A QUALITY IMPROVEMENT APPROACH TO REGIONAL UTILIZATION OF REMOTE MONITORING IN CARDIAC DEVICE CLINICS

Abstract

Cardiac implanted electronic devices (CIED) are assessed for optimal function every 6-12 months in device clinics. Patient complexity, increasing demands on clinics, advancing technology and current evidence are driving the need to include remote monitoring as an integral component of care for CIED patients. A blended model of follow up care, using in- clinic visits and remote monitoring, has been challenging to integrate into Interior Health’s six device clinics. Clinicians have expressed frustration with previous implementations, citing missing key elements such as: support in change management, a clearly defined model of care, integration into clinic operations, clinic policy and protocols and data to drive practice change. This presentation will describe a quality improvement project aimed at increasing the utilization of remote monitoring in device clinics across a health service area challenged by not only variation in practice and resources, but vast geography. A pilot was designed and implemented in one clinic using PDSA cycles to integrate this technology. Change management strategies were introduced to support education, process development, clinic scheduling and data tracking tools resulting in an 80 % enrollment rate of new implants. Building on the success of this pilot, the presentation will showcase how this comprehensive approach, led by a Regional Clinical Nurse Specialist, was then replicated in three out of six Interior Health device clinics to provide sustainable, quality health care for CIED patients closer to home. Evaluation measures will include: enrollment rates for new implants, avoidable ED visits and early identification and treatment.