Fifteen years ago, cardiac electrophysiologists may have felt like kid siblings who had to share a bedroom with an older brother or sister. That has changed.

In their earlier years, electrophysiology operations were often small. If they needed a catheterization lab facility, they may have knocked on the door of their interventional cardiology colleagues and negotiated sharing quarters. That may have meant access during down time or off hours.

The field is now larger and more sophisticated. Physicians and staff need to be highly skilled and adept with technologies that are rapidly changing. Electrophysiologists have earned a room of their own, to borrow from Virginia Woolf, and with that they have the added burden of maintaining quality and value in their labs. Inefficiency can impact the quality of care and cut into margins.

In this issue, cardiac cath and electrophysiology leaders share experiences with workflow in the lab. At times they face a tradeoff, knowing that implementing some initiatives likely will slow productivity and make cardiologists unhappy. Many physicians and administrators will empathize over the challenges of EMRs and documentation to demonstrate appropriate use, and most will recognize the value of integrating these systems into practice.    

That is the kind of workflow change that essentially must be done. Then there is the change that should be done, sometimes to the cries of “but this is how we have always” fill in the blank. Ordered supplies, transported patients, scheduled cases. These legacy systems can disrupt workflow, add cost and drag down quality. Replacing “always” with “better” takes leadership and some willpower, but as the examples in our cover story show, they pay off in the end.

Interventional cardiology and electrophysiology are beyond adolescence; it is a sign of maturity that subspecialists can learn from each other by sharing what works and what doesn’t work. All agree there is no one-size-fits-all approach for maximizing workflow in labs. But it is a mutual goal and one that requires constant vigilance.