AP-453071-5 SHOCKED BY EFFICIENCY: PATIENTS RECEIVE QUALITY CARE IN AN ALLIED PROFESSIONAL CARDIOVERSION PROGRAM THAT ALLEVIATES LAYERS OF SYSTEMIC STRAIN

Abstract

Performance of electrical cardioversion (CV) for atrial fibrillation (AF) by allied professionals (APs) can reduce physician resource utilization and may be associated with greater efficiency without compromising patient safety. To demonstrate that a cardioversion service overseen and performed by APs is associated with improved efficiency and reduced physician utilization while maintaining patient safety. In July 2020, we initiated a protocol whereby electrophysiology APs were trained, privileged, and credentialed to independently perform CVs at our institution. Each AP performed ten supervised CVs and subsequently proceeded independently with periprocedural documentation, CV performance, coordination of care, and patient education for those referred to the program. An analysis was performed assessing a cohort of patients (randomly selected from 2018-2022) to compare the average patient length of stay and adverse events under the EP AP service vs the EP/Cardiologist service. Since the initiation of the AP CV protocol (from July 2020 to November 2022), there were 422 CVs performed by an AP out of 1,048 total CVs. A chart review was performed assessing a random cohort of 104 CVs from 2018-2022: 52 (50%) by APs and 52 (50%) by MDs. The average length of stay in the procedure suite for AP CV was 90.8±26.3min vs 114.1±33.5min when performed by a physician, representing a time savings of 23.3min per patient (p <0.01). In addition, the time from outpatient elective CV order to time of CV was 18.4±11.8 days for APs vs 19.4±12.5 days for physicians. There were no adverse events in any of the AP CVs. The APs involved in the CV service universally felt that this independent activity improved job satisfaction. Independent performance of CVs by APs is significantly more time efficient without compromise in patient safety. Additional benefits to the EP AP CV service include improved scheduling availability, easier coordination with anesthesia services, offloading of physician workload, and increased AP job satisfaction.