What is the size of your EP labfacility and number of staff mem-bers? What is the mix of creden-tials at your lab?

At Kaweah Delta Medical Center, wework in one EP lab and occasionally inone of three cath labs. Our staff includesan EP physician, three full-time RNs, andone full-time EP tech.

When was the EP lab started atyour institution?

The EP program at Kaweah DeltaMedical Center began in July 2007 withthe arrival of Dr. Sukhvinder (Sukh)Bhajal.

What types of procedures areperformed at your facility?

Ablations by Dr. Sukh Bhajal includesupraventricular tachycardia, ventriculartachycardia, atrial flutter, atrial fibrillation,and AV node. Device implants includepacemakers, loop recorders, ICDs, andbiventricular devices. Dr. Bhajal also per-forms lead extractions.

Approximately how many areperformed each week? Whatcomplications do you find duringthese procedures?

We perform 12–15 procedures weekly.We have had two pericardial effusions inthe last two years.

Who manages your EP lab?The EP lab is managed by Dr. Sukh

Bhajal.

Is the EP lab separate from thecath lab? How long has thisbeen? Are employees cross-trained?

Yes, the EP lab has a dedicated staffseparate from the cath lab staff. Thisbegan a year after the program started,when a dedicated EP lab was built. Staffmembers are not usually cross-trainedfrom the EP lab to the cath lab; howev-er, there are a few staff members with

both cath and EP lab experience whowill occasionally work in both labs.

Do you have cross training insidethe EP lab? What are the regula-tions in your state?

All RNs are trained to perform eachtask in the lab, and the EP tech doeseverything except sedation.

What new equipment, devicesand/or products have been intro-duced at your lab lately? Howhas this changed the way youperform those procedures?

We utilize the CARTO mapping sys-tem (Biosense Webster, Inc., a Johnson& Johnson company, Diamond Bar,CA), GE Prucka (GE Healthcare,Waukesha, WI), Siemens fluoroscopy(Siemens, Malvern, PA), laser leadextraction system (Spectranetics,Colorado Springs, CO), and SequoiaICE imaging (Siemens). The newestadvances in EP technology allow us todo procedures more efficiently and withgreater precision.

Who handles your procedurescheduling? Do you use particu-lar software?

Outpatient procedures are scheduledby a service that coordinates with Dr.Bhajal’s office, and inpatient proceduresare scheduled directly by Dr. Bhajal.

What type of quality control/qual-ity assurance measures are prac-ticed in your EP lab?

We monitor our program by the 2009Joint Commission patient safety standard,use a pre-op checklist, and the Pyxis(Cardinal Health, Dublin, OH) comput-erized medication administration system.The department monitors safety issues,radiation exposure, and expiration dateson all products.

Kaweah Delta Medical CenterVisalia, California

Spotlight Interview

See SPOTLIGHT page 12

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From left to right: Terry Schneider, CRT, Sylvia Casey, RN, Dr. Sukh Bhajal,Daphne Bremner, RN, and Tony Reyes, RN.

Terry Schneider, CRT.

Daphne Bremner, RN.

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How is inventory managed atyour EP lab? Who handles thepurchasing of equipment andsupplies?

The inventory is currently managedand purchased by the EP tech. We areconstantly looking for new ways to savemoney, especially as our volume contin-ues to grow.

Has your EP lab recently expand-ed in size and patient volume, orwill it be in the near future?

After the addition of the new EP lablast year, our volume and efficiency haveboth increased significantly. Since patientsin this area were unaware of many of theservices an electrophysiologist can pro-vide, the initial volume was low, but nowthrough Dr. Bhajal’s efforts to educatephysicians on the benefits of ablation anddevice therapy, the volume has grownexponentially.

What measures has your EP labimplemented in order to cut orcontain costs? In addition, inwhat ways have you improved effi-ciencies in patient through-put?

We use the minimum number ofcatheters necessary, and we use third partyreprocessing for our ICE catheters. Amajor way we can cut costs with allimplanting physicians is using the appro-priate device for the appropriate patient(i.e., not using a high-end pacemaker fora patient who has complete heart blockor atrial fibrillation).

How are new employees orientedand trained at your facility?

New employees undergo a six-weekpreceptorship under a seasoned employeein his or her field. After the six weeks, theemployees begin to work independentlywith close supervision.

What types of continuing educa-tion opportunities are provided tostaff members?

Kaweah Delta’s EP lab staff attends theHeart Rhythm Society meeting eachyear as well as other regional programsoffered through either the hospital orindustry, so they may continue honingtheir skills and keep abreast of the newestadvances in the EP world.

How is staff competency evalu-ated?

Dr. Bhajal evaluates the EP lab staffbased on their performance.

How do you prevent staffburnout? In addition, do you prac-tice any team-building exercises?

EP staff members work 3 days a weekand are not required to take call, whichprevents burnout. We definitely worklong hours on the days we are in the lab,but knowing there is no pager to carry isa great advantage. The EP lab staff has fre-quent social gatherings where teambuilding is practiced.

What committees, if any, arestaff members asked to serve onin your lab?

The EP nurses are active in theMagnet Program, which was developedby the American Nurses CredentialingCenter (ANCC) to recognize health careorganizations that provide nursing excel-lence. The program also provides a vehiclefor disseminating successful nursing prac-tices and strategies.

How do you handle vendor visitsto your department?

Kaweah Delta Medical Center has acheck-in policy where vendors arerequired to get a badge and check in onlyfor their scheduled appointments.

Does your lab utilize any alterna-tive therapies?

No.

How does your lab handle calltime for staff members?

The EP lab staff is not required totake call because of the long hours theyput in during the 3 days that they are inthe lab.

Does your lab use a third partyfor reprocessing?

Yes, we use third party reprocessing forour ICE catheters, which helps savemoney.

Approximately what percentageof your ablation procedures aredone with cryo? What percent-age is done with radiofrequency?

One hundred percent of ablations aredone with radiofrequency in our lab.

Do you perform only adult EP pro-cedures or do you also do pedi-atric cases? Is there cross train-ing for pediatric cases?

The majority of our patients areadults, but Dr. Bhajal is trained in bothadult and pediatric EP procedures.

What measures has your lab takento minimize radiation exposure to

S P O T L I G H T I N T E R V I E W N O V E M B E R 2 0 0 912

SPOTLIGHTContinued from page 10

The EP lab was started from theground up with new staff, becausethere was no EP service in the area prior to Dr. Bhajal. Within oneyear from the opening of the lab,we were performing more than 500 procedures annually.

Sylvia Casey, RN.

Dr. Sukh Bhajal.

From left to right: Terry Schneider, CRT, Dr. Sukh Bhajal, and DaphneBremner, RN.

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13S P O T L I G H T I N T E R V I E WN O V E M B E R 2 0 0 9

physicians and staff?We abide by ALARA recommenda-

tions pertaining to shielding, time anddistance.

Do your nurses/techs partici-pate in the follow up of pacemak-ers and ICDs?

The device vendors are responsible forall of the device follow-up at KaweahDelta Medical Center.

What trends do you see emerg-ing in the practice of electro-physiology? How is your labpreparing for these futurechanges?

There is an increase in atrial fibril-lation ablations, as well as an increasein lead extractions. Our volume issteadily increasing in each of theseprocedures.

When was your last inspectionby the Joint Commission?

Our last review was in 2008.

Give an example of a difficultproblem or challenge your labhas faced. How it wasaddressed?

When the program first started inJune 2007, there was not a dedicatedEP lab, so we were constantly strug-gling for lab time. In July 2008, a ded-icated EP lab was opened to addressthis problem, and it has made thingsmuch more efficient.

Describe your city or generalregional area. How does it dif-fer from the rest of the U.S.?

Visalia, California is a communityof 120,000 people located in TulareCounty, in the heart of the CentralValley. It is about 3 hours north of LosAngeles, and about 3 hours south ofthe San Francisco Bay Area. Our com-munity is largely agriculturally-basedeconomically. We are also an area witha large indigent population due to theagriculture work environment. Ourair quality is poor, and that is anotherfactor that impacts the health of ourcommunity. Having more than a 51%Hispanic population, we also see ahigh percentage of our populationwith diabetes.

Please tell our readers whatyou consider unique or innova-tive about your EP lab andstaff.

The EP lab was started from theground up with new staff, because

there was no EP service in the area priorto Dr. Bhajal. Within one year from theopening of the lab, we were performingmore than 500 procedures annually.

For more information, please visit:

www.kaweahdelta.org

Would you like to participate in EP Lab Digest’s Spotlight Interview?

If your lab has not yet participated in a Spotlight Interview, let us know! Pleaseemail “jelrod@hmpcommunications.com” for a complete list of questions.

Your Spotlight article could appear in an upcoming issue of EP Lab Digest!

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