When a hospital is considering expanding cardiology services to include EP and catheter ablation treatment, an assessment of existing clinical services is in order. One of first questions to address is whether hospital already has an established open-heart surgery program. While there are no defined regulations that require “on site” availability of open-heart surgery services when performing catheter ablations, it appears to be an accepted medical practice.

As previously stated, two recognized organizations that provide electrophysiology clinical competency recommendations are ACC and NASPE. However, ACC defers to NASPE for specific guidelines. NASPE produces clinical competency recommendations for EP services. Recommended guidelines state “Comprehensive catheter ablation programs require a fully equipped invasive electrophysiological laboratory and ready access to surgical support and facilities. It was felt that full cardiac surgical support was desirable; nevertheless, at minimum, facilities performing ablation should have thoracic surgical backup.”2 The guidelines are not specific regarding need to have open-heart surgery available “on site,” leaving this open for interpretation.

However, what NASPE policy statement on catheter ablation, as published in PACE, does present, are equipment and clinical process recommendations. Cine or digital imaging, and hemodynamic monitoring and recording of, at very least, arterial pressures and O2 saturation are recommended. Standard cath lab radiation exposure precautions must be maintained, especially in extended ablative procedures.

Equipment required for ablations includes an external defibrillator with non-invasive pacing, a radiofrequency current generator with temperature and impedance monitoring capability and a power output of at least 50 Watts. Other desirable equipment includes mapping equipment, and recording equipment capable of monitoring a minimum of three surface leads and at least four intra-cardiac leads concurrently. Hard copies of these recordings also need to be available for cardiologists’ immediate review.

Airway maintenance equipment, such as oxygen, suction and general anesthesia should be available. If your lab is doing pediatric cases, general anesthesia is mandatory.

Staff in cardiac cath/EP labs can differ from hospital to hospital. Members of EP team for ablation procedures generally will be similar to that of cath lab. In addition to cath lab training, EP staff requires experience and ongoing specialization with EP procedures. Ideally, if volume allows, there should be staff dedicated to EP lab.

Staffing for ablations should consist of at least three team members in addition to attending physician. It is “recommended that staff utilized for ablative procedures have experience with at least 30 catheter ablations before working independently in EP lab, and that they continue to assist on 30 cases per year.”3 The number of physicians involved in case, their experience, and difficulty of case can change staff composition to include more or less personnel.

According to a report by Agency for Health Care Policy and Research (AHCPR), most common reasons for a hospital admission in United States are:

1.infant birth (3.8 million/year) 2.coronary atherosclerosis (1.4 million/year) 3.pneumonia (1.2 million/year) 4.heart failure (990,000/year) 5.myocardial infarction (774,000/year)

Of significance, cardiac-related conditions account for three of five top reasons for hospital admission. Of greater importance, cardiovascular admissions generally account for 20% to 40% of total hospital revenue. This snapshot of today’s health care service needs is expected to continue to change with aging of population and increasing demand for cardiovascular services.

Offering new services and programs such as coronary angioplasty and open heart surgery provide an ideal venue to market to potential patients, but exploring consumer rationale behind this reveals market drivers beyond “getting word out”. The need for information on scope of cardiovascular services available, knowledge of types of services that hospital provides very well, patient and physician endorsements, and community outreach all forward an organization’s mission in cardiovascular care.

One of first questions to be answered when a decision is made to specifically market and brand cardiovascular services: Can traditional method for identifying general hospital market be applied to determining cardiovascular patient market? Hospitals traditionally have looked at service areas and differentiated them into primary, secondary and tertiary based on geography and known referral patterns. A niche strategy requires a different approach.