Key result
Nurse-led CRT care pathway linked to ~50% fewer hospitalization days vs usual care.
Why the study?
CRT requires intensive, complex, multidisciplinary care typically handled by highly specialised physicians, prompting the development of a standardised care pathway to transition to nurse-led care.
Does a standardized nurse-led CRT care pathway reduce resource use and improve process metrics compared to usual physician-led care in patients receiving CRT?
Cohort (n=237)
No
Does a standardized nurse-led CRT care pathway reduce resource use and improve process metrics compared to usual physician-led care in patients receiving CRT?
Absolute Event Rate: 2.4% vs 4.8%
p-value: p=<0.0001
Implementation of a standardized, nurse-led CRT care pathway significantly reduces healthcare resource utilization and process times without compromising clinical outcomes.
May support nurse-led CRT pathways to reduce resource use; leaves open confirmation in randomized trials.
BACKGROUND: Cardiac resynchronisation therapy (CRT) requires intensive, complex and multidisciplinary care to maximize the clinical benefit. In current practice this is typically a task for highly specialised physicians. We report on a novel multidisciplinary, standardised CRT care pathway (CRT-CPW). Experienced clinicians developed a CPW with simple and broadly applicable aids based on clinical evidence and identified shortcomings in the current CRT care. The resulting CPW was implemented at the Maastricht University Medical Center, aiming at a transfer from heterogeneous physician-led care to standardized nurse-led care. METHODS: Two CRT patient cohorts were compared in this analysis. The benchmarked usual care cohort (2012-2014, 122 patients) was compared with the CRT-CPW cohort (2015-2017, 115 patients). The primary outcomes were process-related: number of physician consultations, nurse consultations, length of stay (LOS) at implantation and total hospitalisation days during 1-year follow-up, and referral-to-treatment time. Clinical outcomes were assessed to adress non-inferiority of quality of care. RESULTS: Patients in the CRT-CPW cohort consulted nurses and technicians significantly more often than patients in the usual care cohort (2.4±1.5 vs 1.7±2.0, p<0.0001 and 4.3±2.5 vs 3.7±1.5, p=0.063, respectively). Patients with CRT-CPW consulted physicians significantly less often (1.7±1.4 vs 2.6±2.1, p<0.001). Referral to treatment time was significantly reduced in the CRT-CPW group (23.6±18.4 vs 37.0±26.3 days, p=0.002). LOS at implantation and total hospitalisation days were significantly reduced in the CRT-CPW group (1.1±1.2 vs 1.5±0.7 days, p<0.0001 and 2.4±4.8 vs 4.8±9.3, p<0.0001, respectively). Clinical outcome analyses showed no significant difference in 12-month all-cause mortality and heart failure hospitalisations. CONCLUSION: The introduction of a novel CRT-CPW resulted in a successful transition of physician-led to nurse-led care, with a significantly reduced resource use and equal clinical outcomes. Future evaluations will focus on impact on outcomes versus costs, to evaluate cost-effectiveness of the CRT-CPW.
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Stipdonk et al. (2021) conducted a cohort in Cardiac resynchronisation therapy (n=237). Standardised CRT care pathway (CRT-CPW) vs. Usual care was evaluated on Total hospitalisation days during 1-year follow-up (p=<0.0001). A standardized nurse-led cardiac resynchronization therapy care pathway significantly reduced total hospitalization days (2.4 vs 4.8 days, p<0.0001) and physician consultations compared to usual care.
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