Abstract 14046: An International Assessment of the Clinic Staff Time Required to Manage Cardiac Device Patients

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Eliana Biundo ◽  
Juliette Hennion ◽  
Sarah C Rosemas ◽  
David Lanctin ◽  
Emmanuelle Nicolle
Keyword(s):  
Electronic Device ◽  
Standard Of Care ◽  
Clinic Visit ◽  
Staff Time ◽  
Cardiac Device ◽  
Clinic Staff ◽  
Remote Transmission ◽  
Time And Motion ◽  
Time Required

Introduction: Remote monitoring (RM) of cardiac implantable electronic device (CIED) patients is guideline-recommended standard of care alongside in-office follow-up. However, overall workload requirements for device management are not well understood, which may hinder implementation of optimal follow-up strategies including remote solutions. This study sought to characterize processes and clinic staff time required for remote and in-person device follow-up of a CIED patient. Methods: A time and motion workflow evaluation was performed in 11 CIED clinics: 6 US; 5 Europe (UK, France, Germany). Participating clinics manage an average of 5,758 (range: 870-22,000) CIED patients. The duration of each CIED management task was repeatedly timed during 1 business week (5 days) of observation at each clinic. All device models/manufacturers were included. Mean staff time for a remote transmission and an in-person clinic visit were calculated, including clinical and administrative tasks. Annual staff time for follow-up of 1 CIED patient was modeled using data on CIED transmission volume, clinical guidelines, and published literature. Results: A total of 276 in-person clinic visits and 2,173 RM activities were observed. Mean staff time required per remote transmission ranged from 9.4-13.5 minutes for therapeutic devices, and 11.3-12.9 mins for insertable cardiac monitors (ICMs), while staff time per in-person visit ranged from 37.8-51.0 mins and 39.9-45.8 mins, respectively (Table 1). The estimated annual time to manage one therapeutic device patient was lower (1.6-2.4 hours) than an ICM patient (7.7-9.3 hours), due to fewer device follow-ups. Conclusions: RM allows for efficient and continuous care as a complement to in-person follow-up. However, overall CIED patient follow-up requires considerable staff time. These data should be considered in addressing barriers to RM adoption, such as challenges in workflow implementation and inconsistent reimbursement.

scholarly journals Clinic time required to manage cardiac implantable electronic device patients: a time and motion workflow evaluation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
E Biundo ◽  
A Burke ◽  
S Rosemas ◽  
D Lanctin ◽  
E Nicolle
Keyword(s):  
Remote Monitoring ◽  
Electronic Device ◽  
Future Research ◽  
Funding Source ◽  
Staff Time ◽  
Private Company ◽  
Remote Transmission ◽  
Time And Motion ◽  
Time Required

Abstract Background The population with cardiac implantable electronic devices (CIEDs) is growing, creating workload for device clinics to manage these patients. However, the CIED follow-up workflow is poorly understood. This study sought to characterize the workflow and staff time for CIED patient management. Methods A time and motion workflow evaluation was performed in 6 U.S. CIED clinics, which manage an average of 4,217 patients. Each task involved in CIED management was repeatedly timed, including all manufacturers, during 1 business week at each clinic. Mean staff time for a remote transmission and an in-person visit were calculated, including all clinical and administrative (e.g: scheduling, documentation) activities related to the encounter. Annual staff time for follow-up of 1 patient was modeled using CIED transmission data for the 6 clinics, guidelines for CIED follow-up, and published literature. Results 124 clinic visits and 1,374 remote monitoring activities were observed. Staff time required per remote transmission ranged from 12.1–13.4 minutes (depending on the CIED type), and time per visit was 43.4–51.0 minutes. Including all remote and in-person follow-ups, the estimated total staff time per year to manage one pacemaker, ICD, CRT, and ICM patient was 2.3, 2.4, 2.4, and 9.3 hours, respectively (Table 1). Conclusion CIED clinic workflow is complex and requires significant staff time. Remote monitoring is an efficient complement to in-office visits, allowing for continuous follow-up of patients. Future research should examine heterogeneity in clinic processes to identify the most efficient workflow. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Medtronic

Abstract 286: Clinic Time Required To Manage Cardiac Implantable Electronic Device Patients: A Time And Motion Workflow Evaluation

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Eliana Biundo ◽  
Alan Burke ◽  
Sarah C Rosemas ◽  
David Lanctin ◽  
Emmanuelle Nicolle
Keyword(s):  
Remote Monitoring ◽  
Patient Management ◽  
Electronic Device ◽  
Future Research ◽  
Staff Time ◽  
Remote Transmission ◽  
Time And Motion ◽  
Number Of Patients ◽  
Time Required

Background: The number of patients with cardiac implantable electronic devices (CIEDs) is growing, creating workload for device clinics to manage this population. Remote monitoring of CIED patients is a guidelines-recommended method for optimizing treatment in CIED patients in combination with in-person follow-up. However, the specific steps involved in CIED management, as well as the HCP time required for these activities, are not well understood. The aim of this study was to quantify the clinic staff time requirements associated with the remote and in-person management of CIED patients. Methods: A time and motion workflow evaluation was performed in 6 U.S. CIED clinics. Participating clinics manage an average of 4,217 (range: 870-10,336) CIED patients. The duration of each task involved in CIED management was repeatedly timed, for all device models/manufacturers, during one business week (5 days) of observation at each clinic. Mean time for review of a remote transmission and for an in-person clinic visit were calculated, including all clinical and administrative (e.g., scheduling, documentation) activities related to the encounter. Annual staff time (inclusive of all clinical and administrative staff) for follow-up of 1 CIED patient was modeled using device transmission data for the 6 clinics, clinical guidelines for CIED follow-up, and published literature (Table 1). Results: During 6 total weeks of data collection, 124 in-person clinic visits and 1,374 remote transmission review activities were observed and measured. On average, the total staff time required per remote transmission ranged from 11.9-13.5 minutes (depending on the CIED type), and time per in-person visit ranged from 43.4-51.0 minutes. Including all remote and in-person follow-ups, the estimated total staff time per year to manage one Pacemaker, ICD, CRT, and ICM patient was 2.3, 2.4, 2.4, and 9.3 hours, respectively. Conclusion: CIED patient management workflow is complex and requires significant staff time in cardiac device clinics. Remote monitoring is an efficient complement for in-office visits, allowing for continuous follow-up of patients with reduced staff time required per device check. Future research should examine heterogeneity in patient management processes to identify the most efficient workflow.

Clinic Time Required for Remote and In-person Management of Cardiac Device Patients: A Time and Motion Workflow Evaluation (Preprint)

2021 ◽  
Author(s):  
David Lanctin ◽  
Eliana Biundo ◽  
Marco Di Bacco ◽  
Sarah Rosemas ◽  
Emmanuelle Nicolle ◽  
...  
Keyword(s):  
Patient Management ◽  
Clinic Visit ◽  
Future Research ◽  
Staff Time ◽  
Cardiac Device ◽  
Cardiac Implantable Electronic Devices ◽  
Time And Motion ◽  
Number Of Patients ◽  
Time Requirements ◽  
Time Required

BACKGROUND The number of patients with cardiac implantable electronic devices (CIEDs) is growing, creating substantial workload for device clinics. OBJECTIVE This study aimed to characterize the workflow and quantify clinic staff time requirements to manage CIED patients. METHODS A time and motion workflow evaluation was performed in 11 US and European CIED clinics. Workflow tasks were repeatedly timed during one business week of observation at each clinic. Observations were inclusive of all device models/manufacturers present. Mean cumulative staff time required to review a Remote device transmission and for an In-person clinic visit were calculated, including all necessary clinical and administrative tasks. Annual staff time for follow-up of 1 CIED patient was modeled using CIED transmission volumes, clinical guidelines, and published literature. RESULTS A total of 276 in-person clinic visits and 2,173 remote monitoring activities were observed. Mean staff time required per remote transmission ranged from 9.4-13.5 minutes for therapeutic devices (pacemaker, ICD, CRT) and 11.3-12.9 mins for diagnostic devices (insertable cardiac monitors (ICMs)). Mean staff time per in-person visit ranged from 37.8-51.0 mins and 39.9-45.8 mins, for therapeutic devices and ICMs respectively. Including all remote and in-person follow-ups, the estimated annual time to manage one CIED patient ranged from 1.6-2.4 hours for therapeutic devices and 7.7-9.3 hours for ICMs. CONCLUSIONS CIED patient management workflow is complex and requires significant staff time. Understanding process steps and time requirements informs implementation of efficiency improvements, including remote solutions. Future research should examine the heterogeneity in patient management processes to identify the most efficient workflows.

scholarly journals Clinic time required to manage remote monitoring of cardiac implantable electronic devices: impact of outsourcing initial data review and triage

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
E Nicolle ◽  
D Lanctin ◽  
S Rosemas ◽  
M De Melis
Keyword(s):  
Initial Data ◽  
Remote Monitoring ◽  
Staff Time ◽  
Clinic Staff ◽  
Remote Transmission ◽  
External Monitoring ◽  
Time Savings ◽  
Monitoring Center ◽  
Time Required ◽  
Monitoring Service

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Medtronic Background Remote monitoring is guideline-recommended to manage cardiac implantable electronic device (CIED) patients. With the continuous growth of implanted patients, clinic workload to review transmissions is increasing. Outsourcing initial data review and triage to an external monitoring center could be a valuable option for more efficient allocation of staff time, as high-skilled healthcare professionals can focus on patients in need rather than non-actionable data. Purpose The objective was to estimate the potential clinic staff time saved when outsourcing part of remote transmission review. Methods A previous time and motion evaluation described workflow tasks and time required for remote transmission review (4 EU sites, 674 observations). From real-world experience with a third-party monitoring service, the steps that can be outsourced were determined considering existing clinic-driven protocols for triage and transmission escalation. Staff time required with and without the monitoring service was thus modeled and compared. Results Outsourcing to an external monitoring center can reduce clinic staff time between 77.4% and 84.7% depending on device type. Absolute time savings range from 32.7 to 82.6 hours per year per 100 patients for therapeutic devices, and 301.3 hours for insertable cardiac monitor (ICM) patients, due to the higher frequency of transmissions in diagnostic devices. Conclusion Time to review remote transmissions can become overwhelming for clinics as growing CIED population often outpaces available staffing resources. Outsourcing initial review and triage to an external monitoring center (ensuring quality and regulatory compliance) can be an efficient option to save dedicated staff and facility time for other crucial healthcare activities. Clinic Staff Time Savings Per YearPacemakerICDCRTICMTRANSMISSIONS PER PATIENT PER YEARGreen (no further review required when outsourcing)3.04.35.020.8Yellow/Red (medical action/decision required)0.60.80.93.8ANNUAL STAFF TIME PER PATIENT, minutesNo outsourcing25.346.658.5219.7Outsourcing to monitoring center5.77.78.938.9ANNUAL STAFF TIME PER 100 PATIENTS, hoursNo outsourcing42.277.697.4366.2Outsourcing to monitoring center9.612.914.964.8TIME SAVED PER 100 PATIENTS, hours (%)32.7 (77.4%)64.7 (83.4%)82.6 (84.7%)301.3 (82.3%)Abstract Figure. Outsourcing Remote Transmission Review

scholarly journals Clinic Time Required for Remote and In-person Management of Cardiac Device Patients: Time and Motion Workflow Evaluation (Preprint)

JMIR Cardio ◽  
10.2196/27720 ◽  
2021 ◽  
Author(s):  
Amber Seiler ◽  
Eliana Biundo ◽  
Marco Di Bacco ◽  
Sarah Rosemas ◽  
Emmanuelle Nicolle ◽  
...  
Keyword(s):  
Cardiac Device ◽  
Time And Motion ◽  
Time Required

Abstract 287: Vendor-neutral Clinic Management Software Use Is Associated With Time Savings For Remote Monitoring

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Eliana Biundo ◽  
David Lanctin ◽  
Sarah C Rosemas ◽  
Emmanuelle Nicolle ◽  
Alan Burke
Keyword(s):  
Remote Monitoring ◽  
Full Time ◽  
Staff Time ◽  
Cardiac Device ◽  
Review Time ◽  
Management Software ◽  
Clinic Management ◽  
Remote Transmission ◽  
Cardiac Devices ◽  
Time Savings

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.

The Use of a Novel Super-Oxidized Solution on Top of Standard Treatment in the Home Care Management of Postsurgical Lesions of the Diabetic Foot Reduces Reinfections and Shortens Healing Time

2018 ◽  
Vol 17 (4) ◽  
pp. 268-274
Author(s):  
Elisabetta Iacopi ◽  
Lorenza Abbruzzese ◽  
Chiara Goretti ◽  
Nicola Riitano ◽  
Alberto Piaggesi
Keyword(s):  
Diabetic Foot ◽  
Chronic Wounds ◽  
Standard Of Care ◽  
Healing Time ◽  
Complete Healing ◽  
Group A ◽  
Reduced Rate ◽  
Group B ◽  
Time Required

There are still many unmet needs in the treatment of chronic wounds, especially regarding microenvironment modulation. Nexodyn is a novel super-oxidized solution capable of contrast bacterial proliferation. We aimed to evaluate if this solution, on top of standard of care, was safe and effective in improving diabetic foot outcome. We selected 50 patients admitted in our department to be submitted to surgery for acute diabetic foot infection. All patients were left open to heal for secondary intent. We divided patients into 2 groups: Group A (n = 25, male/female = 17/8, age = 67.3 ± 12.1 years, hemoglobin A1C = 7.9 ± 1.1%), patients treated with standard of care and, on top of this, Nexodyn solution, and Group B, treated only with standard of care. After discharge, patients continued Nexodyn application. We followed up patients until complete healing or up to 6 months. No differences between groups in healing rate, while time required for complete healing was significantly shorter in Group A (64.9 ± 12.1 days vs 147.4 ± 23.1 days, P < .01). During follow-up, the group treated with Nexodyn showed a reduced rate of reinfections (12 patients in Group B vs 3 patients in Group A, P < .05) and of further debridement procedures (1 patient in Group A vs 10 patients in Group B, P < .05). Nexodyn provided effective protection against reinfections in diabetic foot patients, thus reducing the necessity for debridement procedures and their healing time and presents a safety profile similar to saline solution.

scholarly journals Feasibility of Frailty Assessment Integrated with Cardiac Implantable Electronic Device Clinic Follow-up: A Pilot Investigation

2021 ◽  
Vol 7 ◽  
pp. 233372142098734
Author(s):  
Abdel Albakri ◽  
Ariela Orkaby ◽  
Michael A. Rosenberg
Keyword(s):  
Daily Activity ◽  
Time Series Data ◽  
Electronic Device ◽  
Clinic Visit ◽  
Assessment Tools ◽  
Risk Scores ◽  
Series Data ◽  
Activity Data ◽  
Wide Range

Background: The concept of frailty was originally created to explain why individuals of the same age have differing risk of disease, and it has since been found to be negatively associated with outcomes for a wide range of medical conditions, including cardiovascular disease and cardiac procedures. Although numerous risk scores and assessment tools have been proposed, opportunities for practical assessment of frailty remain limited. In this pilot study, we examine the feasibility of using routine follow-up of patients with cardiac implantable electronic devices (CIEDs) for assessment of frailty. Methods: From September 2017 through March 2018, 49 consecutive patients seen in CIED clinic were enrolled. Among the frailty assessments performed at the clinic visit included a 4-meter walk time, FRAIL scale calculation, Rockwood Frailty score assessment by another treating provider, mini-cog assessment, and analysis of daily activity measures on the CIED. Results: Among the three device manufacturers of patients’ CIEDs, only Boston Scientific released analyzable activity time series data. On nine patients in whom daily activity data could be analyzed, there was no difference in mean daily activity (148.3 ± 31.9 vs. 100.1 ± 25.1 min/day, p = .27) between patients with and without an abnormal frailty or cognitive assessment, although interestingly, those with an abnormal assessment had a higher standard deviation of activity per day (52.6 ± 5.9 vs. 31.4 ± 4.7 min/day, p = .03). Conclusion: It is possible that a higher variation in daily activity over the course of a year could be a better indicator of frailty or cognitive impairment than average daily activity.

scholarly journals 269 Management of cardiac implantable electronic device follow-up in COVID-19 pandemic: lessons learned during Italian lock down

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Agostino Piro ◽  
Michele Magnocavallo ◽  
Giampaolo Vetta ◽  
Alessia Bernardini ◽  
Marco Valerio Mariani ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Electronic Device ◽  
Home Monitoring ◽  
Standard Of Care ◽  
Technical Support ◽  
Lessons Learned ◽  
Easy Access ◽  
Acute Decompensation ◽  
High Degree

Abstract Aims Remote monitoring (RM) has significantly transformed the standard of care for patients with cardiac electronic implantable devices. It provides easy access to valuable information, such as arrhythmic events, acute decompensation manifestations, and device-related issues, without the need of in-person visits. Methods and results Starting 1 March, 332 patients were introduced to an RM programme during the Italian lockdown to limit the risk of in-hospital exposure to severe acute respiratory syndrome-coronavirus-2. Patients were categorized into two groups based on the modality of RM delivery [home (n = 229) vs. office (n = 103) delivered]. The study aimed at assessing the efficacy of the new follow-up protocol, assessed as mean RM activation time (AT), and the need for technical support. In addition, patients’ acceptance and anxiety status were quantified via the Home Monitoring Acceptance and Satisfaction Questionnaire and the Generalized Anxiety Disorder 7-item scale. AT time was less than 48 h in 93% of patients and 7% of them required further technical support. Despite a higher number of trans-telephonic technical support in the home-delivered RM group, mean AT was similar between groups (1.33 ± 0.83 days in home-delivered vs. 1.28 ± 0.81 days in office-delivered patients; P = 0.60). A total of 28 (2.5%) urgent/emergent in-person examinations were required. A high degree of patient satisfaction was reached in both groups whereas anxiety status was higher in the office-delivered group. Conclusions The adoption of RM resulted in high patient satisfaction, regardless of the modality of modem delivery; nonetheless, in-office modem delivery was associated with a higher prevalence of anxiety symptoms.

Automatic Remote Monitoring of Implantable Cardiac Devices in Clinical Practice – The Lumos-T Safely Reduces Routine Office Device Follow-up (TRUST) Trial

2010 ◽  
Vol 6 (3) ◽  
pp. 87
Author(s):  
Niraj Varma ◽  
Keyword(s):  
Clinical Practice ◽  
Remote Monitoring ◽  
Home Monitoring ◽  
Implantable Devices ◽  
Cardiac Device ◽  
Cardiac Devices ◽  
Enhance Patient Safety ◽  
Implantable Cardiac Devices ◽  
Post Implantation

The use of implantable electronic cardiac devices is increasing. Post-implantation follow-up is important for monitoring both device function and patient condition; however, clinical practice is inconsistent. For example, implantable cardioverter–defibrillator follow-up schedules vary from every three months to yearly according to facility and physician preference and the availability of resources. Importantly, no surveillance occurs between follow-up visits. By contrast, implantable devices with automatic remote monitoring capability provide a means for performing constant surveillance, with the ability to identify salient problems rapidly. The Lumos-T Reduces Routine Office Device Follow-up Study (TRUST) demonstrated that remote home monitoring reduced clinic burden and allowed early detection of patient and/or system problems, enabling efficient monitoring and an opportunity to enhance patient safety. The results of the trial have significant implications for the management of patients receiving all forms of implantable electronic cardiac device.

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