Spotlight Interview

Spotlight Interview: AdventHealth

Cathy Lucey, RN, BSN, MS and Raymond Ward, RCIS, Director of the EP/Cath Labs
Adventist Health System, Tarpon Springs, Florida

Cathy Lucey, RN, BSN, MS and Raymond Ward, RCIS, Director of the EP/Cath Labs
Adventist Health System, Tarpon Springs, Florida

We have been serving the community since 1927. The hospital came about thanks to the vision and dedication of Dr. Elmer W. Burnette, a resident who convinced the city that building Tarpon Springs General Hospital — only the second hospital in all of Pinellas County — would make the city a better place to live. However, just a few years later, Tarpon Springs was hit hard by the Great Depression, and in 1947, the city commission decided to close the hospital due to post-war demands draining the city’s resources. Undeterred, Dr. Burnette then set up a community foundation comprised of the city’s civic organizations and churches to help raise money for the hospital. Eventually, the city commission agreed to lease the hospital to the Tarpon Springs Hospital Foundation for $1 a year.

Tarpon Springs continued to grow, and by 1972, bed capacity at Tarpon Springs General had more than doubled.

In the mid 1970s, a 24-hour emergency room and intensive care unit were also established. By the early 1990s, the newly named Helen Ellis Memorial Hospital had become a modern, eight-story hospital.

In 2000, the hospital entered into an affiliation agreement with the University Community Hospital (UCH) in Tampa. In the late 2000s, UCH and the Adventist Health System (AHS) began collaborating on a proposition to build a new hospital in the Wesley Chapel area. In 2009, UCH and AHS merged, and the Helen Ellis Memorial Hospital became part of AHS in 2010. This hospital become known as Florida Hospital North Pinellas. In January 2019, the hospital name was changed to AdventHealth.

When was the EP program started at your institution? By whom?

Our EP program was established in 2005 by Dr. Raul Jimenez.

What is the size of your EP lab facility? Where is the EP lab in relation to the cath lab?

There is one EP lab at this facility. The EP and cath labs are adjacent in location, and are in close proximity to the emergency department as well. Cardiac catheterizations are also performed in the EP lab.

Are employees cross-trained?

Yes, employees are cross-trained to work in both the EP and cath labs.

What is the number of staff members? What is the mix of credentials at your lab?

The EP/cath team at AdventHealth has 12 staff members: 10 permanent staff, and 2 travelers. There is a mix of credentials in our labs, including physicians, registered cardiovascular technologists, registered nurses, and radiologic technologists.

What types of procedures are performed at your facility? What types of complex ablations are performed?

Procedures performed here include device implantations (loop recorder implants, pacemakers, ICDs, biventricular devices), cardioversions, His bundle pacing (introduced earlier this year), tilt table studies, and EP studies/ablations for SVT, ventricular tachycardia, and atrial tachyarrhythmias (atrial fibrillation, atrial flutter).

We typically do 3-4 pacemaker and ICD implants per week. We currently perform 5-6 ablations each month. We are building our EP program with new state-of-the-art equipment.

Does your lab implant MR conditional pacemakers or ICDs, as well as subcutaneous or leadless devices?

Approximately 29% of implants are with MR conditional pacemakers or ICDs. We do not yet implant leadless or subcutaneous devices.

Does your lab use contact force sensing technology during radiofrequency ablation of atrial fibrillation?

Yes, our lab uses the TactiCath Quartz Contact Force Ablation Catheter (Abbott).

Who manages your EP lab?

Dr. Raul Jimenez is the medical director of the EP lab, Raymond Ward is the director of EP/cath labs, and Sean McLean is the supervisor of the EP/cath labs.

What type of hospital is your EP program a part of?

We are a community hospital. Our hospital is part of AdventHealth, which represents a large network of healthcare facilities in the nation.

What types of EP equipment are most commonly used in the lab? What imaging technology do you utilize?

We utilize the EnSite Precision Cardiac Mapping System, EP-4 Cardiac Stimulator, and diagnostic EP catheters from Abbott. We also implant ICDs and pacemakers from Medtronic, Abbott, BIOTRONIK, and Boston Scientific.

What new initiatives or technologies have recently been added to the EP lab, and how have they changed the way you perform procedures?

Our EP lab recently updated its 3D mapping equipment, which has allowed us to do EP studies and ablations with minimal to zero fluoroscopy. We were the first hospital in the immediate area to do three-dimensional EP studies and ablations.

How is shift coverage manager (typical hours)? How does your lab handle call?

Our typical hours are from 7 AM to 3:30 PM. We do not schedule EP cases on weekends or public holidays.

Tell us what a typical day is like in your EP lab.

A typical day begins with the pre-operative area prepping patients (i.e., consents, labs, IVs, and anesthesia assessments). Patients arrive to pre-op an hour and a half prior to procedures. The EP nurse or supervisor transfers the patient to the EP lab, where the patient is given additional time for any questions with physician, techs, and nurses. There is a different dynamic every day in the EP lab. For example, per day we usually perform 1-2 ablations or 1-2 device implants or heart caths, depending on the schedule.

Who handles procedural scheduling? What software is used?

Procedures are scheduled through physician offices to our facility’s central scheduling management system using Cerner. A designated staff member is assigned to ensure that physicians’ orders and patient history/physicals are completed, and that anesthesia and vendors are notified for the next day.

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

Every patient requires a checklist to be completed prior to coming to the lab. This includes a check of consents, allergies, procedure approval, labs, updated history/physical, pre-procedure medications, and all other preparations have been completed. Anesthesia also assesses the patient prior to procedures.

How is inventory managed at your EP lab? Who handles the purchasing of equipment/supplies?

Inventory is managed by Sean McLean, who oversees ordering for both the EP and cath labs.

How has managed care affected your EP lab and the care it provides patients?

Managed care has not greatly affected our care. However, some insurance providers have denied loop recorders for patients.

Have you developed a referral base?

Yes, referrals are done through our primary care providers, cardiologists, and neurologists.

In what ways have you cut or contained costs, and improved efficiencies in the lab?

Our lab uses resterilized catheters. We utilize opportunities to buy in bulk. In addition, we practice good corporate contracting for healthcare.

Tell us about your reprocessing or catheter recycling efforts.

We use Stryker for reprocessing of our cables and diagnostic EP catheters. We also send all of our EP catheters for platinum recovery.

How are new employees oriented and trained at your facility?

Currently, our hospital works with sister facilities at AdventHealth to provide staff members with training on EP mapping. We have a robust educational department that offers several training modalities. Our cath lab also offers a 3-hour class for nursing care, charting, and post-cath care and sheath pulling.

What types of continuing education opportunities are provided to staff? How many of your staff members attend medical conferences each year?

Our vendors have been very helpful with offering continuing education opportunities. We also participate in annual EP conferences when available.

How is staff competency evaluated? Does staff receive a bonus based on performance?

Staff members have competencies that are signed off on by their preceptor. The lab has yearly competency checklists on equipment. We like to operate off of the “see one, do one” process with a trainer.

The hospital also offers a yearly cost of living raise for all employees.

How do you prevent staff burnout and turnover? What approaches do you use for team building?

We provide an adequate staffing matrix and utilize travel staff with the busy season. We understand that time off is important to staff, so we are very open to requests for days off. We also understand that appointments can’t always be after hours, so staff are allowed to leave work early if necessary.

How do you handle vendor visits to your department?

When vendors sign into the facility in the front lobby, a printed paper name badge is obtained for them to wear. They are notified the day prior about procedures.

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

Patients are given warming blankets and leg props, and there is a concentrated effort on positioning. Our staff members are compassionate, and make tremendous efforts to help patients feel at ease during procedures.

Describe a particularly memorable case from your EP lab and how it was addressed.

The most memorable case for our team was the first EP study and ablation with the new 3D mapping equipment. We were amazed with the unique images and that we did not have to use fluoroscopy.

Do you utilize lifestyle modification as therapy for your patients with atrial fibrillation?

Yes, our approach to AFib includes medication management with anticoagulation, ablation, sleep apnea evaluation for appropriate patients, weight loss counseling, smoking cessation, aggressive risk factor modification, and cardiac rehabilitation.

Tell us more about your approach to reduce fluoroscopy time. What percentage of cases are done without fluoro? What types of radiation protective shielding and technology are used?

We utilize very low fluoroscopy to zero fluoroscopy — approximately 99% of our cases are done without fluoro. In the cases where fluoro is used, we wear lead aprons and glasses during procedures, staff wear badges to check for accumulative radiation exposure, and there is a lead shield in place for the physician. Approximately 50% of our EP studies are done with no fluoro.

What are your methods for device infection prophylaxis?

Patients are instructed by their physician’s office to wash their chest with a scrub solution for 3 days prior to the procedure. We utilize very strict prophylaxis measures, starting from the pre-operative area (chlorhexidine, baths, nose swabs) until the procedure is complete. All patients are carefully prepared and receive a pre-procedure IV antibiotic. The patients and staff wear masks from pre to post procedure. Patients’ chests are prepped with strict measures, and 3 different solutions are used to prepare the patient for incision. The device pocket is irrigated with antibiotic solution, then covered with a sterile dressing. Patients follow up with their physician one week post procedure.

How do you use the NCDR Outcome Reports to drive QI initiatives at your facility?

Our director and supervisor have biweekly meetings to discuss deficiencies. The doctors and staff are then educated about more efficient outcomes. All deficiencies are usually corrected in the charting by the physician and/or staff before the next submission due date.

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

Evolving technologies such as three-dimensional electroanatomic mapping, contact force technology, and grid catheters are making EP procedures faster, safer, and more predictable, and are leading to better outcomes.

Do you utilize digital tools or wearable technologies in your treatment strategies for patients?

Yes, we utilize the LifeVest Wearable Defibrillator (ZOLL Medical Corporation) as well as implantable loop recorders.

Has your lab achieved EP accreditation, or does it plan too in the future?

The hospital has received Chest Pain Center Accreditation. We plan to achieve cath and EP accreditation in the future, but have no specific timeline yet.

How do you see social media changing the field of healthcare? Are staff members encouraged to participate in the EP community on social media? Are social media policies in place for this?

Social media plays a large part in our hospital. Facebook allows patients to seek out others who might have had the same or a similar procedure. The hospital policy on social media is to follow HIPAA.

Describe your city or general regional area. How is it unique from the rest of the U.S.? What specific challenges does your hospital face give its unique geographic service area?

Located north of Tampa, Tarpon Springs is in a quiet corner of the busy Tampa Bay metro region. The population is approximately 25,000 people. The city is near the Anclote River, which is about 2 miles from the Gulf of Mexico.

The city maintains great effort to retain its small-town feel. In fact, USA Today even nominated Tarpon Springs the “Best Historic Small Town” in 2018.

Tarpon Springs is world-renowned for its sponge industry, and widely considered to be the “sponge capital of the world.” The first Greek immigrants arrived in the 1880s, expanding and refining sponging in Tarpon Springs. The Sponge Docks on Dodecanese Boulevard have quaint shops, bakeries, and Greek restaurants, drawing visitors from all over the world. The beautiful Dodecanese area is decorated in blue and white, the same colors as the Greek flag. The area offers boat tours and fishing tours, as well as special year-round events such as festivals.

The town is also the site of the Spring Bayou, where the largest Epiphany Day celebration takes place in America. In this 105-year-old tradition, young men dive for a cross every January 6. Whoever retrieves the cross gets a year of good luck. Last year, more than 10,000 visitors came to join in the celebration.

There are some problems for people commuting to and from work. The main road is U.S. Highway 19, which has only two lanes. Traffic can often be backed up for miles, causing emergency vehicles and emergent patients to have problems getting to the hospital during commute hours. There are plans in the future to extend Meres Boulevard to US-19, which would help the traffic in close proximity to the hospital, but no definite timeline is in place.

Please tell our readers what you consider special about your EP lab and staff.

Our electrophysiology staff is passionate about the care we provide to our patients. Our team’s excellent compassion comes from multiple medical professions bringing their different skills and knowledge to our lab. Our medical director, Dr. Jimenez, is supportive and committed to educating the staff. Overall, we are a very close family — we may have our ups and downs, but the entire staff comes together as a great team. 

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