Key result
Outsourcing remote monitoring to external data centres would handle ~40% of transmissions but decrease in-hospital workload by only 15-25%, as most time is spent solving clinical problems.
Why the study?
The authors sought to describe the workflow and workload of real-world remote monitoring at their telecardiology centre to assess the feasibility of outsourcing this service.
Is it feasible to outsource the remote monitoring of implantable cardiac defibrillators to external data centers?
Observational (n=262)
No
Is it feasible to outsource the remote monitoring of implantable cardiac defibrillators to external data centers?
Outsourcing remote monitoring of ICDs to external data centers would only marginally decrease hospital workload, as most time is spent managing clinical problems rather than reviewing normal transmissions.
Outsourcing may yield only modest workload reductions for ICD remote monitoring; hypothesis-generating for targeted workflow interventions.
AIM: To provide a detailed description of the workflow at our telecardiology centre and to analyse the workload of real-world remote monitoring with the aim to assess the feasibility to outsource this service. METHODS: study was conducted on the same service by documenting and monitoring every action performed by specialised nurses when analysing and solving remote monitoring transmissions. 337 contacts in 262 patients were collected during this period. RESULTS: Both analyses indicated similar numbers of events and interventions. Unplanned transmissions were more challenging and required more interventions than planned transmissions. Relatively little time (retrospective median: 1.83 min; prospective median: 1.56 min, per event) was spent on incoming non-actionable 'normal' transmissions (retrospective: 46%; prospective: 40% of all events). Retrospectively 54% and prospectively 60% of transmissions showed abnormalities and were responsible for most of the time expended. Disease-related issues were the most frequent cause for these 'abnormal' alerts. Contacting patients and physicians were key interventions undertaken. Interaction initiated by patients mainly involved the installation process (42%) and bedside monitoring problems (32%). CONCLUSION: External data centres could deal with 40% of the transmissions, but the decline in workload would be negligible for the in-hospital remote monitoring team, because very little time is spent dealing with the many 'non-event' transmissions whereas most of the time is spent solving clinical problems. Providing sufficient resources and optimising communication protocols is necessary to aid in managing the workload of the remote monitoring team. Implications for practiceContacting patients and physicians are key interventions for specialist nurses in remote monitoring centres.Detailed timing confirmed that most time was spent on relevant disease-related clinical problems.Despite dealing with ∼40% of transmissions, outsourcing to external data centres would decrease the workload only by 15-25%.Patient initiated contacts with questions concerning remote monitoring form a high burden and should be countered by scaling the service and creating communication protocols.
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Lapage et al. (2022) conducted an observational in Implantable cardiac defibrillators (n=262). Remote monitoring workflow analysis was evaluated on Time spent on remote monitoring transmissions and workload analysis. Outsourcing remote monitoring to external data centres would handle ~40% of transmissions but decrease in-hospital workload by only 15-25%, as most time is spent solving clinical problems.
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