Miss Cara Mercer
To detect infrequent arrhythmias, an implantable loop recorder that stores a single-lead electrocardiogram can be used. This small device is placed in a left pectoral pocket under local analgesia, traditionally at a local cath lab. Our study shows that an implant at a non-medical, non-cath lab is safe, cost-effective and has the potential to improve the patient experience.
This paper describes the experiences of developing a non-medical, non-catheter laboratory based implantable loop recorder (ILR) service.
ILRs are small subcutaneous, single-lead, ECG monitoring devices that are placed in the left pectoral area under local analgesia. Compared to external rhythm monitoring devices, the ILRs have advantages such as recording over a longer period of time, higher patient acceptability and they record even at a time of total loss of consciousness where a ‘clutch’ type of monitor will not.
Traditionally, ILR devices have been implanted by medical staff in the cath-lab. An implant usually takes 30-45 minutes depending on operator skill and patient anatomy. Recently an injectable ILR device has become available that requires less surgical training than the previous devices. With this development, a new service was envisioned. Previously the Lincolnshire Heart Centre had only one cath-lab but entering the process of developing a primary percutaneous angioplasty service for ST-elevation myocardial infarction. As part of the business planning process we scrutinised what services were currently being undertaken to learn where and by whom. We felt that with increasing inpatient demands and the need to enlarge the cath-lab capacity, moving the ILR implants from a consultant cardiologist led service within the cath-lab to an alternative clinical environment would support this effort. As a result an alternative non-medical implantation service was developed.
The development of this new service has had several major patient and organisational benefits that include shorter waiting times, less cancellations and increased flexibility to implant ‘urgent’ devices in transient loss of consciousness. The latter has reduced length of stay within our emergency assessment unit. Moreover, this service means that the department has been able to undertake more procedures in the cath lab. Data from 2013–14 suggest that an additional 32 × four-hour cath lab sessions were made available for alternative use. Adverse events (infection/erosion) are comparable with published data at less than 1%.
In conclusion, the non-medical, non-cath lab based implantation is safe, cost-effective and has the potential to improve patient experience while also increasing both cardiologist and cath-lab capacity.
For more details, please read the full text of this report.
Authors: Alun Roebuck, Cara Mercer, Joanne Denman, Andrew R Houghton, Richard Andrews
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