced technologies needed for managing care in individuals with interventional EP or CIED needs are significant. We are committed to fostering proficiency in all aspects of EP care, and feel that 2 years should be the minimum national requirement.

Does your lab provide any educational materials for patients who may have additional questions about their condition or a procedure?

Yes. We created a brochure and additional ‘take home’ educational material for patients and their families specific to undergoing procedures such as pacemaker or ICD implants, ablations, and EP studies. This brochure includes terminology the patient may be exposed to or hear, what to expect in the procedural environment (from registration through discharge), a map of where you can go in our environment for nourishment, pharmacy purposes, parking, etc., along with the specific information an individual is given for the type of procedure they are undergoing.

Give an example of a difficult problem or challenge your lab has faced. How it was addressed?

In 2008, our department was faced with undergoing a $25 million renovation, which included essentially tearing down the entire suite and rebuilding it in phases. The project involved building two new EP labs and one new cath lab, equipment (fluoro) upgrades in two other existing cath labs, a new inventory supply room, a new equipment storage area, two new soiled utility rooms, a new clean supply room, a new physician viewing room, renovating 12 holding area bays and adding four new ones, a new staff lounge, building two new nursing stations, a new patient bathroom, and 2 new staff locker rooms. The challenge was how we could make these necessary upgrades happen while maintaining operations as usual. The phased approach to this project included redistributing supplies to different areas of the department, moving staff and physicians to different areas within the department while their areas were under construction, and ensuring our quality and standards were still providing exceptional care. It was a chess match with each phase; however, the staff pulled together and made sure that patients still received exceptional care. Our quality never deteriorated and, in fact, we had no reportable infections during the entire 2-year project. The key factor in handling this enormous challenge was constant communication between the nurse manager and staff during the project.

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

Lankenau Medical Center is located in Montgomery County, Pennsylvania, which is a suburban county northwest of Philadelphia. As of 2010, the county was the third most populous county in Pennsylvania. Many of its residents work in the city; however, Montgomery County is also a major employment center with large business parks in Blue Bell, Lansdale, Fort Washington, Horsham, and King of Prussia, which attract thousands of workers from all over the region. The strong job base and taxes generated by those jobs have resulted in Montgomery County receiving the highest credit rating of AAA from Standard & Poor’s, one of fewer than 30 counties in the United States with such a rating. It is the 20th wealthiest county in the country as measured by personal per-capita income and was named the 9th Best Place to Raise a Family by Forbes magazine in 2008.

Please tell our readers what you consider unique or innovative about your EP lab and staff.

For over 150 years, Lankenau Medical Center has been the region’s destination of choice for healthcare, sustaining a commitment to providing a superior patient care experience. Our EP lab is renowned for its combined mission of excellence in patient care, academic achievement, and innovative research. We are one of the largest medical and surgical programs for heart disease and arrhythmia management in the region. We maintain state-of-the-art electrophysiology labs for treating heart rhythm disorders and employ some of the most dedicated and talented professionals in the area. We’ve adopted a continuity of care model that features staff staying by your side the moment you arrive in our unit until the minute you are discharged from our department. This familiarity of staff throughout your stay in our lab is unique and innovative because there is very little fragmentation of care. The staff who admits you to our holding area will be the same staff with you during your procedure. This same staff will also ensure you are cared for post procedure until discharge from our department to home. This allows patients and their family to feel comfortable knowing their loved one is not just being seen by an array of providers. This personalized aspect of care, along with our ability to partner with industry leaders in mastering the technological advancements in electrophysiology, makes us unique providers of EP services.

For more information please visit http://www.mainlinehealth.org/lankenau