Efficiency Improvement of the Clinical Pathway in Cardiac Monitor Insertion and Follow-Up: Retrospective Analysis
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".