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How Do Allied Professionals Fit into HRS September 23, 2011

Posted by Heather M. Ross, DNP, ANP-BC, CCDS, CEPS, FHRS in Allied Health Professionals.
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Have  you ever wondered how Allied Professionals (AP) fit into the governance structure of the Heart Rhythm Society (HRS)? There are allied professional members of many committees and subcommittees. These members are nominated by committee chairs and ultimately appointed by the incoming president of HRS. (more…)

Woot, Woot! We’re in San Francisco! May 4, 2011

Posted by Heart Rhythm Society in Allied Health Professionals, Scientific Sessions.
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Editor’s Note: Erica Zado, PAC, FHRS, a physician’s assistant at the Hospital of the Univ of Pennsylvania, offers a unique perspective for Heart Rhythm 2011 attendees and will serve as a guest blogger over the course of the meeting.

Every year I’m excited to come to the Heart Rhythm Society’s 32nd Annual Scientific Sessions, but I’m even more excited when it’s in San Fran (my apologies to Boston andDenver). I arrived yesterday and the city is as beautiful as I remember it — clear blue skies, the bay, the bridge, the shopping!! At the hotel, I was given a map of the area, and there they were, just where I remembered them: Nordstrom and Bloomies one half of a block away. Sweet!

But back on point: Heart Rhythm 2011 is a time to learn new things, see what research others around the world are conducting, present the science we are doing,  and check in at the exhibits to see new technology. (more…)

Remote Device Monitoring in the Real World June 16, 2010

Posted by Heather M. Ross, DNP, ANP-BC, CCDS, CEPS, FHRS in Allied Health Professionals.
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I was in Philadelphia last weekend for an advanced level allied professional educational program. Along with outstanding lectures from experts and local faculty, program attendees raised some excellent points and questions about providing high level electrophysiology care challenging practice environments.

One interesting topic focused on how to incorporate remote device monitoring into practice workflows. (more…)

Expanding NP Services: Effect on Heart Rhythm Care April 23, 2010

Posted by Heather M. Ross, DNP, ANP-BC, CCDS, CEPS, FHRS in Allied Health Professionals.
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Are you a nurse practitioner? Do you work with one? In a recent post about transitions in health care policies, Dr. Amit Shanker mentioned the issue of scope of practice. Have you ever wondered why nurse practitioners and physician assistants function so differently at different institutions? It’s partly due to practice and institutional policies, but even more closely related to state legislatures. That’s right: scope of practice is determined by your elected state legislators.

Twenty-eight states are currently considering expanding nurse practitioners’ scope of practice to alleviate the national shortage of primary care physicians and provide care for the estimated 32 million Americans who will gain health insurance in the next few years.  These state-level policy changes would reflect health reform legislation including nurse practitioners as medical home providers. (more…)

Providing Quality Care to Patients While Pushing Buttons March 9, 2010

Posted by Heather M. Ross, DNP, ANP-BC, CCDS, CEPS, FHRS in Allied Health Professionals.
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 Some days I feel like I just push buttons. No, I’m not reliving my teenage years when I tormented my parents. I’m referring to checking devices in outpatient clinics.

Pacemakers and ICDs have become wonderfully intricate. We can program for, or around, almost anything. We have pages of diagnostics to review. We have numbers to analyze, recalls to review, and spreadsheets to populate. Ain’t technology grand?  But, what about the patient?  During all of our button-pushing, do we forget that there is a patient underneath the programmer wand? On the other end of a remote monitoring transmission? Generating an electrogram interesting enough that we took out calipers? (more…)

What’s Missing from the Autopsy March 1, 2010

Posted by Heather M. Ross, DNP, ANP-BC, CCDS, CEPS, FHRS in Allied Health Professionals.
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A few months ago, one of my neighbors died suddenly. I didn’t know her well, but I knew that she was a healthy 40 year-old mother of young children. I wasn’t close to the family and struggled with the role I should take with her husband and children. Of course, unexpected death in a young person raised my SCA antenna, but would it be prying to insert myself into her family’s grieving process?

I weighed my “nosy neighbor-ness” against my clinical knowledge that sudden cardiac arrest could have implications for the children, and reached out to the family by e-mail.  Her husband responded to my offer of assistance very quickly. Indeed, her death was unexpected and unexplained. He asked if I would review the autopsy report with him when it was available. 

And then I heard nothing, until last week when my widowed neighbor e-mailed me with the autopsy report that he had just received. (more…)

Repeat Paroxysmal AF Patients…what does this mean for AF in 2010? February 17, 2010

Posted by David Wiggins, RN, BS BME, CEPS in Allied Health Professionals.
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 As I begin this year assisting with repeat ablations on atrial fibrillation (AF) patients who had AF procedures in 2009 and 2008 (and 2007…), I find myself wondering what will be ‘new’ in AF ablation this year.  Paroxysmal AF patients – the ones I typically see once and never again – are becoming fewer and fewer.  Much like the well of coronary patients who dried up a couple of years ago, post-DES, the number of AF patients that can actually be treated ablatively seems, in my very narrow world view, to be dwindling.

 I spend a lot of my working hours wishing that AF (and for that matter, VT) ablation had the cure rate that AVNRT and the other “solved” arrhythmias have.  Independent of the widely-variable published success rates for AF, the AF patients are the ones I see over and over again for procedures, often with the same results.  And I know this observation is not limited simply to where I work.

 So then, what will it be for AF in 2010? Will CFAE sites be shown to be the “answer” for AF? What about AF “nests?” Will it be a new ablation technology, such as the laser balloon? Will it be the surgeons assisting us in the relatively new “hybrid” procedures in the OR that allow us to treat this arrhythmia in a more permanent fashion? Or will we ever have a long-term solution for persistent and permanent AF other than AV node ablation? (more…)

Streamlining for Efficiency February 16, 2010

Posted by Heather M. Ross, DNP, ANP-BC, CCDS, CEPS, FHRS in Allied Health Professionals.
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Healthcare reform is in full swing and cardiology practices across the country are strategizing for how to continue to care for our patients who have increasingly complex care needs despite declining reimbursements.  Many practices have reported plans to cut staff in order to keep the practice afloat.  Over the past several months, my practice has undergone a variety of changes that have left us with a strong but lean personnel profile.  And yet, the nationwide cutbacks loom large for private and academic practices.

Rather than feeling helpless, we have thought a great deal about incorporating efficiencies into our practice in order to streamline processes and maximize our ability to provide patient care that benefits both us and our patients in terms of time and cost efficiencies. (more…)

In the EP Lab… February 3, 2010

Posted by David Wiggins, RN, BS BME, CEPS in Allied Health Professionals.
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Looking back on all the procedures I assisted in 2009,  I can’t help but feel that my job devolved from functioning as an EP technologist to functioning as the ‘audio-visual geek’ for my service.

Running multiple 3D mapping (and other) systems, with fewer systems than labs, requires moving each system from lab to lab based on lab physician assignment. Add to this constraint that anesthesia is only available in one room, plus certain RF generators are only compatible with certain catheters that physicians want to use, and you find yourself moving equipment on a daily basis. 

Equipment, I’ll add, that was clearly designed to be installed once and moved never.  I spent literally tens of thousands of dollars last year on replacing cables and service calls.  I’m on a first-name basis with the engineers from all of the big ablation companies; when they come in to town for a service call, I take them out to dinner. (more…)

New Year’s Resolution: ATP February 1, 2010

Posted by Heather M. Ross, DNP, ANP-BC, CCDS, CEPS, FHRS in Allied Health Professionals.
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The New Year is here, full of personal resolutions to eat better and exercise more. So far, a few (handfuls of) M&Ms may have accidentally found their way to me. And my plan to exercise every day is, well, still in the planning phase.

But despite my personal resolution…um…plans, I am determined to make my professional resolution stick. 2010 will be the year of ATP – that is, making sure that antitachycardia pacing (ATP) is programmed for every appropriate patient, according to evidence shown by Walthen et al. (2004) in the PainFREE RX II trial.

This year, I’m taking special note to check the tachy zones to make sure that even for prophylactic ICDs, there is a VT zone with ATP programmed. And if there’s not, I have a plan in place to address it in my practice.

I hope that none of my patients ever have to have ATP, and that their prophylactic ICDs remain prophylactic and not therapeutic. But just in case, I feel good knowing that I have done everything I can, using all the evidence available, to avoid unnecessary shocks in 2010 and onward.

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