Enhancing efficiency in a cardiac investigations department by increasing remote patient monitoring

OBJECTIVE: Remote monitoring (RM) of patients with cardiac rhythm management devices enables healthcare teams to effectively and efficiently monitor patients with heart problems without the requirement in-person patient visits. RM has been associated with safer and higher quality care but was not being used to its full potential in this setting. Cardiac rhythm management had observed an average implant rate of 295 devices per year over the past 13 years, resulting in a five-fold growth in patient follow-up in clinics. This increased demand was becoming unmanageable, with impacts on care quality. This study aimed to enhance the enrolment of eligible patients to RM. DESIGN: A pre-post design. SETTING: A 600-bed city centre teaching hospital in Dublin, Ireland. PARTICIPANTS: Hospital staff and patients eligible for RM. INTERVENTIONS: Lean Six Sigma methods were used to develop patient education materials on RM and the clinic area was redesigned to enable RM enrolment and monitoring. MAIN OUTCOMES MEASURES: Number of unscheduled attendances to clinic and RM enrolment. RESULTS: At baseline, the clinic was processing 102 RM follow-up checks with 140 unscheduled attendances on average per month. Following implementation, RM enrolment increased to 335 RM follow-up checks (194% increase), with 41 unscheduled attendances on average per month (70% decrease). These results were sustained one-year post-implementation. CONCLUSIONS: These process changes have streamlined workflow by reducing the number of unscheduled attendances to clinic and increased the use of RM among the eligible patient population. This has meant safer, more timely responses to cardiac events and enhanced care quality.