Spotlight Interview: Florida Hospital Zephyrhills

Florida Hospital Zephyrhills is a 139-bed regional medical center located in East Pasco County. It is a member of the Florida Hospital network of Adventist Health System, the largest health care provider in the state of Florida. Florida Hospital Zephyrhills has been nationally recognized by the American Heart Association, the American Stroke Association, The Joint Commission, the Leapfrog Group, and HealthGrades for excellence in providing top quality patient care with special emphasis on safety and patient outcomes. The award-winning Heart Institute has received recognition in the treatment of coronary intervention, heart failure, chest pain, open heart surgery, and electrophysiology procedures. The Brain and Spine Institute provides brain surgery, spine surgery and minimally invasive neuro-interventions, immediately responds to acute strokes, and has been awarded Advanced Certification for Primary Stroke Centers by The Joint Commission. 

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 one dedicated EP lab with three dedicated staff members. Our EP lab has one surgical tech, RCES; one CV tech, and one RN, RCS.

When was the EP lab started at your institution?

The EP lab was established in September 2007.

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

Our EP lab performs multiple procedures including ablations, electrophysiology studies, device implants, TEEs, and cardioversions. We perform from 12 to 20 procedures per week.

What is the primary goal of your program?

Because we are a non-profit, faith-based organization, our primary goal, in addition to performing ablations and device implants, is to extend the healing ministry of Christ while providing high-quality, cost-effective, defect-free cardiac care for our community — a mission that all team members take very seriously. We believe, because of our mission, that we are providing a higher level of care than one might receive at a facility that is not faith based.

Who manages your EP lab? 

Jameel Lakhan, RCES is the Clinical Coordinator, Debbie Toole, RN, BSN, RCIS is our Cardiac Cath Lab Manager, and Gwen Alonso is the AVP of Cardiac Services.

Are employees cross-trained?

Yes, the cath lab staff is crossed-trained to the EP lab and the EP lab RN is cross-trained to cath lab.

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 begun using the Biosense Webster’s new Carto System and St. Jude Medical’s EnSite System for cardiac mapping. These systems have ensured patient safety, more efficiency, and improved ablation accuracy. 

Have you recently upgraded your imaging technology?

The EP lab imaging equipment was upgraded to an Omega Medical Imaging system in 2011.

Who handles your procedure scheduling? Do they use particular software? 

The cardiac cath and EP labs share a secretary that organizes and handles the patient scheduling. Add-on and emergent procedures are handled by Jameel, the clinical coordinator. The secretary uses the Cerner system to schedule procedures.

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

The EP lab follows core measures for antibiotic pre-op medication administration. Time out procedures and patient identifiers are performed in accordance with The Joint Commission regulations. All equipment is tested every morning prior to starting procedures. 

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

The inventory is managed by Jameel using the QSight system. Jameel presents all equipment needs to the cardiac cath lab manager, and orders supplies using the QSight system. 

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

The EP lab volumes continue to increase every year. There are not any current plans to expand the program.

Have you developed a referral base?

Yes, we are receiving referrals from neighboring cities.

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

The use of the QSight system has helped to contain and manage supply costs. 

Does your EP lab compete for patients? Has your institution formed an alliance with others in the area?

Our EP lab does compete for patients. We have our sister facility in a nearby community. 

How are new employees oriented and trained at your facility?

New employees complete a weeklong hospital orientation. Once the staff arrives at the EP lab, orientation begins based on the new staff member’s previous experience and knowledge base. For a new but seasoned EP employee, this orientation usually lasts for a month. The staff is evaluated monthly and at the end of 90 days.

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

Many of our continuing education opportunities are provided by our vendor in-services. Our staff also attends conferences whenever possible. The hospital often provides continuing education opportunities with our electrophysiologists and cardiologists as guest speakers.

How is staff competency evaluated?

The staff completes a yearly hospital-wide and EP-specific competency evaluation. Competencies are also evaluated with every new piece of equipment introduced into the EP lab environment.

Do you encourage your staff members to take the Registered Cardiac Electrophysiology Specialist (RCES) exam? How many members of your lab have taken the exam? Does staff receive an incentive bonus or raise upon passing the exam?

All staff is encouraged to advance their education and complete the RCES registry exam. One member of our EP team has the RCES credential. Another staff is RCS, and our newest staff member is testing very soon. Currently the facility does not offer incentive bonuses or raises for RCES completion.

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

We prevent staff burnout by encouraging staff to utilize vacation days. Our cardiovascular service line is currently launching a series of team-building opportunities.

What committees, if any, are staff members asked to serve on in your lab?

The EP staff is not required to serve on any committees, but all staff is encouraged to serve on committees such as the Unit-Based Council.

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

Vendor visits are scheduled through the secretary for routine visits and participation in procedures. We do not contract with vendors.

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

We had a patient with a penicillin allergy that we medicated with vancomycin for a device implant, and everything went great. The patient was brought in three months later for a lead revision and was again given the vancomycin, but this time had a full anaphylactic shock. We subsequently coded this patient with a successful outcome. The patient returned to the EP lab later using a different antibiotic and had a highly successful outcome. The lesson we learned was to always monitor the patient post antibiotic, even if a previous reaction has not been recorded.

How does your lab handle call time for staff members? 

Our EP staff is not required to take call. All after hours or weekend device implants are performed by the on-call cath lab team.

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

Our EP lab utilizes the hospital’s central reprocessing department. This system is very efficient and works well.

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

We are not currently using cryo. Radiofrequency is used on 100% of our ablations.

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

Only adult EP procedures are performed at our facility.

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

Our physicians are protected by their personal lead aprons. The EP lab table is equipped with a lead shield. All our staff and physicians’ radiation exposure is monitored and reported quarterly.

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

Our EP lab visits the patients through rounding the day following the implant prior to discharge. All follow-up appointments are performed at the physician office. 

What innovative EP techniques are being utilized in your lab?

One technique that we are utilizing is the use of angioplasty by our interventional cardiologists when the subclavian vein is occluded.

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

All of our outcomes are reported by our data analyst and reported to the EP physicians and cardiologists on a regular basis.

What are your thoughts on EHR systems? Does it improve your quality of care?

The EHR system is an excellent source for maintaining a high level of quality of care. The entire patient’s history is at the staff and physicians’ fingertips. Multiple years of patient history can be accessed and is easily organized. Previous techniques and equipment used on a repeat patient are accessible. The EHR allows the physician to access and utilize the patient’s previous visit and medical history for more accurate diagnosing.

What are some of the dominant trends you see emerging in the practice of electrophysiology? How is your lab preparing for these future changes?

We have seen our atrial fibrillation/flutter ablation volume grow significantly over the last year. Our staff is using in-servicing and conferences to stay informed regarding emerging trends. The use of our vendors and representatives providing information regarding new devices and products is another way to keep informed. 

How has your lab handled device recalls?

All patients with a recalled device are brought in for evaluation of the recalled device or lead. The vendors notify the EP lab and Material Management department of any device recalls.

Does your hospital offer a device support group? 

We are launching our ICD/pacemaker support group in July 2013, organized and led by one of our CV techs in the EP lab. Every ICD/pacemaker patient is mailed a letter inviting them to participate in the support group.

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

A problem we have faced was the potential fallout of core measures with antibiotic therapy prior to procedure start. Our physicians would tell us they were available and we would administer the antibiotic, only to find our physician delayed — causing potential fallout in core measures. We addressed this issue by speaking with the physicians and no longer administering the medication until the physician had arrived at the facility and was visiting the unit.

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

Our city is in a growing area in central Florida. We are highly seasonal, with our winter residents arriving from October to December and returning north from April to May. The population in our city triples with the winter residents. We have a high elderly population with many retirees. We differ from much of the U.S. because of our major shifts in population in accordance with the winter residents.

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

Our EP is special in our mix of staff. We are fortunate that our staff has a diverse background. Our RCES has a surgical/anesthesia tech background, which allows for an excellent resource regarding sterile technique, suturing for physicians, and in case of emergency, assisting with surgical procedures. Our RN has an echocardiogram background. She is well versed in performing echo procedures as well as demonstrating strong critical care nursing skills. Our CV tech has a strong background and desire for knowledge of cutting-edge technology. She has excellent troubleshooting skills and great patient interaction.

Visit www.FHZeph.org for more information.