Spotlight Interview: St. Luke’s Regional Medical Center

Tonja LaDue, RCIS, MBA, Regional Director, Heart & Vascular Services, St. Luke’s Heart,
Boise, Idaho

Tonja LaDue, RCIS, MBA, Regional Director, Heart & Vascular Services, St. Luke’s Heart,
Boise, Idaho

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

The electrophysiology lab at St. Luke’s is a decentralized lab that is approximately 800 square feet in size. The lab’s hemodynamic monitoring system is located within the lab. There is a core team of four highly trained staff members. Additionally, there are 13 cross trained rotating staff members from the cardiac cath lab that assist with monitoring and circulating.

What is the mix of credentials in your lab?

The mix of credentials in the EP lab includes nurses and technicians. This includes our core team members, Toni Salladay, BSN, John Wilson, ARRT, Kelvin (Kelly) Gilchrest, RCES, Lead Technician, and Jeff Schoeben, RCIS.

When was the EP lab started at your institution?

It originated in 1991 inside the cardiac catheterization lab. The electrophysiology lab was later constructed in May 2004 as a separate lab. It was the first electrophysiology lab to be established in the state of Idaho.

What types of procedures are performed at your facility?

We provide comprehensive electrophysiology services. We perform ablation procedures for all types of supraventricular arrhythmias, as well as ventricular arrhythmias including PVCs and idiopathic and ischemic ventricular tachycardias. We also provide comprehensive catheter-based therapy for all atrial arrhythmias, including right and left atrial flutter as well as ablation of paroxysmal and persistent atrial fibrillation. Additional procedures include implantable devices such as permanent pacemakers (including bi-ventricular), defibrillators (including bi-ventricular) and loop recorders. We perform approximately 1,150 EP procedures annually.

What is the primary goal of your program?

The primary goal of the lab is to provide a comprehensive electrophysiology service to the people of our region. St. Luke’s Regional Medical Center is a tertiary hospital that provides our patients with extensive cardiovascular services. The electrophysiology lab is such an integral part of the specialized care we provide our patients.

Who manages your EP lab?

There is a dedicated lead electrophysiology tech, Kelly Gilchrest, RCES, in addition to a cardiac catheterization lab manager, Steven Newsome, RCIS, who oversee the clinical and daily operations of the lab. Together, they have over 35 years of EP and cardiac cath lab experience. Kelly is an exceptional tech in the EP lab, and is sought after by the physicians for his expertise. All EP staff are highly trained and dedicated to performing procedures in the EP lab. It truly takes a special person to work in the EP lab, and we have the best and the brightest.

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

We currently have available the most advanced 3D electroanatomical mapping, intracardiac echocardiography and different ablation technologies, including open- and closed-irrigation radiofrequency ablation and cryoablation. We will soon have cryoballoon ablation technology available to complement our current approach to patients with atrial fibrillation.

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

All of our EP physicians are employees of St. Luke’s, which allows them to have their patients scheduled through their offices using the Resource One software. With this software, the physicians, office secretaries, cardiac observation unit clerk, and the cath lab manager and secretary are able to access and view the EP lab schedule at any given time. Once the patient is scheduled, it is simultaneously communicated to those team members about the procedure. With this system in place, it has optimized our utilization of the EP lab.

Have you developed a referral base?

We have a large regional referral base that includes family practice physicians, cardiologists, and other physicians. Because a portion of our patients come from a more rural area, we have an outreach program as well. Our EP physicians periodically round in the rural St. Luke’s clinics and physician offices. They also provide community-wide education to our patients and healthcare providers in regards to new technology, procedures, and services provided by our lab.

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

The highest quality patient care is always first and foremost. Once that has been determined with each selected device, cost containment measures can be taken. We have an annual Request for Proposal (RFP) that is submitted every July to our vendors and any vendor wanting to conduct business with St. Luke’s Heart. Our St. Luke’s Heart RFP committee meets monthly to review the costs of supplies used by the invasive service line, which includes the implantable devices, cryocatheter, the ICE catheters, IVUS catheters, guides, wires, ablation supplies, etc. With the assistance of our hospital supply chain management team, we determine the potential savings with each vendor’s (or potential vendor) device or supply item. We began this aggressive process in March 2009, and since then we have saved over $3.2 million — over $2.1 million of this was from cardiac rhythm devices (CRM). Our contracts are renewed annually to maintain the diligence of pricing.

How are new employees oriented and trained at your facility?

New employees are required to attend a two-day, hospital-wide orientation as well as a three-day nursing orientation. Once they have completed their hospital and nursing orientation, their orientation for the EP lab begins. The cath/EP lab clinical educator will initiate their orientation and education requirements. They are assigned a preceptor and given a Performance-Based Development System Checklist (PBDS – clinical competency, education, and hospital and unit orientation book) that has to be completed within 90 days with an evaluation of the staff member.

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

Staff are encouraged to attend hospital lectures, conferences, and seminars, including our annual Heart Symposium. Many outside conferences and educational opportunities are made available to the staff as well. A minimum of two staff members attend an event every year.

How is staff competency evaluated?

Staff competency is evaluated annually by the clinical educator through a skills lab. Medication administration is checked off and tested every six months.

How do you handle vendor visits to your department?

Vendors are required to complete the hospital’s security credentials that include vendor identification, immunizations, and a confidentiality agreement that has to be renewed annually. Once they have been credentialed by our hospital security team, they can contact the cath lab secretary to schedule an appointment, or if it is related to a procedure, the secretary will schedule them in a room. If a vendor is scheduled in a room (i.e., pacemaker), he or she must wear a red scrub hat at all times. A vendor is not allowed free access to any of the labs, and is not allowed in the labs without an appointment.

How does your lab handle call time for staff members? How often is each staff member on call? Is there a particular mix of credentials needed for each call team?

The EP lab staff are on-call from 3:30 pm until 7:00 pm nightly, with no weekend call. The mix of credentials is maintained at all times, with a minimum of one RN and two EP techs.

Do you perform only adult EP procedures or do you also do pediatric cases? Is there cross training for pediatric cases?

The EP lab performs both adult and pediatric EP procedures. All EP techs are trained to perform both.

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

Lead suits are available to every staff member and physician. Lead shields and aprons are utilized throughout the lab. The mapping system is utilized during the more arduous ablation procedures. The dosimetry badges our staff and physicians are required to wear allow us to review and report the radiation exposure of each individual.

What innovative EP techniques are being utilized in your lab?

We offer our patients the latest technologies in infrastructure, including 3D mapping and different ablation techniques such as radiofrequency and cryoballoon ablation. With the advent of our Center for Atrial Fibrillation, we offer our patients a comprehensive multidisciplinary treatment approach, including catheter-based and surgical options.

What are some of the dominant trends you see emerging in the practice of electrophysiology? How is your lab preparing for these future changes?

The most important trend we have witnessed is the combination of resource maximization, modern infrastructure, clinical outcomes and safety. We have very strict procedural guidelines. When combined with the latest infrastructure and optimal clinical care, we can assure we will continue to provide the best care in Idaho and the Intermountain West. All of our physicians are board certified in cardiac electrophysiology, with a vast experience in all aspects of EP.

What are your thoughts about non-EPs implanting ICDs? Do you train such individuals?

All of our ICD/CRT-D implanting physicians have completed a 1-2 year fellowship training in cardiac electrophysiology and maintained their cardiac electrophysiology board certification. Our institution does not participate in physician training of non-EP high-energy device implantation.

Does your staff provide any educational materials for patients who may have additional questions about their condition/procedure?

Our nurses in the Cardiac Observation Unit (COU) provide additional educational materials as well as strict discharge instructions. Our COU is an outpatient admit and discharge unit. Nurses at the physician offices also provide the patients with educational materials.

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

The city of Boise is nicknamed the City of Trees because of its stunning scenery and abundant natural resources. It has a population of over 205,000 people, and over 616,000 in the metropolitan area. Boise is home to Boise State University, the state’s largest university. Boise differs from the rest of the U.S. because it is consistently ranked on the national “best places” lists for families, businesses, and recreation year after year.

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

The EP lab has played an important role in St. Luke’s Regional Medical Center, being ranked among the best in the country for the fifth time and for the third year in a row on the 2010-2011 Thomson Reuters 50 Top Cardiovascular Hospitals survey.

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