Efficiency Improvement of the Clinical Pathway in Cardiac Monitor Insertion and Follow-Up: Retrospective Analysis
Notice bibliographique
Résumé
Background: The insertable cardiac monitor (ICM) clinical pathway in Tampere Heart Hospital, Finland, did not correspond to the diagnostic needs of the population. There has been growing evidence of delegating the insertion from cardiologists to specially trained nurses and outsourcing the remote follow-up. However, it is unclear if the change in the clinical pathway is safe and improves efficiency. Objective: We aim to describe and assess the efficiency of the change in the ICM clinical pathway. Methods: Pathway improvements included initiating nurse-performed insertions, relocating the procedure from the catheterization laboratory to a procedure room, and outsourcing part of the remote follow-up to manage ICM workload. Data were collected from electronic health records of all patients who received an ICM in the Tampere Heart Hospital in 2018 and 2020. Follow-up time was 36 months after insertion. Results: The number of inserted ICMs doubled from 74 in 2018 to 159 in 2020. In 2018, cardiologists completed all insertions, while in 2020, a total of 70.4% (n=112) were completed by nurses. The waiting time from referral to procedure was significantly shorter in 2020 (mean 36, SD 27.7 days) compared with 2018 (mean 49, SD 37.3 days; P=.02). The scheduled ICM procedure time decreased from 60 minutes in 2018 to 45 minutes in 2020. Insertions performed in the catheterization laboratory decreased significantly (n=14, 18.9% in 2018 and n=3, 1.9% in 2020; P=<.001). Patients receiving an ICM after syncope increased from 71 to 94 patients. Stroke and transient ischemic attack as an indication increased substantially from 2018 to 2020 (2 and 62 patients, respectively). In 2018, nurses analyzed all remote transmissions. In 2020, the external monitoring service escalated only 11.2% (204/1817) of the transmissions to the clinic for revision. This saved 296 hours of nursing time in 2020. Having nurses insert ICMs in 2020 saved 48 hours of physicians' time and the shorter scheduling for the procedure saved an additional 40 hours of nursing time compared with the process in 2018. Additionally, the catheterization laboratory was released for other procedures (27 h/y). The complication rate did not change significantly (n=2, 2.7% in 2018 and n=5, 3.1% in 2020; P=.85). The 36-month diagnostic yield for syncope remained high in 2018 and 2020 (n=32, 45.1% and n=36, 38.3%; P=.38). The diagnostic yield for patients who had stroke with a procedure in 2020 was 43.5% (n=27). Conclusions: The efficiency of the clinical pathway for patients eligible for an ICM insertation can be increased significantly by shifting to nurse-led insertions in procedure rooms and to the use of an external monitoring and triaging service.
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,002 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
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