Improving the Efficiency of Heart Failure Care

Abstract

Background Ambulatory pulmonary artery (PA) pressure-directed clinical management of Heart Failure (HF) patients has been shown to reduce HF hospitalizations; however the work flow associated with remote hemodynamic monitoring in such patients has not been studied. We performed a time and motion study in a group of patients with heart failure. Methods A non-interventional, single site “time and motion” study of usual care processes was conducted in the Heart Failure clinic of a 630-bed community hospital between July - October 2017. All enrolled patients were NYHA class III. Patients previously implanted with an ambulatory PA pressure sensor (CardioMEMSTM, Abbott; CMEM group), as well as sensor-eligible patients who had not previously received the implant (non-CMEM group), were recruited at a routine HF clinic visit. The usual care visit, for both CMEM and non-CMEM group, was observed from the time the patient arrived at the clinic to the time they left. The in-clinic observation was quantified based on the time spent in the prep area, exam room area, dictation, and scheduling desk. Primary reason for telephone calls made to CMEM group was captured. Results The HF clinic workflow was observed for 53 patients (n = 24 CMEM, n = 29 non-CMEM). The mean clinic visit time were 48:55 ± 15:34 minutes for CMEM and 55:57 ± 21:42 minutes non-CMEM (p = 0.07). 75% of the visit time was spent in the exam room with the provider. Telephone call duration was 5:47 ± 15:09 minutes (N = 92) with a median of 2:13 minutes of which, 52% were related to review of pulmonary artery pressures, 29% to HF monitoring, 12% to labs, and 3% to medication change. Conclusion This is the first characterization of the practical implications of utilizing remote hemodynamic monitoring. The additional time spent during follow-up calls was partially offset by shorter office visits. In addition, since most of the office time involved the provider (exam room) as opposed to nurse time (phone calls), the utilization of CardioMEMS™ may improve provider efficiency. The economic implications of remote hemodynamic management and office visits for HF patients can be studied based on these data.