Spotlight Interview: Methodist Hospital

Howard Mattingly, RN, Team Leader, EP Lab

Howard Mattingly, RN, Team Leader, EP Lab

What is the size of your EP lab facility and number of staff members? What is the mix of credentials at your lab? We have three EP Labs: one single-plane lab, one biplane lab and one Stereotaxis lab. We perform about 1,200 cases a year. We have eight regular staff members and two supplemental, all of whom are nurses (except for one technologist). When was the EP lab started at your institution? The EP Lab was started here in 1994.  What types of procedures are performed at your facility? We perform diagnostic EP studies, all types of ablations, and all types of device implants, including BiVs and lead extractions. What is the primary goal of your program (AF ablations, lead extractions, BiVs, etc.)? Our academic practice focuses on complex ablations primarily atrial fibrillation and ventricular tachycardia. Our two private practice groups focus on EP and implants. We are also one of two referral centers for lead extraction in the state of Indiana. Approximately how many are performed each week? What complications do you find during these procedures? We typically perform five to six ablations (mostly for AF), six to eight BiV implants, eight to 12 other implants, one or two lead extractions, and two to four EP studies per week. Who manages your EP lab? The team leader manages day-to-day operations and reports to the cath/EP Lab manager. Is the EP lab separate from the cath lab? How long has this been? Are employees cross-trained? The cath and EP labs are together and have been for about 10 years. There are three cath lab techs who have cross-trained to EP, and three of the EP staff have cross-trained to the cath lab. What new equipment, devices and/or products have been introduced at your lab lately? How has this changed the way you perform those procedures? Our Stereotaxis lab opened about a year ago, but we recently added CARTO RMT (remote magnet technology), now that Stereotaxis ablation catheters are available. Our physicians are just starting to get comfortable with the technology, and so far the reviews are mixed. Everyone who went to HRS this year is getting enthusiastic about it, and we're hoping Stereotaxis will decrease procedure times and improve outcomes as we progress. Who handles your procedure scheduling? Do you use particular software? We have a scheduling secretary who coordinates with the cath and EP team leaders and organizes the schedule. We're using a Cerner scheduling program throughout the hospital. What type of quality control/quality assurance measures are practiced in your EP lab? Our current initiatives focus on tracking and preventing device infections, monitoring sedation administration and complications, improving procedure start and turnover times, and minimizing overtime. To minimize overtime, we are running a pilot program that moved several staff to 10-hour shifts. Monitoring sedation is also a major focus, because the nurses use propofol infusions on many of our procedures, and any increase in complications could result in losing that privilege. So far, we've done very well with it. How is inventory managed at your EP lab? Who handles the purchasing of equipment and supplies? Most of our routine supplies are stored in Omnicell units in each lab. Materials Management monitors usage, reorders, and restocks them for us. Items not in the Omnicells are ordered by the department, based on established par levels. New products are brought to an EP Products/Operations group monthly for review. The EP team leader, the cath/EP manager, one physician from each practice, and representatives from Materials Management evaluate the product and can recommend either stocking it, testing it in a trial evaluation, or denying it. No other approval is usually needed. Equipment and a justification for buying it can be proposed by the EP team leader or cath/EP manager, and are forwarded to administration during the budget preparation each year. The approved budget is released at the beginning of each year. Has your EP lab recently expanded in size and patient volume, or will it be in the near future? The hospital, in coordination with the existing physician practices, established a new practice to better support patients at our existing facilities and to expand into underserved areas in our region. This practice has just started generating volume, and expects to grow into a major group. Have you developed a referral base? Yes, we receive referrals from all over Indiana and other states as well. Recently, several communities have asked Clarian to help them develop or expand services, so we are working to expand our referral base into these areas. 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 work very closely with our vendors on contracts to contain device costs, and we continually modify our trays to reduce the number of individual items being opened for any procedure. We have a products committee, and all new items must be sponsored by a physician and presented to the committee before being stocked. We are also tracking our start and turnover times very carefully and looking at means to reduce these delays and increase volume without adding overtime. We've also worked very hard with our physicians to limit the number of after-hours cases. Overtime was a major source of staff dissatisfaction, and created problems for management as well. What procedures do you perform on an outpatient basis? Outpatients can remain in the hospital up to 23 hours, so many of our device implants and ablations can be kept overnight and still be considered outpatients. In general, our device replacement, EP study and uncomplicated ablations that do not require entering the left heart usually go home the same day the procedure is performed. How are new employees oriented and trained at your facility? New employees are scheduled for hospital and nursing orientation before starting work in the department. They are assigned a preceptor in the department as well as a mentor to cover when the preceptor may be off work. They receive an orientation manual that includes basic material, some policies and some quizzes. New employees and their preceptors are assigned to procedures so they can complete training objectives. As team leader, I try to meet with the employee and preceptor once a month to determine goals and progress. What types of continuing education opportunities are provided to staff members? We try to send one or two staff members to HRS each year. We also post other regional in-services that might be available, and bring in vendors to do in-services on new products or techniques. We attend occasional case presentations given by our teaching faculty and fellows, and we present programs within the department on basic EP principles or seminars we've attended. How is staff competency evaluated? Staff are reviewed annually using a tool that allows the employee and the manager to review progress and accomplishments over the past year. We compare input and set goals for the following year. How do you prevent staff burnout? Minimizing overtime helps. One of our staff has assumed the role of social director and tries to organize lunch parties occasionally as well. How do you handle vendor visits to your department? Do you contract with vendors? We ask that only one vendor attend a procedure unless they are training a new CSR. Vendors are asked to make appointments in advance, and anyone who arrives without an appointment is usually asked to make an appointment for a future date and leave. We establish contracts with the vendors using our Materials Management Department as an intermediary. Physicians rate competing products based on features, administration sets cost limits and the Materials Management staff negotiates the contract after reviewing proposals with us. Does your lab utilize any alternative therapies? We have the first Stereotaxis lab installed in Indiana. With the recent release of the CARTO RMT catheters, which are designed for use with Stereotaxis, our doctors have started using the system more and we are very excited about the possibilities it offers. How does your lab handle call time for staff members? We do not have call. Does your lab use a third party for reprocessing? Yes.