Impact of novel insertable cardiac monitoring system on real-world cardiac device clinic workflow

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Insertable cardiac monitors (ICMs) continually monitor for cardiac arrhythmias, enabling appropriate therapeutic intervention. However, clinic workload to manage ICM patients can be significant. The recent LINQ II ICM system was designed with several features to streamline clinic practice, including remote reprogramming and on-demand data pull capabilities, tablet-based clinician device programmer, smartphone app-based patient monitor, patient management service, and elective data triaging service. Purpose To characterize the impact of the LINQ II ICM system on clinic workload compared to previous ICM systems. Methods A detailed workflow survey was taken by clinicians at 66 unique cardiac device clinics across UK/Ireland. The total number of ICM patients per clinic averaged 563 patients (median = 500). Respondents included cardiac physiologists (94%), cardiac nurses (4%), and physicians (2%). Results Overall, 82.5% of respondents reported that the LINQ II ICM system is more efficient compared to previous ICM workflow, with a total clinic time savings of 9.3 hours/week (Table). Use of a tablet-based device programmer was estimated to save 19.9 minutes per ICM patient during the initial device insertion and activation, while the patient management service saved 30.6 minutes per new patient on monitor set-up and education. Two-thirds (68.6%) of respondents reported that app-based patient monitoring increases efficiency of remote monitoring, attributable to fewer disconnected monitors and reduced patient calls due to information available in the app (e.g., device battery life, data transmission status). The majority (85.7%) felt that remote reprogramming increases efficiency, as remote reprogramming was estimated to save an average 20.0 minutes of staff time compared to an in-clinic reprogramming. More frequent reprogramming of device alerts also led to an average 13.5% reduction in the rate of non-actionable ICM alerts, and overall 43.1% fewer in-person clinic visits. Conclusions New ICM system features appear to streamline the clinic workflow associated with managing ICM patients, freeing up valuable clinician time to devote to patient care activities.