IMPACT OF CENTRALIZED REMOTE MONITORING ON THE EFFICIENCY OF CARDIAC DEVICE PATIENT CARE

Abstract

Over 250,000 Canadians are living with Cardiac Implantable Electrical Devices (CIEDs). These devices improve survival & reduce morbidity, but their follow-up is resource intensive; both in terms of the healthcare system & recipients (travel, parking & time). Remote Monitoring (RM), CIED follow-up in a patient’s home or a centralized area, is an important adjunct to conventional follow-up. Home-based RM has been shown to reduce cost & enhance quality of life without compromising safety. However, centralized RM is less well studied. Centralized RM uses a single device to collect the data from multiple CIEDs centrally (e.g., an emergency department or ED) for the Clinician to review and interpret, similar to a home-based RM encounter. To assess the feasibility, acceptance and impact of CareLink Express[TM], a centralized RM tool, in a large urban region. CareLink Express was implemented at 4 high volume EDs in a large metropolitan area. ED staff identified CIED patients that required evaluation, an ECG technician performed CIED interrogation via CareLink Express & the CIED Clinician on call was notified. The Clinician then reviewed the interrogation from home & reported the results to ED staff and the on call electrophysiologist, as necessary. A total 243 evening and nightshift CareLink Express assessments occurred over 12 months. Most assessments did not require direct assessment by the CIED clinician or electrophysiologist. CareLink Express assessments eliminated an estimated 486 hours of travel and 1,458 hours of Clinician overtime. This resulted in a savings of $54,171. Clinician assessment of CareLink Express was universally positive, with reduced travel time cited as its’ main advantage. ECG technician satisfaction was also high. ED length of stay was estimated to be reduced by an average of nearly 4 hours per CareLink Express assessment (total reduction of 785 hours). This reduced ED wait times and resulted in an estimated further cost savings of $51,679. Reliable, comprehensive estimates of costs are complex since our implementation of this tool involved multiple departments, clinics & hospitals. The sources required for costs are being collated and will be available at the time of presentation. Centralized remote monitoring via CareLink Express was easy to implement, perceived as valuable and user friendly & allowed for efficient collection of CIED data. This process reduced staffing costs & travel plus enhanced the care of patients in the ED, resulting in improved ED bed utilization and additional savings.