Delays In Patient Care Research Articles

Workflow Improvement after Implementing Remote Blood Allocation Devices at an Academic Medical Center Blood Bank

Abstract Introduction/Objective Patients with hematological cancer routinely receive red blood cell (RBC) transfusions in the outpatient infusion clinical setting as part of their clinical therapy. Typically, RBCs are delivered to the outpatient infusion clinic via the pneumatic tube (P-tube). However, due to the recent expansion of the hospital footprint and the new location of the transfusion services, the P-tube encountered challenges that impacted the reliability of the delivery of RBC, which can delay patient care and affect patient satisfaction. This study’s purpose is to evaluate the pre-and post-implementation of the Haemobank-20 (HB20), remote blood storage and dispensing device, by reviewing the turn-around time (TAT) and the number of orders fulfilled outside of the transfusion service. Methods/Case Report Blood products are stocked to the HB in the infusion center. An electronic transfusion schedule is reviewed the night before scheduled transfusions to ensure appropriate inventory. When a patient is ready for the transfusion, the clinical nurse will use the device to retrieve blood products for the patient from the HB20. The average timed delivery time from the transfusion service to the outpatient infusion center is about 11 minutes. Data was retrospectively gathered from a 10-month interval before and after HB20 implementation to evaluate the number of orders fulfilled by the HB20. Results (if a Case Study enter NA) The HB has helped maintain nurse-to-patient ratios, reduced traffic at the blood bank issue window, and significantly sped up the turnaround time of RBCs from 11 minutes to less than 60 seconds. Before HB implementation, staff at the blood bank received 2853 units of RBCs through the blood bank window. This has been decreased by 61.2 percent to 1136 RBCs. Conclusion Implementing the Haemobank-20 in the outpatient infusion center has successfully reduced the turnaround time and the workload within the Transfusion Services. The current results study demonstrate that the remote blood-release system is safe and helpful in improving the efficiency of blood issue for patients in remote outpatient locations.

EDITORIAL COMMENT

Prior authorizations (PAs) are a means by which insurance companies ostensibly regulate the overutilization of costly medications and medical services. While controlling health care costs is an important consideration, PAs are increasingly criticized for the administrative burdens placed on health care practices and providers, with resultant delays in patient care and the potential for harm when patients are unable to get their indicated treatments/services. Acknowledging these criticisms while balancing the need for prudent resource management, a consensus statement for improving the PA process was put out in 2018 by the American Medical Association (AMA), American Hospital Association, America's Health Insurance Plans, the American Pharmacists Association, Blue Cross Blue Shield Association, and the Medical Group Management Association emphasizing the need for reform.

PSAT055 ACTH-Dependent or ACTH-Independent: The Importance of a Reliable ACTH Assay in Solving a Case of Cushing Syndrome

Abstract Background Reliable laboratory assays are of paramount importance in the field of endocrinology, as our ability to make diagnoses and recommend the appropriate treatment, rely heavily on them. Clinical Case A 36-year-old woman presented to our clinic with a history of a 30-pound weight gain over the course of a year and hypertension that was sub-optimally controlled on two antihypertensive medications. On physical exam she exhibited facial plethora, moon facies, central obesity, dorsocervical fat pad, and reddish abdominal striae. Laboratory data revealed a 24 hr urine free cortisol 277 mcg/24 h (n ≤ 45 mcg/24 h), 8 am cortisol after 1 mg dexamethasone suppression test 19.2 mcg/dL (cut-off <1.8 mcg/dL) with a dexamethasone level 179 ng/dL (n 140-295 ng/dL). Serum DHEAS <15 mcg/dL (n 35-430 mcg/dL) which was suggestive of an adrenal source of cortisol. CT scan of the adrenals revealed a 3.0×2.3 cm right adrenal nodule, 14 HU, relative washout of 58%, absolute washout of 68%, consistent with an adenoma. However, plasma ACTH was 20 pg/mL (n 0-46 pg/mL) which was suggestive of an ACTH-dependent etiology. Repeat ACTH levels through our local lab ranged between 17-27 pg/mL. An MRI of the brain was obtained which showed a normal pituitary gland without evidence of an adenoma. Due to the discrepancy between the clinical picture and the ACTH levels, the patient's case was discussed with the medical director of our local lab. It was decided to obtain another sample for ACTH which was tested for heterophile antibodies but did not yield any meaningful results. The patient denied being on any supplements that could interfere with the ACTH assay. The sample was then sent out to an outside lab with a plasma ACTH level <1 pg/mL (n 7.2-63 pg/mL), which was consistent with the patient's clinical presentation of an adrenal source of cortisol excess. Further investigation revealed that our local lab used a Siemens Immulite assay which was likely detecting interference, whereas the outside lab used the Roche Elecsys assay. In previous studies, the Roche assay has highly correlated with intact ACTH that has been measured by HPLC-MS/MS. The patient was started on ketoconazole and has been referred for right adrenalectomy. Clinical Lessons Heterophile antibodies and ACTH fragments are common culprits of ACTH immunoassay interference, but they can be difficult to detect if there is not a high index of suspicion. Erroneous laboratory results can lead clinicians to perform unnecessary procedures and delay patient care. This case highlights the importance of a reliable plasma ACTH assay to inform clinical judgment. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

Futility of the Third-Party Peer-to-Peer Review Process and Entailed Delays to Cancer-Directed Therapy

<h3>Purpose/Objective(s)</h3> The health plan management process of prior authorization (PA) ostensibly exists to control healthcare spending and to ensure evidence-based practice. However, the process of PA is cumbersome, creating de novo bureaucratic and operational costs, and entails delays to the initiation of treatment. This study investigates the rates of overturned PA denials for radiation services, radiotherapy (RT) prescription alterations, and the associated delays to treatment initiation at a high-volume academic radiation medicine department. <h3>Materials/Methods</h3> We queried de-identified departmental billing records for the 7-month period from 1/12/21 to 8/12/21. We obtained the cases referred for PA, and then obtained the subset for which prior authorization was denied and a peer-to-peer (P2P) review referral was made. The latter cases were subdivided into those in which the original denial was overturned, those in which the initial prescription was upheld but without requested image-guided radiation therapy (IGRT), those in which the initial prescription was denied but a downgraded modality (e.g., 3-dimensional conformal radiotherapy in place of intensity-modulated radiation therapy (IMRT)) was approved, and those in which RT was denied outright. We calculated the rates of each of the above categories, as well as the associated delays to initiation of treatment (mean, median, and range). <h3>Results</h3> Of the 1620 RT courses prescribed during the analyzed period, 697 cases (43%) were managed by insurance plans requiring PA, of which 123 (17.6%) were denied and referred for P2P review. 85 of the 123 (69.1%) had the denial overturned without altering the initial prescription. 5 cases (4.1%) were overturned but without requested IGRT. 26 cases (4.1%) were only approved for a downgraded modality. 5 cases (4.1%) were denied again on P2P review and RT abandoned, and in 2 cases (1.6%), the ultimate disposition was not available. For the cases ultimately approved without alteration, the mean delay to treatment initiation was 12.1 days (median 11, range 0-37). For the cases approved without IGRT, the delay was mean 6.8 days (median 6, range 5-9). For the downgraded treatment modalities, the delay was mean 9.8 days (median 9, range 1-23). Overall, in 15 cases (12.2%) the delay was > 20 days. <h3>Conclusion</h3> The majority of radiotherapy services initially denied were ultimately approved without alteration following P2P, but with resultant delays in patient care. Our analysis further suggests that the PA process is associated with treatment delays and added operational expense. Additional cross-departmental and cross-regional evaluations may further validate these findings.

An Adjusted Process to Improve Efficiency and Efficacy of Adsorption Procedures to Resolve Warm Autoantibody Cases.

The presence of warm autoantibodies in patient plasma typically causes extended delays in patient care due to panreactive antibody identification tests. Adsorption is the primary method for resolution. A modified adsorption procedure was devised with the intent to minimize delays, and the aim of the study was to evaluate its efficacy. To evaluate the in-house developed (experimental) adsorption method, specimens were tested in parallel with the standard adsorption method described in the AABB Technical Manual, 20th edition. Specimens selected demonstrated panreactivity at the submitting facility and contained adequate volume for parallel adsorption studies. Ninety specimens were tested with both methods. Ninety specimens achieved complete adsorption with the experimental method and 88 specimens achieved complete adsorption with the standard method. Two underlying alloantibodies, which have been reported to cause hemolytic transfusion reactions and potential renal graft rejection, were detected using the experimental method that the standard method failed to detect. The experimental method demonstrated a significant reduction in rounds of adsorption required to resolve warm autoantibody reactivity, enhanced antibody detection ability with adsorbed plasma, and more cost-effective outcomes compared to the standard method. A follow-up study is planned to assess whether the incubation time can be decreased with the experimental method to further improve the efficiency of the method without sacrificing efficacy.

Managing Undesired Pregnancy After Dobbs.

Although both medication abortion (MAB) and aspiration procedures are safe and effective, the Supreme Court decision in Dobbs v. Jackson Women’s Health Organization removed federal protection of access to abortion services. Abortion access is now illegal or severely limited in many states, leading to delays in abortion care for patients in all states. In this rapidly evolving landscape, primary care physicians (PCPs) must be familiar with laws surrounding abortion care in their own and neighboring states. PCPs must also be prepared to expedite abortion care by sharing resources, obtaining testing when needed, and counseling patients about expected outcomes following abortion.

Blurry Diagnosis of Ocular Syphilis

The incidence of syphilis is on the rise worldwide which may be due to increased diagnosis.Given the wide variety of presenting symptoms, syphilis can pose many diagnostic and therapeutic difficulties for doctors. In turn, these difficulties frequently leadto a noticeable delay in patient care. Here we present a case of ocular syphilis in ahomosexual male patientpresenting with uveitis with no prior symptoms except for an itchy rash in the pelvic area. The patient was treated with IV penicillin after which full vision was restored. By presenting this case, we hope to stress the importance of adding syphilis in the differential diagnosis of men who have sex with men (MSM)who present with otherwise unexplained rash and/or uveitis.

S619 Open Access Colonoscopy: A Study on Indications, Appropriateness and Efficiency of Colonoscopy Referrals in a Tertiary Care Center

Introduction: Open access colonoscopy (OAC) refers to screening colonoscopies ordered by primary care providers (PCP) without a specialist’s evaluation. In our institution, referral candidacy is based on specific parameters including a PCP visit within 6 months, controlled chronic conditions, normal laboratory values, and no gastrointestinal (GI) complaints. All referred patients are reviewed by a nurse, and patients that do not meet these criteria are considered rejected from OAC. OAC is currently challenged by inappropriateness of referrals and low follow-up rates. We sought to assess the rate of inappropriate OAC referrals, effectiveness of OAC, and identify most common reasons for rejection. Methods: This retrospective study was conducted at a large tertiary care center. All patients referred to OAC in October 2020 were included and a random sample of 200 patients was selected for manual chart review. Data collected includes: demographics, comorbidities, date of approval/rejection, reasons for rejection, and rates of colonoscopy completion. Results: Of the 200 patients reviewed, 1 was removed due to incomplete data. Of the remaining 199 patients, the mean age was 61, 98 (49%) were female, 79 (44%) were white, and 86 (48%) were black. A total of 114 (57%) were approved for OAC, of which 63 (55%) completed their colonoscopies with a mean of 121 days post-approval (SD=107, range 5-498 days). A total of 85 (43%) were rejected from OAC. The most common reasons for rejection included high risk comorbidities (26%), outstanding/abnormal laboratory results (21%), active GI conditions (18%), not due for colonoscopy (11%), uncontrolled diabetes (A1c >10; 7%), uncontrolled hypertension (1.2%) and lack of PCP visit within 6 months (4%). Among the 85 rejected patients, only 31 (36.5%) followed up with GI/PCP, of whom 21 (24.7%) underwent a colonoscopy. There were no significant differences between the accepted and rejected groups regarding age, gender, ethnicity, or insurance. (Table) Conclusion: Our study revealed that OAC continues to be significantly burdened by the high rate of inappropriate referrals that lead to delays in patient care and increased resource utilization. Rejected patients have low follow up rates and lower colonoscopy completion rates. As OAC use continues, future studies should assess the efficacy of various interventions targeting current flaws in the referral process to help achieve higher rates of successful and more efficient colon cancer screening. Table 1. - Summary of patient demographics and OAC approval/rejection data All Patients(N=199) Age (Mean ± SD) 61.4 ± 8.7 Gender FemaleMale N (%) 98 (49.2%)101 (50.8%) Race WhiteBlackOther N (%) 79 (43.6%)86 (47.5%)16 (8.8%) ApprovedOAC referrals Approval rate N (%) 114 (57.3%) Colonoscopy completion rate N (%) 63 (55.3%) Duration between OAC approval and colonoscopy completion (Mean days ± SD) 121.3 ± 107.4 RejectedOAC referrals Rejection rate N (%) 85 (42.7%) Colonoscopy completion rate N (%) 21 (24.7%) Duration between OAC rejection and colonoscopy completion (Mean days ± SD) 129.8 ± 96.4 Reason for Rejection High Risk ComorbiditiesOutstanding/Abnormal LabsActive GI ConditionNot Due for ColonoscopyNo PCP Visit in Last 6 MonthsOther N (%) 22 (25.8%)18 (21.2%)15 (17.6%)9 (10.6%)3 (3.5%)18 (21.3%)

Creating a single point of referral and standardized care pathway for patients with melanoma to improve access to care.

127 Background: Access to care is often a challenge for healthcare organizations – especially as pressures on time increase and workforce availability decreases – and is often complex to solve. In this quality improvement (QI) initiative, a team from a rural academic medical center deployed the Lean Six Sigma approach to develop a two-pronged method that reduced the median time to first visit for new melanoma patients. Methods: The project team deployed the Define, Measure, Analyze, Improve, and Control (DMAIC) processes to address access for melanoma patients after the healthcare organization set a goal that 55% of new specialty care patients be seen within 10 days. Define: Concern was raised by the melanoma clinical care team that the lack of a well-defined and standardized referral workflow for melanoma patients could delay patient care. Measure: Data from the electronic medical record (EMR) indicated that only 31% of incoming referrals were seen within 10 days, and the median number of days to first visit was 15, or 50% over the organizational standard. Analyze: Analysis found considerable waste in the existing referral system. First, untrained staff made referral and routing decisions, meaning patients could potentially be seen by inappropriate departments based on the assessment of those not specialized in melanoma care and treatment. This led to the second area of waste: rework. Every referral had to be reviewed by multiple staff in several departments to ensure the referral made was appropriate based on the characteristics of disease. This was a very labor-intensive processes that allowed too many patients to “slip through the cracks” of the system. Improve: Two interventions were deployed to address the identified waste. First, a centralized referral point for all melanomas monitored by the Program Coordinator. Second, a referral questionnaire developed by an interdisciplinary team to guide where routine cases should be referred. Early results show that the interventions had marked impact on the time to first appointment for all referrals, whether originating inside of the organization or out. After the intervention 54% of newly referred patients were seen within 10 days. Results: Control: A standard report was built to support the project team in monthly monitoring of the KPI, days from referral to patient seen. The report is monitored by a dedicated Program Coordinator who can escalate any issues during regular interdisciplinary care team meetings. Conclusions: Improvements in access can be achieved by adopting standard work that is targeted to reduce waste in the referral workflow. The model developed by this QI initiative is easily replicable and may be especially useful for interdisciplinary teams who provide care to complex diseases.[Table: see text]

EP-488 Pre-operative electronic checklists as a systematic method to improve patient care

AimsThe COVID-19 pandemic has resulted in major changes in pre-operative assessment, as consultations became conducted over the telephone, and pre-operative tests carried out a few days before surgery to coincide with the COVID testing visit. This increased the chances for preoperative tests to be missed. A recent audit in our unit revealed missed investigations just before surgery. A checklist was introduced to identify issues early and help reduce avoidable delays.MethodsAn audit was performed for completeness of preoperative preparations. A pre-operative checklist was created to include pre-operative investigation reports, routine laboratory results, proof of COVID-19 swabs and vaccination records, correct details on the theatre lists, signed consent forms with clearly visible patient marking. The checklist was launched and the team, including doctors and nurses, were educated on its value in improving patient care.ResultsThe implementation of electronic pre-operative checklists resulted in an immediate improvement of care, with preliminary results showing issues with a potential of causing delays being promptly identified and addressed. Late identification of issues could not be entirely avoided; however, this was discussed with team members, further education was provided, and data collection continues, to ensure good practice is sustained.ConclusionCOVID-19 has reduced the time for hospital visit and face to face interactions, but this created the opportunity for missed tests and processes leading to delays and cancellation of surgery. The checklist in our case has proven useful in identifying issues early and promptly managing potential delays in patient care.

Implementation of the Acute Care Clinic Easy Scheduling System at the Brooke Army Medical Center.

ABSTRACTIntroductionEmergency departments (EDs) have continued to struggle with overcrowding, causing delays in patient care and increasing stress on the medical staff and resources. This was further illustrated during the recent coronavirus disease 2019 pandemic, where we saw large unpredictable surges to the ED as hospitals tried to meet the medical needs of patients while trying to minimize the spread of coronavirus disease. A previous study from the Department of Emergency at the Brooke Army Medical Center (BAMC) found that nearly half of the patients presenting to the ED could have been managed in a primary care setting. We sought to pilot an alternate appointment scheduling system, Acute Care Clinic Easy Scheduling System, to allow patients to see and book available appointments while waiting in the ED waiting room.Materials and MethodsOur appointment display system was created through collaboration with the BAMC Information Management Division. A Tableau data interface connects to the Composite Health Care System to view available primary appointments across the San Antonio Military Health Care System. These are displayed in real-time on multiple TV screens outside the ED and in the ED waiting room. Patients were provided signage that provides a way to call or use a World Wide Web–based interface to immediately schedule the open appointments within the next 48 hours. Patients voluntarily opted to use this system and may opt to leave the ED if another appointment became available within an acceptable time frame to them.ResultsThis section is not applicable to this article.ConclusionsExpansion of the Acute Care Clinic Easy Scheduling System within the Military Health Care System may (1) help reduce ED crowding, (2) improve access to care through a live-tracking system that patients can review and select from, and (3) reduce the number of unfilled primary care appointments. The system in place in the BAMC ED serves as a template for other MTFs to use.

Improving access to imaging availability in otology clinic.

Radiologic imaging is an essential component in the workup of many patients with neuro-otologic conditions. However, patients often present for consultation with a neurotologist without the imaging that they have already undergone as part of their workup by a referring clinician. This disconnect causes frustration for clinicians and possible delays in care for patients. Anecdotally, clinicians felt that patients who had contact with clinic coordinators before their appointment were more likely to have their prior imaging available for review at the time of their initial consultation. We aimed to increase the rate at which new patients brought their prior imaging to their initial consultation to at least 80% by improving previsit communication with patients and referring providers. Key stakeholders identified pain points in the flow of information from patients' outside facility workups. We then used the Plan-Do-Study-Act quality improvement framework to develop, implementand iterate on two interventions intended to improve communication with patients, referring clinicsand outside imaging centres. Chart review was used to assess the proportion of patients with imaging available for review at the time of initial consultation and a short satisfaction survey was sent to attending neurotologists in the preand postintervention periods. Before any interventions, 56.5% of typical new patients who reported having prior imaging had that imaging available for review at the time of their initial consultation. Following our interventions, this percentage increased to 73.5% and then 80.9% of new patients, respectively. Additionally, physicians reported improved satisfaction in several areas and spent less time reviewing imaging outside of clinic visits after our interventions. Improved communication and tracking of image receipt in clinics receiving many referrals saves physicians' time, reduces frustrationand cuts down on the overall administrative burden following patients' appointments.

Uncovering a Failed Pediatric Patient Population in Rural America: A Statewide Analysis of Over 1,000 Dog Bite Injuries.

Pediatric dog bites are prevalent and often devastating. Population-based data on these injuries can aid public health intervention efforts. However, most existing literature comes from single institutions in urban settings. We assess a statewide cohort to compare injury characteristics in urban and rural regions and find predictors for inter-hospital transfer. Data from 1,007 injuries from 2000 to 2015 were analyzed. Patients in rural areas were younger, more likely to be white and low-income, and more likely to receive delayed patient care. Injuries occurring in public settings as opposed to the private residence were more likely to involve males, occur in low-income areas, and involve non-white patients. Patients who required inter-hospital transfer were more likely to require a surgical subspecialist and operative repair. Our population analysis reveals children living in rural areas as a previously unidentified vulnerable patient population that may be suitable targets for public health interventions.

A Study on Analysis of Patient Food Delivery in a Multispecialty Hospital, Coimbatore

Abstract: Dietary department within hospital sector is responsible for complete supply of foods and feeds to patient and their family members. Any error in this department will lead to delay in patient care. In this study, the researcher analyses the food delivery system and finds out whether right food is delivered for all patient at right time. This topic is an initiative to provide suitable suggestion to overcome errors and to improve the overall food delivery standards. The data collection method was used to find the patient food delivery to the right food, right time to the patient. Time delay is calculated throughout the study to find out the reason for food delay. The purpose of the study is to improve food delivery process at hospital. Keywords: Food error, Time delay, Dietary department, Solid food, Liquid food, Package food.

Telemedicine for the pediatric preoperative assessment during the COVID-19 pandemic: Evaluating patient and provider satisfaction

The COVID-19 pandemic has presented unprecedented challenges in delivering healthcare to surgical patients. To avoid delays in patient care while still minimizing COVID-19 infection risk to patients and providers, anesthesiology preoperative clinics were presented with the opportunity to implement telemedicine to assess patients’ risks prior to surgery. This study explores patient and provider satisfaction with video-based telemedicine preoperative clinic visits during the COVID-19 pandemic via a patient and provider satisfaction survey. A vast majority (>93%) of patients expressed overall satisfaction with telemedicine visits. Similarly, >85% of providers agreed with the benefits of and expressed overall satisfaction with the preoperative telemedicine visits. Overall, patient and provider study participants had positive feedback in response to anesthesia preoperative telemedicine visits. Future studies could assess the preference of telemedicine to in-person visits once the fears of COVID-19 spread have been mitigated, as well as an assessment of outcomes comparing telemedicine and in-person visits.

PACS downtime drill: testing departmental workflow with an enterprise imaging viewer and archive.

In today's workflow, radiologists rely on the picture archiving and communication system (PACS) to view images. Unplanned downtime causes significant delays in patient care and lengthy downtimes can have lasting effects on patient care and end-user confidence. The purpose of this manuscript is to describe the planning and implementation of a disaster drill where the departmental PACS was taken off-line and the hospital enterprise viewer was used for departmental image interpretation.

Creating a Process for the Implementation of Tiered Huddles in a Veterans Affairs Medical Center.

ABSTRACTIntroductionIn 2019, the Veteran’s Health Administration began its journey in pursuit of becoming an enterprise-wide High Reliability Organization (HRO). Improving the delivery of safe, high quality patient care is a central focus of HROs. Requisite to meeting this goal is the timely identification and resolution of problems. This is best achieved by empowering and engaging both clinical and non-clinical staff across the healthcare organization through the promotion of robust collaboration and communication between various disciplines. Improved care coordination and increased accountability are two important subsequent outcomes. One method for accomplishing this is through the implementation of tiered huddles.Materials and MethodsAn extensive review of the current literature from 2013 until June 2021 was conducted for evidence highlighting the experiences of other healthcare organizations during implementation of huddles. Following the review, a tiered huddle proposal was developed and presented to the executive leadership team of a healthcare system for approval. Pilot testing of the tiered huddle implementation plan began in October 2021 over a 12-week period with three services. On average, the pilot services had between three to four tiers from frontline staff to the executive level of leadership.ResultsOver the 12-week period, out of the possible 120 tiered huddles that could have been conducted, 68% (n = 81) were completed. Of the tiered huddles conducted, 99% (n = 80) started and ended on time. During the pilot test, seven issues were identified by frontline staff: coordination of pre-procedural coronavirus testing, equipment/computer issues, rooms out of service, staffing levels, and lack of responsiveness from other departments. Issues related to staffing, unresponsiveness from other departments, and equipment concerns required elevation to a higher-level tier with no issues remaining open. Delays in patient care, or prolongation of shift hours for staff because of tiered huddles, was low at 2.5% (n = 2). For the duration of the pilot test, a total of 75 minutes accounted for shifts being extended among five staff members.ConclusionsThe success of this initiative demonstrates the importance of thoughtfully creating a robust process when planning for the implementation of tiered huddles. The findings from this initiative will be of immense value with the implementation of tiered huddles across our healthcare system. We believe that this approach can be used by other healthcare institutions along their journey to improving patient safety and quality.

Introduction: Occupational Hazards to the Joint Replacement Surgeon

Introduction: Occupational Hazards to the Joint Replacement Surgeon

Remote programming of cardiac implantable electronic devices: A novel approach to program cardiac devices for magnetic resonance imaging.

Magnetic resonance imaging (MRI) in patients with MRI-conditional cardiovascular implantable electronic devices (CIED) remain a logistical issue for device programming during the scan. In current practice, a trained person needs to be present on-site to program CIED for MRI scan. This can cause delay in patient care, rescheduling of tests and increase healthcare costs. A novel remote programming (RP) strategy can be utilized to reprogram the CIED remotely. We sought to explore the feasibility and safety of RP of CIEDs in patients undergoing MRI scan. We implemented the Medtronic CIED RP software at our institution after ensuring HIPAA compliance. The MRI technician started the session by contacting an off-site remote operator and placing a programmer wand from the 2090 Medtronic programmer over the CIED. The remote operator logged into a remote access software and provided a unique access code to the MRI technician. After entering the access code into the programmer, the remote operator was able to program the device as needed. We conducted a periodic audit of the first 209 patients who underwent RP of CIEDs for MRI. Outcomes analyzed were successful completion of RP sessions and time saved per scan. Of the 209 MRI scans, 51 scans were performed urgently. There were no connectivity and programming problems or need for MRI rescheduling. In-person reprogramming was not required for any patient. All scans were completed safely in a timely manner, and there were no reports of CIED malfunction. Time saved per scan was estimated to be 28 ± 10 min. Remote programming of CIEDs for MRI scans is a safe and effective strategy.

Proper Titration Orders Are Essential for Patient Safety.

Proper Titration Orders Are Essential for Patient Safety.