Trinity Health System

JoAnn Mulrooney, VP Patient Care Services and Barbara Banfield, RN, Director of Critical Care and Cardiac Services, Trinity Health Systems, Trinity Medical Center West, Steubenville, Ohio
JoAnn Mulrooney, VP Patient Care Services and Barbara Banfield, RN, Director of Critical Care and Cardiac Services, Trinity Health Systems, Trinity Medical Center West, Steubenville, Ohio
What is the size of your EP lab facility and number of staff members? What is the mix of credentials at your lab? Trinity operates one EP lab. There are four staff members assigned as core staff. These staff members also rotate to the cardiac holding area as well as the cardiac catheterization area and peripheral vascular lab. Qualified staff includes registered nurses, surgical scrub technicians and radiology/cardiovascular technicians. When was the EP lab started at your institution? Electrophysiology studies started at Trinity in 2002. The lab was upgraded with the addition of two board-certified electrophysiologists, Dr. Maninder Bedi and Dr. Kat Maleki, in 2007 and 2009. What types of procedures are performed at your facility? Procedures performed here include diagnostic EP studies, ablations for ventricular tachycardia, supraventricular tachycardia, and atrial flutter, and device implants including biventricular pacemakers, implantable defibrillators and standard pacemakers. What is the primary goal of your program? The primary goal of our program is the diagnosis and treatment of cardiac arrhythmias with ablations and/or device implants. Who manages your EP lab? The clinical portion of the lab is managed by a cardiovascular clinical manager and medical director. Is the EP lab separate from the cath lab? How long has this been? Are employees cross-trained? This new lab is separated from the cath lab geographically and has been this way since its origination. Employees are cross trained to other areas inside the cardiovascular program. Do you have cross training inside the EP lab? What are the regulations in your state? Staff has been cross trained to work in other areas. The state of Ohio mandates that only an RN can 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? Recent upgrades to the lab include a new Omega biplane EP lab. This equipment, along with other accessories such as a CartoSound mapping system (Biosense Webster, Inc.) and intracardiac echo, will enable our EP lab to begin performing atrial fibrillation ablations. Patients currently have to travel outside of the immediate area for this type of service. Who handles your procedure scheduling? Do you use particular software? Scheduling is done through a centralized scheduling staff that enters the input into the electronic system utilizing a MSM format. Scheduling is supported through staff from registration. What type of quality control/quality assurance measures are practiced in your EP lab? Quality indicators are included in the contract of the medical director. Quality awareness is managed through peer review by physicians; we will also be doing a revamped peer review by evaluating all cardiology services together at monthly meetings. The Joint Commission Universal Protocol is used during every procedure and data collection is done to ensure the proper procedure is followed. How is inventory managed at your EP lab? Who handles the purchasing of equipment and supplies? Inventory is managed through materials management, with a dedicated staff member to stock and order for the EP lab. Some of the physicians have participated in the negotiated price constraints for the hospital. Physician input is obtained as to what type of equipment they would like. Final decisions are made by a group after clinical and financial aspects have been addressed. Has your EP lab recently expanded in size and patient volume, or will it be in the near future? In addition, have you developed a referral base? EP lab volumes are expected to increase as the system begins to offer services such as atrial fibrillation ablation, which could only be done previously at larger tertiary settings. Cardiologists who currently have been referring outside of Trinity for EP treatment can now take advantage of quality care here. In what ways have you improved efficiencies in through-put? Efficiency is being achieved through the training and retention of skilled staff. Staff learn to rotate so that they are more versatile. Patient throughput is streamlined by having pre-procedural assessments done in the cardiac holding area. When an overnight stay is necessary, patients generally stay in one particular clinical unit with specially trained staff. How are new employees oriented and trained at your facility? Currently new employees spend orientation time in all aspects of our heart center to establish a sense of vision and to experience the continuum of care. How do you prevent staff burnout? Staff burnout is addressed proactively, by encouraging time off and being flexible whenever possible. How do you handle vendor visits to your department? Do you contract with vendors? Vendors who are associated with the lab are verified for authenticity via a program called Vendormate prior to being permitted on the clinical unit. Vendors are contracted through material management and clinical support committees. Do you perform pediatric cases? EP procedures at our institution are only done on adult patients over the age of 18. What measures has your lab taken to minimize radiation exposure to physicians and staff? Staff has yearly radiation training to minimize exposure. Also, fluoroscopy time is regularly recorded and monitored as part of our quality control program. What about device recalls? How has your lab handled these? Any equipment is thoroughly in serviced and inspected prior to use. All patient information, including devices, is inputted into a national database. This enables easy recall of any device. All device recalls are handled through the risk management department with stringent follow up. Is your lab doing transtelephonic device follow-up? Our individual cardiologists and electrophysiologists do follow-up transtelephonic diagnostics. Are you ACGME-approved for EP training? Trinity is one of the few electrophysiology labs that offers training for other physicians from around the country. Quarterly, Dr. Maninder Bedi, Medical Director of the EP lab, currently offers a two-day training seminar that provides physicians with hands-on training in the implantation of devices. Please tell our readers what you consider unique or innovative about your EP lab and staff. The new EP lab offers great quality services here at home. Prior to the upgrades made to our EP lab, patients had to travel at least 50 miles to obtain the same service that we offer at home. This was not only stressful for the patient but also to the families. The staff and physicians of the EP lab and Trinity Heart Center are passionate about their patients and have received numerous awards for outstanding customer service. As Trinity continues towards our “Quest to be the Best,” our EP lab and cardiac diagnostic services certainly contribute to our vision statement of being the BEST community hospital, offering quality services, close to home.