Spotlight Interview: Overlake Hospital Medical Center

Steve Rowell, RDCS Clinical Director, Invasive Cardiology

Steve Rowell, RDCS Clinical Director, Invasive Cardiology

What is the size of your EP lab facility and number of staff members? What is the mix of credentials at your lab? Invasive Cardiovascular Services at Overlake Hospital Medical Center operate five laboratories. We provide comprehensive electrophysiology, diagnostic and interventional cardiac catheterization, interventional radiology and endovascular peripheral interventions. Due to program growth, we opened two new EP labs on February 20, 2006. Eleven registered nurses and 16 technologists staff invasive Cardiovascular Services. Three dedicated electrophysiologists, Derek M. Rodrigues, MD, FACC, Alan Heywood, MD, FACC, and Jeffrey Fowler, MD, FACC operate out of Overlake. Within the EP section, Robert Johnson, RT, Harry Sparks, RT, and Ken Stevens, RN provide dedicated EP technology services with support from the remainder of the department. All staff are ACLS certified. When was the EP lab started at your institution? Dedicated EP services at Overlake Hospital began in 1996 as an expansion of cardiac cath, which started in 1976. Dr. Derek Rodrigues was the initial driver for EP services. Dr. Alan Heywood joined the Overlake staff in 1997. The most recent addition to the medical staff was Dr. Jeffrey Fowler, who joined us in 2005. What types of procedures are performed at your facility? Our EP section provides comprehensive electrophysiology services, including diagnostic EP including 3D mapping, therapeutic ablative procedures (radiofrequency and cryo), pacemaker, ICD and CRT rhythm management procedures. What is the primary goal of your program (AF ablations, lead extractions, BiVs, etc.)? The goal of our program is to be the destination of choice for comprehensive electrophysiology services for our patients and physicians throughout the Puget Sound region. Approximately how many are performed each week? What complications do you find during these procedures? The entire Invasive Cardiovascular Services division encounters approximately 75 patient visits per week. Of that total, fifteen patients are here for EP procedures. We performed 450 device implants and 275 diagnostic or therapeutic EP procedures last year. No unusual complications were noted. Who manages your EP lab? The lab is managed by Steve Rowell, Clinical Director, Invasive Cardiovascular Services. He is responsible for the operation of all five labs. Lead Technologist Robert Johnson supports him in EP. Is the EP lab separate from the cath lab? Are employees cross-trained? The EP lab is a separate entity within the Invasive Cardiovascular Services division. On February 20, we opened our two new EP labs. They are physically located away from the Cardiac Cath labs, but staff is integrated to all areas. The remainder of the division supports a core EP staff of three. All EP staff are fully cross-trained in cardiac catheterization and interventional radiology. Do you have cross training inside the EP lab? What are the regulations in your state? The core EP staff has developed from the ranks of Cardiac Cath Lab Radiology Technologists. Recently Ken Stevens, a cath lab RN, cross-trained to assume an EP Technologist role. This dual skill set has proven valuable in providing staffing flexibility. What are some of the new equipment, devices, and products introduced at your lab lately? How has this changed the way you perform those procedures? As mentioned earlier, we proudly opened our two new electrophysiology suites on February 20, 2006. Our previous single lab operated at nearly 100% capacity and program growth was difficult. Planning for this expansion began in 2004, and this $2.2 million project has been completed on budget. Our new labs are equipped with Toshiba Infinix single-plane ceiling-mounted imaging systems. Tilt table and DSA are included in both rooms. Our EP systems are Bard, with Bloom stimulators and EPT generators. CryoCath and Chilli pumps add to ablation capabilities. Our 3D mapping system is Endocardial Solutions (ESI). Intracardiac Echocardiography is performed with Acuson Cypress and IVUS with Boston Scientific Galaxy. Who handles your procedure scheduling? Do you use a particular software? Erika Gaskill, Program Assistant, handles our procedure scheduling. Erika is the air traffic controller that holds everything together. She works with the lead technologist and charge nurses in all sections to coordinate daily workflow, schedule additions and delays, in order to maximize our physician and staff time. How is inventory managed at your EP lab? Who handles the purchasing of equipment and supplies? EP inventory, like all of invasive cardiology, has to this point been handled by simple physical inventory, with reorders processed on the hospital materials management platform. We are in the process of converting to an Omnicell inventory control system for all supplies. We have used Omnicell for some time for pharmaceuticals. This materials conversion will allow real-time inventory management by the materials management department, as well as guaranteeing charge capture on all items dispensed. Has your EP lab recently expanded in size and patient volume, or will it be in the near future? With the addition of a third electrophysiologist, growth in our population base, and the continued increase of implantable devices, we project a robust expansion in EP. As such, we did add the second lab to increase access to our patients and physicians. How has managed care affected your EP lab and the care it provides patients? Reimbursement is decreasing from all payers. We are very proactive in the business development phase to assure new programs or modalities are fully researched for charging, coding and costs prior to introduction. 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? The hospital is in the process of adopting a Value Analysis Team (VAT) process that requires all new products be introduced and approved by the VAT team for that section. The EP products will be under the Endovascular VAT, made up of representatives from Surgery and Cardiology. The goal is to reduce duplication of inventories, reduce the number of vendors in order to improve pricing, and to assure that all contract, reimbursement and charge master needs are in place prior to introduction of the product for demo or adoption. Does your EP lab compete for patients? Has your institution formed an alliance with others in the area? The Northwest Washington/Puget Sound area is a very mature cardiac market. There are at least four high-end EP programs in the metropolitan area. Competition exists for patients and staff. We compete by providing the latest technology as well as highly competent staff, and by providing a positive patient experience. What procedures do you perform on an outpatient basis? Most uncomplicated ablative procedures are performed as outpatients. Most devices and complex ablations are treated as inpatients. How are new employees oriented and trained at your facility? Following general hospital orientation, new staff is teamed with a department preceptor. Over time, we have developed complete competency checklists for all areas (cath lab, EP, interventional radiology). Staff does not operate independently until the preceptor signs off all areas of competency. What types of continuing education opportunities are provided to staff members? We see continuing education as a method to improve care and to retain employees. Our physicians present monthly lecture topics. The topics are suggested by staff or medical staff, and then Joe Doucette, MD, FACC, Invasive Cardiology Medical Director coordinates appropriate speakers for the topic. Topics range from radial artery access issues to carotid stenting to cardiogenic shock. Additionally, we have doubled our efforts to get staff out to national meetings. This year, approximately 16 staff will attend the ACC in Atlanta, Heart Rhythm Society in Boston, Summer in Seattle in Bellevue, or TCT in Washington, D.C. How is staff competency evaluated? Overlake Hospital utilizes an E-Learning system that post all available in-service and competency modules online. Staff can complete required programs from any network PC or can log on from home. We also undergo ACT (Annual Competency Review), in which staff provides return demonstration on crucial department-specific procedures. Licensure and certifications are managed through the Human Resources (HR) department, with reminders generated for staff and managers of upcoming expiration of credentials. How do you prevent staff burnout? We were faced with this very issue late last year. With the increase in privately held outpatient labs, we lost many of our senior staff to fixed hours and no-call environments. Call obligations increased, as did overtime. In collaboration with staff, HR, and hospital executives, we developed a recruitment and retention plan that addresses a multitude of issues. Instead of the traditional 10-hour workdays, we allowed staff to choose between 8-, 10-, or 12-hour shifts. We also allowed staff to pick their workdays based on seniority. The result was a hybrid schedule with 8-hour, 10-hour, and 12-hour crews that allowed an expansion of coverage hours and an increase in the number of scheduling slots within a standard workday. This has reduced the amount of overtime allowing staff to integrate work and home life into a workable partnership. We also reevaluated wage and standby rates to place us in the highest pay tier in the region. The final part of our retention plan was to increase our participation at national meetings as described above. How do you handle vendor visits to your department? Do you contract with vendors? Vendors are limited in their department access. They are allowed only by appointment with a stated reason for the visit, and are required to check in with Material Management prior to entering the department. Vendors are encouraged to provide in-service training to the staff, but only if CMEs are offered. This places the focus on education and not product marketing. How does your lab handle call time for staff members? How often is each staff member on call? How frequently do they have to come in, on average? Is there a particular mix of credentials needed for each call team? As described earlier, the EP section is integrated into the Invasive Cardiovascular Services division. EP staff stands call in the general rotation. No specific EP call exists. Call frequency is approximately five days each month, and callbacks are common as we serve a large suburban area. Most patients are coronary in nature, with some cerebral/stroke patients. Our call crew consists of two technologists and one registered nurse. Does your lab use a third party for reprocessing? We use a third party to reprocess diagnostic EP catheters and intracardiac echo transducers. As this program is fairly new, we have yet to determine the full benefit of the practice. Approximately what percentage of your ablation procedures are done with cryo? What percentage is done with radiofrequency? We have had CryoCath in our lab since July 2005. This modality is used in about 5% of all ablations with excellent results on tight tracts. Do you perform only adult EP procedures or do you also do pediatric cases? Is there cross training for pediatric cases? We focus on adult electrophysiology with an occasional adolescent. Pediatric studies are performed at Children's Hospital in Seattle. The needs of the community are met. What trends do you see emerging in the practice of electrophysiology? How is your lab preparing for these future changes? The trend is for an increase in implantable devices with ever-widening inclusion criteria. Supply costs will continue to escalate. New methods of mapping and ablation will continue to develop, with an increase in pulmonary vein ablation therapies. What about device recalls? How has your lab handled these? The two major device recalls in the last year have been taxing on our material, finance, and compliance departments. Separate charge master entries had to be created to indicate replacements without cost. Recently, the CMS FB modifier has been added to signify replacement items. Beginning in April, we will add Condition Code 49 or 50 to differentiate between early replacement and recall replacement. Is your EP lab currently involved in any clinical research studies or special projects? Which ones? Overlake has long been active in clinical research. Current EP research studies are Optimizer, ReThink, AF Suppression in CRTD and Victory. Describe your city or general regional area. How does it differ from the rest of the U.S.? Separated from Seattle by Lake Washington, Bellevue is a rapidly growing metropolitan area. East King County is home to Microsoft, Nintendo and Boeing. Located near the base of Mount Rainer, extensive winter sports venues are available, and the summers are great for boating or hiking in the Cascade or Olympic mountain ranges. Please tell our readers what you consider unique or innovative about your EP lab and its staff. Our uniqueness and innovation is our staff. I am fortunate to be associated with a group of professional technologists, nurses and physicians that are dedicated to the field of electrophysiology. These people have such high standards for professional growth and patient care my greatest challenge is to simply support them. For more information about Overlake Hospital Medical Center, please visit their website: www.overlakehospital.org