Text Box: Dear EP Managers & Staff, 

Two important issues have come up in recent calls that are addressed in this newsletter-  1) How to help create an environment that  encourages your Physician to perform procedures at their highest level, and 2) how your department can prepare to handle procedural complications and equipment   malfunctions with greater efficiency and success.  

Thanks to all of you who visited our Tropical booth at the HRS conference.  It is an honor for us to meet and support the many people who are on the front lines of EP.  Noor Khan is joining EPreward, he has a degree in Hospital Administration and will be managing the Catheter Buy Back program.  If you do not reprocess your catheters, you need to talk with him.  Have a great summer.

Steve Miller, RN & the EPreward Staff 

Improving Physician Performance & 
Attacking Complications

Whether you love them or hate them, whether they appreciate what you do or look right through you, your physician is the most important person during a procedure and you need to do all that you can to maximize their abilities.  Your patient deserves no less than the best outcome your lab can deliver.   Let’s look at two often invisible factors that can have a significant bearing on your doctor’s and staff’s concentration and performance: Pre-procedure routines and anticipatory problem solving.   

Pre-Procedure Routines

Sports psychology has a common thread with physician performance.  Coaches realize the importance of their athlete’s pre-competition (pre-procedure) and pre-execution (pre-task) routines to improve their performance.  These routines assist with the athlete’s ability to block out distractions and focus exclusively on the event in general, as well as the specific skill required at that moment.  Utilizing a few of these borrowed techniques, you can assist your doctors to consistently perform at their highest level.  You want to be their coach in this sense rather than the balloon waving fan screaming in the background.  Their success will improve and they will develop more confidence in themselves and their team, which will breed further success and better patient results.  

While the doctor is the primary operator in a case, the nurses and ancillary staff also play a vital role in the case’s, and ultimately the doctor’s, success.  It is important to establish a good working relationship with your physician for better patient outcomes.  Of course, some physicians’ personalities can be abrasive and less than forthcoming, but a sound readiness and a capable staff goes a long way to establish trust in even the most ornery doctors.  The role of the nurse, the fellow, etc. should not be underestimated in achieving good patient outcomes.

Your doctor may have these routines and not even realize it.  The less experienced and/or more regimented they are the more important it is to respect and facilitate their process.  Watch their “pre-procedure” actions as they enter the room.  Each step helps them become more present minded, leaving behind the difficulties of the day and increasingly narrow their focus into this room right now.  For example:  Places cell phone on table, checks rhythm on monitor, reviews chart, checks on vital signs, ask patient how they are doing, etc.  This initial routine is their pre-game warm up and is often performed in the same sequence before every case.  If you are an experienced EP nurse, do not be afraid to question actions by newer physicians that may seem out of the ordinary or potentially detrimental to the patient.

Prepare your room to fit your physician’s needs.  Note what they want and where they want it, and have it ready for them.  You probably do this to some degree already, but now you will have a greater appreciation for the significance of their actions.  It may help to include this information in a pre-procedure check list (see May’s article).  What documentation do they want to review?  Have it ready where they want it.  How dim do they like the lights?  Put a mark on the dimmer switch.   Where do they like the table controls?  Put a mark on the table.  How do they like the sterile field arranged?  Set it up their way.  You are not only taking care of them, but more important you are taking care of your patient when you do these things.  

Then, just as a basketball player at the foul line goes through specific “pre-task” motions before shooting a free throw, your doctor scrubs, gowns and gloves… then “sigh”, the fenestrated drape is too lateral and has to be repositioned, EKG leads are out of place, etc.   Expletives are sure to follow and thus the physician’s concentration is askew. They are wondering what will happen next that may be more critical, rather than zeroing in on the screens of electrograms, fluoro images and the tactile sensations that should be their focus.  Sound familiar?  I’ve seen it happen many times and have caused my share of them.  Make it your lab’s goal to prevent these distractions and keep your Physicians focused where they need to be, on their procedure.

Text Box: Anticipatory Problem Solving 

Unexpected events during a procedure are not uncommon.  The less routine or more complicated the case, the greater the probability this is going to happen.  When handled poorly these events can destroy your doctor’s and staff’s focus, give them a feeling of failure, and provide fertile ground for more errors (not to mention the ill effect they can have on your patients health or life).  Or, when decisively resolved can make them feel empowered and confident.

Talk with your fellow staff and physicians and write down all of the problems/complications that have happened in the past or potentially will happen in the future.  They can be related to the patient, supplies, equipment, staff, etc.  Don’t ignore them as it is only a matter of time until they occur, because at some point in time they will occur.  Then create a plan to solve each of these problems and write it down.  Use this sheet for staff orientation, training and yearly competency checks as well (ACLS guidelines are a beginning  http://www.acls.net/aclsalg.htm).  If you have access to a word program in the room, create it there and have it available for reference & review.  It is great for using as a quiz between each other while waiting for a case to start. 

Here are a few examples of events to be prepared for: 

A patient becomes hypotensive.  What are the potential causes?  What are your immediate treatment alternatives?  Who calls for a stat echo and how?  Where is the pericardiocentesis tray?  Are Protamine and a 60cc syringe with the tray or scattered about the department?  Is all of the scrub staff trained in preparing for and assisting with a pericardiocentesis?  If your Doctor is not competent with this, who is the first backup and how do you get a hold of them? 

A catheter does not work.  What is your sequence for addressing the problem?   The first step should not be to replace the catheter.  Is there at least one matching cable or catheter available in the procedure room, or are they elsewhere in a storage closet?  There should be working backups for every cable and catheter in the room ready for use.  If all else fails, replace the catheter but remember to retain the original packaging with the lot number for replacement by the company representative and write down what was wrong on the packaging.
The ablation generator fails to work during the middle of a procedure.  The cables are replaced without effect, where is the backup generator kept?  Where is the manual with the error codes?  Do you have a manual and a backup?  How do you reach the rep for a replacement to continue your day? 

Play “what if” with every possible problem and create a preemptive plan to deal with each one.  Every staff member needs to be competent in these “what if” scenarios.  This and making sure everything is at a point of readiness for each procedure will lower your complication rate and improve your outcomes.  We have created a document “Potential EP Lab Patient Complications & Equipment Failure” to get you started.  Develop it into a tool that can be used by each of your staff to ready them for the unforeseen.

If you are the “GO TO” person in the event of a complication or equipment malfunction, don’t strangle your hold on this title to the detriment of your department.  Instead, take pride in elevating the abilities of the rest of your staff to be equally competent.  You are not always going to be there, and you are not always going to have the answer.  Lead your team, rather than keeping them down.  Many labs also conduct mock “events” once or twice a month (time permitting) where scenarios are played out and duties and roles assigned in a hypothetical situation.  This is a good practice for your lab if time and personnel permit.

These simple steps of facilitating the physician’s pre-procedure routines and being prepared for complications with anticipatory problem solving will have a positive psychological effect on the staff and physicians.  Remember you are their assistants NOT their servants.  Preparation for emergencies are good common sense and good practice. If your doc knows the staff is on the look out for, and ready to treat any problem that may arise, this is one less thing they have to be concerned about.  The more comfortable the doctor is with his/her staff the better cultivation of a sound working relationship.  Your staff will act with greater confidence knowing they are prepared for anything.  Enjoy the benefits of your new tools for success and see the difference in your physician’s performance. 

 Our best to all of you as you are the ones that make the difference in a patient’s life.


The EPreward Staff & Guest Contributor 
Ed Donovan, RN- Colombia Presbyterian Hospital, NY,NY


Serving the Heart of Cardiology

www.epreward.com                                                          877-663-8686                                                                     Newsletter Vol. 6

Summer Conferences


June 29th & 30th: London, England; July 18: Des Moines, Iowa.


September Conferences

10th-12th: Washington, DC; 10th: Barcelo    Cardiff Angel, Wales; 14th: Philadelphia, PA; 16th: HRS Exam; 16-18: Brisbane, Australia;  26th: Portland, OR.


See details on our  Conference Calendar page.


Sell your used diagnostic EP


& Ultrasound catheters


If your department does not reprocess any

of your diagnostic catheters, we will “Buy Back” those catheters at a price up to 20 times greater than the platinum value. 

Contact us for more information.  877.663.8686.


Do You Have Unused Supplies

or Equipment?


We have buyers for:


Stockert Ablation Generators


Carto Mapping Systems


EP Catheters and Equipment


Contact EPreward to sell the items you are no longer using, or call 561.375.8034.