Spotlight Interview: St. Mary’s Medical Center

Kelli A. Klaiber, RN, BSN, CCRN-CMC Clinical Manager, Cardiac Cath Lab, EP Lab, and Invasive Cardiology Unit; St. Mary’s Medical Center Huntington, West Virginia
Kelli A. Klaiber, RN, BSN, CCRN-CMC Clinical Manager, Cardiac Cath Lab, EP Lab, and Invasive Cardiology Unit; St. Mary’s Medical Center Huntington, West Virginia

St. Mary’s Medical Center is a 393-bed hospital in Huntington, West Virginia. The medical center serves patients in a tri-state region that includes parts of southern Ohio and eastern Kentucky. St. Mary’s was started in 1924 by the Pallottine Missionary Sisters; it has since grown to become one of the largest hospitals in West Virginia and the Tri-State, with more than 2,600 employees. The main campus supports two satellite campuses, which include a center for education in Huntington and a stand-alone 24/7 ER in Ironton, Ohio.

The St. Mary’s Center for Education includes the longest serving school of nursing in WestVirginia, a school of medical imaging, a school of respiratory care, and a doctorate school of physical therapy. St. Mary’s trains medical residents in several specialties from the Marshall University Medical School and the West Virginia School of Osteopathic Medicine. St. Mary’s physicians performed the first advanced heart procedures in the Tri-State in 1979. St. Mary’s is a regional cardiac leader with many heart procedures now done with minimally invasive techniques. 

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 two dedicated EP labs and occasionally use a lab designated as a cath lab for device implants. Our staff mix consists of RNs, RTs, and a supervisor. 

When was the EP lab started at your institution?

The first electrophysiology procedures were completed in 1993. 

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

We offer a wide range of EP procedures, and average approximately 25 cases per week. Weperform diagnostic EP procedures and multiple ablation procedures for arrhythmias including SVT, WPW, concealed bypass tract, left atrial flutter, right atrial flutter, atrial tachycardia, AVNRT, LVOT, RVOT, ischemic VT, non-ischemic VT, idiopathic VT, and bundle branch block reentry VT, as well as AV node ablation and SA node modification. We also perform PVI procedures using radiofrequency ablation and cryoablation technology. 

Who manages your EP lab?

Our supervisor is Sean Wilson, RN, BSN. He is responsible for the day-to-day operations of the department. Kelli Klaiber, RN, CCRN, CMC is the clinical manager for the EP and cardiac cath labs. Regina Campbell, RN, MSN is the director of our Regional Heart Institute. 

Is the EP lab separate from the cath lab? Are employees cross trained? 

As our EP program grew, the decision was made to have separate cath and EP lab staff. In ourefforts to provide the highest quality of care, it was necessary to have staff dedicated to this highly technical specialty. The cath lab staff are cross trained to do device implants. The EP staff are also cross trained whenever possible to function in various roles within their scope of practice. The cross training provides the highest level of flexibility for staffing the department.

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 added several new items: 

  • The Booker Box (TZ Medical) allows for internal cardioversion/defibrillation using our existing equipment. 
  • The ZeroGravity Radiation Protection System (CFI Medical Solutions) is a weight-free alternative to decrease radiation exposure during long EP cases. Itprovides additional radiation protection for our physicians as well as eliminates orthopedic stress, fatigue, and injuries.
  • The Arctic Front Cardiac Cryoablation System (Medtronic) is used as a safe, efficient, and effective alternative to radiofrequency ablation for PVI.
  • The VantageView System (St. Jude Medical) has a 56” HD monitor that can display up to eight video images, eliminating clutter associated with multiple monitors and giving us the ability to view all data simultaneously. Physicians can design their own pre-set screen configurations based on personal preferences. 

Who handles your procedure scheduling? 

We have a scheduling clerk that coordinates our procedure scheduling. Each physician has set lab days. Procedures that need to be completed outside those days are managed on an individual basis as the need arises. We are not currently using any particular software program.

Who handles purchasing of equipment and supplies?

We have an inventory management specialist who orders our supplies as needed based onPAR levels that are constantly reviewed. An inventory team meets twice a month to discuss any issues related to inventory management, including the addition of new supplies. We use the GE Centricity Cardiology Inventory Management Module via GE MacLab using bar coding technology. 

Has your EP lab recently expanded in size and patient volume?

EP procedure volume continues to grow. We have three EP physicians practicing in our labs, and recruitment is underway for a fourth physician. 

Have you developed a referral base?

We are always working to increase our referral base. In our Provider Relations Department, we have hospital service representatives that are constantly working to promote all of our hospital service lines. We have one EP physician that does an off-site clinic twice a month.

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

One of the goals of our twice-monthly inventory meetings is to cut or contain costs. Keeping supplies to a minimum and doing a thorough evaluation of any new supplies or equipment is part of that process. In 2012, we started a new process for acquiring any new supplies or equipment. A committee consisting of administrative staff and physicians must review any new items prior to a trial or acquisition. The department and/or physician requesting the item must attend the meeting and explain the reason the item is needed.

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

Our vendors are good to assist us with continuing education of staff. They will send in clinical specialists to educate our staff. Our physicians also provide us with education. 

When possible, we have staff that accompany our physicians to the annual HRS scientific sessions. 

How does your lab handle call time for staff members?

The EP lab is not required to take call. In the rare event of an EP emergency procedure, we have very dedicated staff that will volunteer to come in for the procedures. 

Does your lab use a third party for reprocessing? How has it impacted your lab?

We use Stryker as our reprocessing vendor. We are currently reprocessing approved cables and catheters. Reprocessing helps to contain supply costs.

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

Cryoablation was just introduced to our EP labs in December 2012. We have done approximately 25 successful cases.

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

The majority of our cases are for adult EP procedures. The few pediatric cases we have

 completed to date are at least 16 years of age. 

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

We have a Radiation Safety Committee that meets quarterly. Radiation safety education is completed annually. Personal dosimetry reports from physicians and staff are monitored, and any physician or staff with prolonged exposure requires follow-up. Procedures with prolonged radiation exposures are managed according to our Radiation Dose Management Program. 

In addition to the ZeroGravity Radiation Protection System, we also have available lightweight

 sterile radiation protection lead drapes for use during procedures to assist with decreasing the operator’s occupational radiation dose.

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

We have a wide assortment of educational programs available to our patients on a closed-circuit television system. We also use the ExitCare Patient Information System and educational booklets from HeartWise Patient Education.

What measures do you take to prevent staff burnout?

Staff involvement with their schedule helps to avoid burnout. We try to offer as much flexibility as possible. A variety of shift options are available, such as 8-, 10-, and 12-hour shifts. Promoting routine opportunities for continuing education for staff will also help to avoid burnout, increase staff engagement, and promote quality.

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

Our vendors sign annual contracts with our Medical Center. Vendor relations are managed in cooperation with our Materials Management Department. 

All vendor visits must be scheduled in advance with the supervisor. Vendors are required to sign in upon arrival to our facility and wear a vendor ID badge. A company representative is usually present for cases in which their products are being used. 

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

Huntington is a city of just under 50,000 residents according to the 2010 census. It is part of a much larger metro area that includes the cities of Ashland, Kentucky and Ironton, Ohio, in a Tri-State area of approximately 400,000 residents. Much of the job growth for the region in the past century depended on manufacturing and coal mining. The economy is still very dependent on those two industries, but healthcare and educational institutions are now the largest employers in the Tri-State. Huntington is located along the Ohio River midway between Pittsburgh and Cincinnati, and the weather includes four distinct seasons with generally mild weather in all four seasons. The Tri-State has a high rate of obesity, smoking, heart disease, and lung disease. Crime rates and cost of living are considered low compared to the rest of the country.

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

 We have chosen to have staff dedicated to the EP lab. We do not require routine cross training of our cath and EP staff. The required skill set and personalities differ substantially from interventional cardiology. This fosters greater opportunity for professional growth in this specialty.