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Implementation of remote follow-up of cardiac implantable electronic devices in clinical practice: organizational implications and resource consumption.
Journal of Cardiovascular Medicine ( IF 3 ) Pub Date : 2020-09-01 , DOI: 10.2459/jcm.0000000000001011
Massimiliano Maines 1 , Giancarlo Tomasi 1 , Paolo Moggio 1 , Francesco Peruzza 1 , Domenico Catanzariti 1 , Carlo Angheben 1 , Marzia Simoncelli 1 , Massimo Degiampietro 1 , Lucio Piffer 1 , Sergio Valsecchi 2 , Maurizio Del Greco 1
Affiliation  

Aims 

Current guidelines recommend remote follow-up for all patients with cardiac implantable electronic devices. However, the introduction of a remote follow-up service requires specifically dedicated organization. We evaluated the impact of adopting remote follow-up on the organization of a clinic and we measured healthcare resource utilization.

Methods 

In 2016, we started the implementation of the remote follow-up service. Each patient was assigned to an experienced nurse and a doctor in charge with preestablished tasks and responsibilities. During 2016 and 2017, all patients on active follow-up at our center were included in the service; since 2018, the service has been fully operational for all patients following postimplantation hospital discharge.

Results 

As of December 2018, 2024 patients were on active follow-up at the center. Of these, 93% of patients were remotely monitored according to the established protocol. The transmission rates were: 5.3/patient-year for pacemakers, 6.0/patient-year for defibrillators, and 14.1/patient-year for loop recorders. Only 21% of transmissions were submitted to the physician for further clinical evaluation, and 3% of transmissions necessitated an unplanned in-hospital visit for further assessment. Clinical events of any type were detected in 39% of transmissions. Overall, the nurses’ total workload was 3596 h per year, that is, 1.95 full-time equivalent, which resulted in 1038 patients/nurse. The total workload for physicians was 526 h per year, that is, 0.29 full-time equivalent. After 1 year on follow-up, most patients judged the service positively and expressed their preference for the new follow-up approach.

Conclusion 

A remote follow-up service can be implemented and efficiently managed by nursing staff with minimal physician support. Patients are followed up with greater continuity and seem to appreciate the service.



中文翻译:

在临床实践中实施心脏植入式电子设备的远程随访:组织影响和资源消耗。

宗旨 

当前指南建议对所有心脏植入式电子设备患者进行远程随访。但是,远程跟踪服务的引入需要专门的组织。我们评估了采用远程随访对诊所组织的影响,并衡量了医疗资源的利用率。

方法 

2016年,我们开始实施远程跟踪服务。每个病人都被分配到一名经验丰富的护士和一名医生,负责预先确定的任务和职责。2016 年和 2017 年期间,所有在我中心积极随访的患者均纳入该服务;自 2018 年以来,该服务已全面为所有植入后出院的患者提供服务。

结果 

截至 2018 年 12 月,2024 名患者在该中心接受积极随访。其中,93% 的患者根据既定协议进行远程监测。传输速率为:起搏器为 5.3/患者年,除颤器为 6.0/患者年,循环记录器为 14.1/患者年。只有 21% 的传播被提交给医生进行进一步的临床评估,而 3% 的传播需要计划外的住院访问以进行进一步评估。在 39% 的传输中检测到任何类型的临床事件。总体而言,护士的总工作量每年为 3596 小时,即 1.95 个全职当量,从而导致 1038 名患者/护士。医生的总工作量是每年 526 小时,即 0.29 个全职当量。随访 1 年后,

结论 

护理人员可以在最少的医生支持下实施和有效管理远程随访服务。患者会得到更大的连续性随访,并且似乎很欣赏这项服务。

更新日期:2020-08-03
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