A hospital in France cut the time spent on remote monitoring alerts from implantable cardioverter-defibrillators (ICDs) by more than half after developing and instituting decision trees. The management tool allowed cardiologists and nurses to focus their attention on arrhythmias and other pressing issues.
Laurence Guedon-Moreau, MD, and colleagues at Lille Regional University Health Center in Lille, designed the multiple-phase, single-center study to assess and optimize resources used in the remote management of ICD patients. They noted that remote monitoring can be counterproductive if physicians become overloaded with information from intrusive alerts.
They first studied the remote monitoring pathways and then enrolled 427 ICD patients between 2009 and 2010 to evaluate the data transmitted. In the next phase, the cardiologists, nurses and others assessed quantitative and qualitative data to determine roles and design decision trees. In the final phase, they enrolled another 535 ICD patients between 2010 and 2011 to compare resource use and outcomes.
Before implementing the decision trees, the hospital received 3.96 alerts per 100-patient years annually, which dropped to 3.32 alerts per 100-patient years after implementation. The percentage of alerts submitted by cardiologists dipped from 33 percent to 18 percent and reactions to alerts dipped from 6.4 percent to 5.1 percent.
At the same time, the proportion of interventions increased, from 19.4 percent to 28.2 percent.
The total time spent on interventions decreased for both nurses and cardiologists. Nurse time changed from 61 hours and 31 minutes to 34 hours and 50 minutes and physician time went from 24 hours and 5 minutes to 20 hours and 22 minutes.
Overall time spent per alert dropped from 4 minutes 31 seconds to 2 minutes 10 seconds, for a 52 percent decrease. The variability in time spent per alert was reduced, too.
The proportion of alerts submitted to cardiologists that led to no change in patient management was cut by more than half, from 27 percent to 12 percent, for a 56 percent decrease in unneeded reactions to alerts. This “allowed a reallocation of the time spent in favor of clinically relevant alerts,” the Lille researchers wrote.
The changes had an impact on nurses’ use of time as well. Nurses experienced a 58 percent decrease in time spent per alert and a decrease in variability of time spent, “which was partially attributable to the time needed reflect on whether it needed to be referred to the cardiologist,” they wrote. “This decrease in variability of the management of [remote monitoring] is of particularly great importance because [remote monitoring] probably increases the survival.”
The management program did not compromise patient care. Annual rates for alerts that led to hospitalizations were 10.8 per 100-patient years before and 8.1 per 100-patient years after. Annual death rates were 6.6 per 100-patient years before and 4.1 per 100-patient years after.
The study was published online June 23 in Circulation: Cardiovascular Quality and Outcomes. Medtronic contributed to the funding for the study.