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- Title
Manpower and Outpatient Clinic Workload for Remote Monitoring of Patients with Cardiac Implantable Electronic Devices: Data from the HomeGuide Registry.
- Authors
RICCI, RENATO PIETRO; MORICHELLI, LOREDANA; D'ONOFRIO, ANTONIO; CALÒ, LEONARDO; VACCARI, DIEGO; ZANOTTO, GABRIELE; CURNIS, ANTONIO; BUJA, GIANFRANCO; ROVAI, NICOLA; GARGARO, ALESSIO
- Abstract
Manpower of Cardiac Device Home Monitoring Background This study aimed to assess manpower and resource consumption of the HomeGuide workflow model for remote monitoring (Biotronik Home Monitoring [HM], Biotronik SE & Co. KG, Berlin, Germany) of cardiac implantable electronic devices in daily clinical practice. Methods The model established a cooperative interaction between a reference nurse (RN) for ordinary management, and a responsible physician (RP) for medical decisions in each outpatient clinic. RN reviewed remote transmissions and alerts, addressing critical cases to the RP. Results A total of 1,650 patients were enrolled in 75 sites: 25% pacemakers (PM), 22% dual-, 27% single-chamber implantable defibrillators (ICD), 2% PM with cardiac resynchronization therapy (CRT), and 24% ICD-CRT. During a median follow-up of 18 (10-31) months, 3,364 HM sessions were performed (74% by the RN, 26% by the RP) to complete 18,478 remote follow-ups. Median duration of remote follow-ups was 1.2 (0.6-2.0) minutes, corresponding to a manpower of 43.3 (4.2-94.8) minutes/month every 100 patients for nurses and 10.2 (0.1-31.1) for physicians (P < 0.0001). RN submitted 15% of remote transmissions to RP, who decided unscheduled follow-ups in 12% of the cases. The median manpower for phone calls was 1.9 (0.8-16.5) minutes/month every 100 contacted patients. There were 2.84 in-hospital visits/patient, 0.46 of which triggered by HM findings. A cumulative per-patient HM follow-up time of 15.4 minutes (20% of total follow-up time) allowed remote detection of 73% of actionable events. Conclusions HM implemented in the HomeGuide workflow model required <1 hour/month every 100 patients to detect the majority of actionable events with limited administrative workload.
- Subjects
ITALY; HEART diseases; THERAPEUTICS; CONFIDENCE intervals; HEALTH care rationing; HOME care services; IMPLANTABLE cardioverter-defibrillators; MEDICAL cooperation; MEDICAL personnel; SCIENTIFIC observation; PATIENT monitoring; RESEARCH; RESEARCH funding; TELEMEDICINE; DATA analysis software; DESCRIPTIVE statistics; KAPLAN-Meier estimator; MANN Whitney U Test
- Publication
Journal of Cardiovascular Electrophysiology, 2014, Vol 25, Issue 11, p1216
- ISSN
1045-3873
- Publication type
Article
- DOI
10.1111/jce.12482