Spotlight Interview: University Medical Center

Alejandro Perez-Verdia, MD; Eric Knight, RN, EP Lab; Patrick McGinty, RT(R), EP Lab; Nicholas Skeen, MBA Director; Jeff Mize, RT(R), Assistant Director
Lubbock, Texas

Alejandro Perez-Verdia, MD; Eric Knight, RN, EP Lab; Patrick McGinty, RT(R), EP Lab; Nicholas Skeen, MBA Director; Jeff Mize, RT(R), Assistant Director
Lubbock, Texas

UMC Health System is the leader in comprehensive healthcare delivery in West Texas and Eastern New Mexico. More than 300,000 patients a year have come to expect our dedication to service and the top-tier care we provide.

Through UMC’s partnership with Texas Tech University, the health system produces groundbreaking research and innovative technology, including a number of nationally recognized clinical trials in breast and prostate cancers. Patients of the Southwest Cancer Center are treated with the most modern medical systems available.

UMC Health System employs almost 3,000 people. The system has been honored among the Best Places to Work in Texas, and in 2009 employee satisfaction ranked in the 97th percentile compared with hospitals nationwide.

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 electrophysiologists on staff here: Dr. Alejandro Perez-Verdia and Dr. Guy Wells. One of our four lab suites is dedicated to EP studies, and all of the labs are able to do devices. There eight nurses, five x-ray techs, and four scrub techs. All of the staff is cross trained to scrub or circulate according to credentials. Our outpatient area has an additional 10 nurses that perform the admission and post-op care for outpatient procedures.

When was the EP lab started at your institution?

We started doing EP studies in 1999.

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

We are able to perform EP studies, radiofrequency (RF) ablations, device implants, and lead extractions. We also perform cardiac and peripheral angiograms, as well as interventions on both. We perform 8-10 EP studies a week and 8-10 implanted device-related procedures.

Who manages your EP lab?

Nicholas Skeen, MBA is the director of all the cardiac invasive and echo departments. Eric Knight, RN plays a major role in managing the day-to-day functions of the EP lab.

Is the EP lab separate from the cath lab?

No, they are all located in the same area.

Are employees cross-trained?

Everyone is cross trained to circulate and scrub in the EP lab. There are three key members of the team that have been trained to run the EP MedSystems (now St. Jude Medical) and Carto 3 systems (Biosense Webster, Inc., a Johnson & Johnson company, Diamond Bar, CA) that we currently use.

What are the regulations in your state?

The only regulation that affects staffing is that an RN or physician has to administer sedation medications. Therefore, only RNs are allowed to circulate.

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 were upgraded to Biosense Webster’s Carto 3 system in October 2011. The addition of Carto 3 has made it easier and safer to perform complex ablations.

Have you recently upgraded your imaging technology?

We have the Shimadzu Safire flat-panel cameras that receive service pack updates annually.

Who handles your procedure scheduling? What software is used?

Assistant Director Jeff Mize, RT(R) handles the coordination of all the labs. We use Cerner’s schedule book application and a pen/paper schedule book.

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

We maintain cleaning and temperate logs for the labs. Our Biomedical department handles all of the preventative maintenance yearly, and they handle all other issues as needed. We follow Joint Commission procedures that apply to consented procedures.

How is inventory managed at your EP lab?

We use XperIM for inventory management.

Who handles the purchasing of equipment and supplies?

For existing supplies, we have a materials manager that handles all of this. Implanted CRM devices are brought in by a representative of the company and invoiced at a predetermined price. For a capital purchase, the UMC board approves the purchase.

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

During the past year, our volume has increased by 30% on just EP studies.

Have you developed a referral base?

Currently we are doing community outreach to promote our EP program. All physicians conduct outreach and satellite clinics.

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

We only open supplies that are going to be used during the case. We have also done price negotiations with vendors.

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

For long EP studies, we use three staff in a room with the physician. For faster cases, we will rotate in and out with another crew of four to improve room turnover time.

Does your EP lab compete for patients?

In our area we have two other EP labs. One is a dedicated heart hospital. Our patients are mostly referred from our physician network.

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

We cooperate with the other electrophysiologist when it comes to providing supplies to each other and with technical assistance on equipment.

How are new employees oriented and trained at your facility?

New staff members are oriented to basic procedures in the cath labs. When they have completed the orientation in the cath lab, they are allowed to cross train to electrophysiology studies. Every staff member in the cath lab learns their respective position for device implants.

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

We have a once a month breakfast conference that is EP related. Furthermore, we attend EP-related conferences once a year, and contribute to our education library.

How is staff competency evaluated?

We use direct observation methods and a check-off list to prove competency. We have yearly core competencies that all staff participate in. These include a mix of online testing and hands-on demonstrations.

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

Staff are encouraged to seek out new experiences in the labs to prevent burnout. We also try to have an off-site dinner once a month where all the team members can expect a casual time with coworkers.

What committees are staff members asked to serve on in the lab?

All staff members are required to be part of a committee. Every team member provides one training in-service to the rest of the team once a year.

How do you handle vendor visits to your department?

All of our vendors have to be registered with the Vendormate system.

Does your lab utilize any alternative therapies to help patients in the EP lab? 

All of the labs are equipped with satellite radio, so the patient is allowed to pick the type of music they enjoy. All of the nurses can use guided imagery as well as heat or cool therapy if their assessment deems it appropriate. We go above and beyond to make sure that our patients are comfortable during their visit to UMC, and that they receive the highest quality of care.

Describe a particularly memorable or bizarre case that has come through your EP lab. What lessons did you learn from it?

Recently we had an atrial lead loop fall down into the right ventricle, and it was causing the patient to have short runs of VT. Dr. Wells used biopsy forceps and an SRO sheath to push the loop back up into the SVC.

How does your lab handle call time for staff members?

There are two staff members that cover late call for the EP cases. There is a voluntary position available to another RN to stay late with the EP team. On weekends, the regular cath team covers device implants.

How often is each staff member on call? How frequently do they have to come in, on average?

Each staff member that is on the regular cath lab schedule is on call seven or eight days a month. On average, the cath team is called in one to two times per week.

What mix of credentials is needed for each call team?

Call teams consist of two RNs, one x-ray tech, and one scrub tech.

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

We have been using Stryker Sustainability Solutions for catheters and expired product reprocessing. It is another tool we use to cut costs for managed care.

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

We do not use cryo at this time. One hundred percent of our cases are done with radiofrequency, with 20% of cases using irrigated catheters from Biosense Webster.

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

The youngest cases we perform on are those over the age of 14.

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

We use low-dose fluoro settings at 7.5 fps. At this dose, most EP studies stay under 250 milliGrays. We have the RADPAD® (Worldwide Innovations & Technologies, Inc., Kansas City, KS) available to physicians as well as a floating lead glass barrier.

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

Not routinely.

What innovative EP techniques are being utilized in your lab?

For patients that have refractory SVT that is not able to be controlled, we will implant the leads and device, then put a sheath in the subclavian vein to do AV node ablations from the pocket.

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

We have been seeing more same-day discharges with uncomplicated RFA.

What are your thoughts about non-EPs implanting ICDs?

We currently have one private physician that implants ICDs. He has another electrophysiologist do the device testing as appropriate. They work well together to provide the care needed for these types of implants, allowing us to provide the highest quality of care.

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

Device recalls are scheduled from the clinics. We return the devices and apply credit or issue repayments as needed. Our hospital utilizes RASMAS as a third-party manager for recalls.

Is your lab doing web-based/transtelephonic device follow up?

No, the clinic handles all the setup and screening needed for these systems.

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

None at this time.

Are you ACGME-approved for EP training?

No.

What do you think about two-year EP programs?

Dr. Perez-Verdia believes they are appropriate and should be the standard.

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

We provide handouts as well as educational videos.

Does your hospital or lab offer a device support group?

We currently use one-on-one counseling for patients that need additional support.

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

In 2009, the staff of the cath/EP labs were having an increased amount of overtime and long days. UMC had Deephak Swaminath, MD, MBA analyze our daily case load and types of cases. Last year, we went to cath lab schedule smoothing or queuing. Queuing theory was used to help analyze how the product line functioned.  We worked with the cardiologist to smooth schedule by adjusting our operating hours, adjusting some of the MD clinic times, and adding or moving block lab times for the doctors.  We managed to cut overtime and call back due to extended working hours to almost none.  This also had the added benefit of reducing labor costs by 23% per patient.

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

We are centrally located on the South Plains of West Texas. Our coverage area for patients includes 1,000,000 people and 50 counties in Texas, New Mexico, and Oklahoma. Most of our clients live in rural areas.

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

The staff that we have is very adaptable. We are able to run fast-paced procedures, then turn around and do the long cases.

For more information please visit https://www.umchealthsystem.com/