EP Perspectives

Staffing and Education Trends in the Evolution of Electrophysiology

Doreen Bearden, MBA-HA, BSN, RN
Vice President, Consulting and Client Solutions
Healthworks, Inc.
Douglassville, Pennsylvania

Doreen Bearden, MBA-HA, BSN, RN
Vice President, Consulting and Client Solutions
Healthworks, Inc.
Douglassville, Pennsylvania

“There has to be a better way to do this.” That was the thought of Sandra Wolfe-Korejwo, the CEO and Founder of Healthworks, Inc., back in the spring of 1996.

From 1986 until 1995, Sandi worked as a cardiovascular invasive lab technologist and echocardiographer at an urban community hospital in Pennsylvania. Back then, finding work-life balance due to a demanding call schedule was an overriding theme in the invasive cardiology field, and transferring to a job at a different facility was not the solution. However, she went on to take a job at a small community hospital in Lancaster, Pennsylvania, and it was in the context of this new workplace that led her to conceive what is now Healthworks, Inc., which she founded in 1997. Sandi knew that there were many highly skilled cardiovascular healthcare workers like her who loved their chosen career path, but needed more work-life balance. 

Therefore, she developed a business model similar to the private practice physician group, comprised of registered cardiovascular technologists, registered nurses, and registered radiology technologists working in non-invasive and invasive cardiac catheterization, electrophysiology, and radiology labs throughout the tri-state regions of Pennsylvania, New Jersey, and Delaware. However, Healthworks is unique in its operation in that clinical specialists work in their practice area, but can also participate in creating educational content, teaching peers, or working on specialty consulting projects — activities not typically associated with hospital-based employers. This structure helps to promote work-life balance. 

In addition to staffing, the company provides consulting, education, precepting, registry abstraction, quality and outcomes, and vendor training to community and large academic medical centers, physician practices, and imaging and device companies. Associates can be utilized on an “as needed” basis that is determined by gaps in coverage at the clinical facilities, or through defined duration and lab sourcing. The company also recently initiated a “Regional on Call” (ROC) program, in which associates are utilized to cover call at a client facility. The schedule is determined based on the needs of the facility. 

Featured here are perspectives about the evolving staffing and educational trends seen in the field of electrophysiology by members of the Healthworks team.

INTERVIEW WITH SANDRA WOLFE-KOREJWO, FOUNDER AND CEO 

How did the EP division at Healthworks begin?

In 1997, I joined Pottstown Memorial Medical Center for six months on a per diem basis. I introduced the concept of Healthworks to Pottstown, and in August 1998, the first staffing contract was signed to utilize Healthworks for the cath lab and echocardiography staffing services. The Philadelphia VA Medical Center was the second hospital to sign a contract with Healthworks; one of the physicians from Pottstown had been assigned to open a cath lab at the Philadelphia VA Medical Center, so he contacted me to assist him in providing staff to help get the lab started. We worked closely with the physician team at the VA, many of whom also worked at the Hospital of the University of Pennsylvania, and soon after, Healthworks signed a contract with the Hospital of the University of Pennsylvania for cath lab staffing services. 

Our first EP contract came in 2000 from the Hospital of the University of Pennsylvania. However, it wasn’t until we hired Jeffrey Stiffler in 2001 that our expansion into EP really took off. Jeff was initially deployed as a cath lab tech, but was frequently pulled into the EP lab to work. He was then selected by one of our client sites to be trained on three-dimensional mapping. After this training was complete, he began to develop educational content to facilitate staff training on the mapping system as well as basic EP theory. 

Another milestone in our evolution into EP took place when the Hospital of the University of Pennsylvania requested both staffing and education. Healthworks provided 200 hours of onsite education and launched an EP boot camp, which provided one day of didactic training for the new hires and existing staff, as well as three days of clinical training per week for two consecutive 13-week periods for their new hires. There was no downtime for the lab, as Healthworks associates staffed the lab to perform cases while the facility’s staff were getting trained. Healthworks associates also served as preceptors for the new staff.

Since that time, Healthworks has been requested to help open EP programs in Georgia, Texas, and Virginia to train staff at facilities. We have also received contracts from the vendor industry to manage mapping systems as well. 

Why was it important to delve into the EP field? 

At the time, skilled EP technologists were in such short supply throughout the region, and training and educational opportunities for EP were also scarce. Therefore, creating our EP education division as well as our EP boot camp for students was a real “no brainer.” 

What changes do you see ahead in the field of EP?

I believe the time is right to develop an apprenticeship program aimed specifically at helping to recruit more highly skilled healthcare professionals who are outfitted with the skills necessary to assist physicians in the challenging new procedures in the future in cardiology as well as provide hospitals and physician groups with quality outcomes.

INTERVIEW WITH JACKIE KUDOBA, RN, EXECUTIVE VICE PRESIDENT, OPERATIONS

Give us a brief overview of the EP division at Healthworks.

Staffing is the largest portion of the EP business at Healthworks. Our EP clinical associates are nurses and technologists who cover all positions in the clinical setting, including first-assist scrub techs/RNs, circulators, moderate sedation nurses, monitoring and/or documentation, and pre/post recovery RNs, at a wide range of hospitals as well as the vendor community. The EP division also provides customized education to meet the specific needs of each facility where training is needed. 

What is your role in day-to-day operations? 

I manage the schedule for the invasive team (cath and EP associates). I receive requests from the managers at client facilities, and after speaking with them about their specifics needs, I assign our associates to their facility. This is through either a per diem or defined duration agreement, depending on the request from the client facility. The defined duration agreement is akin to a traveling contract, and typically lasts approximately 13 weeks. In the LabSourceSM arrangement, we provide a complete outsource level of service to a hospital, offering management and staffing services within the lab. This coverage model provides efficiency and cost savings to hospitals that have downtime or varying levels of case demand. We have been actively assisting with the provision of staff at some of these facilities for the past 20 years. 

What can you tell us about the EP clinical associates at Healthworks?

The EP clinical associates are a highly skilled professional group who are constantly learning as they travel to multiple facilities throughout the region. Our associates know that they are expected to function in the assigned lab on day one at the client facility. Many had previously worked in the lab alongside a Healthworks associate, and were looking for the same type of opportunity in the workplace. Our associates also enjoy control over their schedule as they work a set schedule, and only take call or work overtime if they chose to do so. 

What are some of the current challenges you’ve seen in EP labs?

If a facility is having difficulty hiring or retaining staff, the staff that remain at the facility can become burned out from constantly having to train new staff. A training program of didactic lectures as well as a preceptor program can help with employee retention, as the staff at the facility will feel valued because of the investment in their education.   

In addition, many managers contact me on behalf of their physicians to request specific associates to work in a scheduled procedure, because they often have difficulty finding staff with the required clinical skills to meet the demands of the lab. Our cross-trained associates can be scheduled in the cath or EP lab.

In another example, an EP manager at a large academic medical center requested our services due to a mass exodus of staff in their lab. Not only did we provide staff to help keep the program running, we also provided didactic education and precepting for the new hires. This was done over a 26-week period. 

INTERVIEW WITH JEFFREY STIFFLER, VICE PRESIDENT, ELECTROPHYSIOLOGY DIVISION

Tell us about your background.

When I was still a student, Sandi (Wolfe-Korejwo) gave a presentation to our class. I was intrigued by the concept of the clinical specialist private practice model. I started my career as a cardiovascular technologist in the cath lab at a suburban community hospital, and joined Healthworks in 2001. 

When did you make the transition into EP?

As a technologist, I scrubbed for device cases while working in the EP lab at Easton Hospital. Koroush “Ken” Khalighi, MD shared a lot of knowledge with our staff there. I was also instructed on the recording system and stimulator at another facility. 

I was drawn to EP because it is like a puzzle and requires logical thinking. Early on in my career when I worked in the EP lab, I would constantly ask questions, and I was determined to share my knowledge with others. At the end of the day, the person who benefits the most from a knowledgeable team is the patient. The clinical team that provides optimal outcomes for patients is a team that has interest in learning and continually gaining knowledge. 

As a private practice clinical associate, I have had the pleasure of working alongside great teachers and mentors who were willing to share their knowledge and expertise with me. Most recently, I had the opportunity to work closely with Dr. Francis Marchlinski and his partners at the Hospital of the University of Pennsylvania. 

At Jefferson Torresdale Hospital, I was trained on 3D mapping. This was also my first teaching opportunity, training other staff members on the mapping system.

What are some of the changes you have seen in EP over the years? 

A lot of hospitals have made the transition to hiring and retaining a dedicated EP team. The field of electrophysiology is complex, and the strategies, techniques, and equipment are everchanging. Having a dedicated team leads to an increase in the knowledge level of the team. However, there is a shortage of nurses and technologists in the cardiovascular/electrophysiology workplace, so the strategy of using a dedicated team for EP helps to ensure that staff are retained. 

I have also noticed a trend in utilizing anesthesia to sedate for the cases, as opposed to having the nurse in the room provide moderate sedation. This enables the nurse time to focus on the patient, and therefore, provide better care. The hospital is also able to provide interdepartmental continuity of care for their patients, as anesthesia is the standard in their operating rooms. 

Technology is developing at a rapid pace, which has led to an increase in the success of ablation procedures. Notably, the jet ventilator for atrial fibrillation ablation, the deflectable sheath, and force sensing technology have led to improvements in patient outcomes.

VT ablations are becoming more common procedures, and we have a better understanding of the theory and technical challenges of this procedure. It is possible that leadless pacemakers may become much more prevalent in coming years. Change is constant with the advancement of science. 

What advice would you give to a nurse or technologist that is interested in working in the electrophysiology lab? 

I would recommend that they have a strong cardiac background. From what I have observed, EP is usually a “love it” or “hate it” type of relationship. Anyone who thinks they are interested in EP should try it first. It is a good idea to shadow or observe a staff member for one or two shifts. One should pair themselves with a senior staff member, physician, or fellow who has a desire and the skillset to teach. I would also recommend having a strong foundation in cardiac anatomy and electrical function of the heart. There are also many good books on electrophysiology that are geared toward allied professionals. EP is like learning a new language. You must build a vocabulary through reading/studying and ask questions along the way. Patience is the key. Give yourself time to learn EP and understand the science behind it. This generally will take 6 to 12 months. 

It is important to remember that EP is logical. As stated by Dr. Mark Josephson: “We are not real scientists. We are phenomenologists.” We observe electrical phenomena and then logically describe it. 

There are over 20 different possibilities in the discovery process leading up to the diagnosis of an unknown arrhythmia. The EP study will prove or disprove diagnosis and treatment options. Each “test” performed during an EP study (through pacing, drug administration, etc.) will rule out possible arrhythmia mechanisms, leaving one arrhythmia diagnosis as the result of the differential diagnosis. At that point, the best treatment plan can be made for the patient.

What advice would you give to lab managers regarding provision of education for the staff?

On-the-job training is a common way to train new staff, but core concepts are often missed along the way. Electrophysiologists should drive education in their labs. In today’s climate, it may be hard to find the funds for education or for the staff to receive this education without impacting the case volume of the lab. However, providing quality education for the staff can help ensure employee retention and quality patient outcomes. 

What is your forecast for the future of EP?

I believe that changes in technology will occur at a rapid pace. Looking back just ten years ago, we roll our eyes at some of the tools that were utilized. I think that devices will also continue to get smaller. 

I predict that there will be new technologies in ablation treatments and strategies. These improvements will be of great benefit to the patient. This is important since due to the aging population, patient volumes will continue to increase. This will translate into a higher demand for dedicated, trained EP staff.