Background:
As cardiac implantable electronic devices (CIEDs) have increased in complexity and sophistication, a transition from in-person follow-up to remote device management has taken place. The amount of information collected via cardiac devices has also increased, making the development of efficient workflows necessary for operational sustainability. Vendor-neutral clinic management software organizes patient, device, and programmer information, and thus has potential to improve remote monitoring workflow and data management. This study sought to examine whether management software use is associated with reduced time to review manage remote transmissions.
Methods:
A time and motion workflow analysis was performed in 6 U.S. cardiac device clinics, 3 of which use management software (Medtronic Paceart Optima™). Participating sites had an average size of 4,217 (range of 870 to 10,336) CIED patients managed. Each step involved in remote transmission review (including all clinical and administrative tasks, such as chart documentation and billing) was repeatedly timed, for all device models/manufacturers, during one business week (5 days) of observation at each clinic. The time to review an average remote transmission was calculated based on the mean time to perform each step as well as published literature, and stratified by sites with or without management software. Annual staff time required for remote monitoring was modeled by multiplying the average remote transmission review time by the average number of annual transmissions per patient across the 6 sites: 16.1 transmissions/year, representing a weighted average of therapeutic cardiac devices (4.2 transmissions/year) and insertable cardiac monitors (38.9 transmissions/year).
Results:
A total of 1,290 remote transmission review activities (725 with management software; 565 without management software) were observed and measured during 6 weeks of data collection. On average, the total staff time to review a remote transmission was 2.1 minutes lower at sites with management software (13.6 vs. 11.5 minutes). Extrapolated to the average clinic size of 4,217 patients, this translates into a potential annual time savings of 2,329 hours for sites with management software (13,026 vs. 15,355 hours of total transmission review time). This represents collective time savings across all clinical and administrative staff, and equates to 1.24 annual full-time equivalents (6.9 vs. 8.2 full-time equivalents).
Conclusion:
Remote monitoring of CIED patients requires significant staff time in cardiac device clinics. Management software is an effective tool in optimizing management of remotely monitored patients, and these benefits may translate into time savings for cardiac device clinics.
102 Detection of atrial high-rate episodes on remote monitoring of cardiac devices: are we following guidelines to determine the need for oral anti-coagulation?
