Clinic Time Required for Remote and In-Person Management of Patients With Cardiac Devices: Time and Motion Workflow Evaluation
BackgroundThe number of patients with cardiac implantable electronic device (CIED) is increasing, creating a substantial workload for device clinics. ObjectiveThis study aims to characterize the workflow and quantify clinic staff time requirements for managing p...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
JMIR Publications
2021-10-01
|
| Series: | JMIR Cardio |
| Online Access: | https://cardio.jmir.org/2021/2/e27720 |
| _version_ | 1827858963656343552 |
|---|---|
| author | Amber Seiler Eliana Biundo Marco Di Bacco Sarah Rosemas Emmanuelle Nicolle David Lanctin Juliette Hennion Mirko de Melis Laura Van Heel |
| author_facet | Amber Seiler Eliana Biundo Marco Di Bacco Sarah Rosemas Emmanuelle Nicolle David Lanctin Juliette Hennion Mirko de Melis Laura Van Heel |
| author_sort | Amber Seiler |
| collection | DOAJ |
| description |
BackgroundThe number of patients with cardiac implantable electronic device (CIED) is increasing, creating a substantial workload for device clinics.
ObjectiveThis study aims to characterize the workflow and quantify clinic staff time requirements for managing patients with CIEDs.
MethodsA time and motion workflow evaluation was performed in 11 US and European CIEDs clinics. Workflow tasks were repeatedly timed during 1 business week of observation at each clinic; these observations included all device models and manufacturers. The mean cumulative staff time required to review a remote device transmission and an in-person clinic visit were calculated, including all necessary clinical and administrative tasks. The annual staff time to manage a patient with a CIED was modeled using CIED transmission volumes, clinical guidelines, and the published literature.
ResultsA total of 276 in-person clinic visits and 2173 remote monitoring activities were observed. Mean staff time required per remote transmission ranged from 9.4 to 13.5 minutes for therapeutic devices (pacemaker, implantable cardioverter-defibrillator, and cardiac resynchronization therapy) and from 11.3 to 12.9 minutes for diagnostic devices such as insertable cardiac monitors (ICMs). Mean staff time per in-person visit ranged from 37.8 to 51.0 and from 39.9 to 45.8 minutes for therapeutic devices and ICMs, respectively. Including all remote and in-person follow-ups, the estimated annual time to manage a patient with a CIED ranged from 1.6 to 2.4 hours for therapeutic devices and from 7.7 to 9.3 hours for ICMs.
ConclusionsThe CIED patient management workflow is complex and requires significant staff time. Understanding process steps and time requirements informs the implementation of efficiency improvements, including remote solutions. Future research should examine heterogeneity in patient management processes to identify the most efficient workflow.
|
| first_indexed | 2024-03-12T13:01:36Z |
| format | Article |
| id | doaj.art-976c774682844fa89ba70ec0d63594ca |
| institution | Directory Open Access Journal |
| issn | 2561-1011 |
| language | English |
| last_indexed | 2024-03-12T13:01:36Z |
| publishDate | 2021-10-01 |
| publisher | JMIR Publications |
| record_format | Article |
| series | JMIR Cardio |
| spelling | doaj.art-976c774682844fa89ba70ec0d63594ca2023-08-28T19:32:02ZengJMIR PublicationsJMIR Cardio2561-10112021-10-0152e2772010.2196/27720Clinic Time Required for Remote and In-Person Management of Patients With Cardiac Devices: Time and Motion Workflow EvaluationAmber Seilerhttps://orcid.org/0000-0002-7137-2341Eliana Biundohttps://orcid.org/0000-0002-1207-6366Marco Di Baccohttps://orcid.org/0000-0002-7151-2148Sarah Rosemashttps://orcid.org/0000-0001-8864-2734Emmanuelle Nicollehttps://orcid.org/0000-0001-7357-5620David Lanctinhttps://orcid.org/0000-0002-1957-5459Juliette Hennionhttps://orcid.org/0000-0001-5914-4613Mirko de Melishttps://orcid.org/0000-0002-9223-4183Laura Van Heelhttps://orcid.org/0000-0003-4583-5135 BackgroundThe number of patients with cardiac implantable electronic device (CIED) is increasing, creating a substantial workload for device clinics. ObjectiveThis study aims to characterize the workflow and quantify clinic staff time requirements for managing patients with CIEDs. MethodsA time and motion workflow evaluation was performed in 11 US and European CIEDs clinics. Workflow tasks were repeatedly timed during 1 business week of observation at each clinic; these observations included all device models and manufacturers. The mean cumulative staff time required to review a remote device transmission and an in-person clinic visit were calculated, including all necessary clinical and administrative tasks. The annual staff time to manage a patient with a CIED was modeled using CIED transmission volumes, clinical guidelines, and the published literature. ResultsA total of 276 in-person clinic visits and 2173 remote monitoring activities were observed. Mean staff time required per remote transmission ranged from 9.4 to 13.5 minutes for therapeutic devices (pacemaker, implantable cardioverter-defibrillator, and cardiac resynchronization therapy) and from 11.3 to 12.9 minutes for diagnostic devices such as insertable cardiac monitors (ICMs). Mean staff time per in-person visit ranged from 37.8 to 51.0 and from 39.9 to 45.8 minutes for therapeutic devices and ICMs, respectively. Including all remote and in-person follow-ups, the estimated annual time to manage a patient with a CIED ranged from 1.6 to 2.4 hours for therapeutic devices and from 7.7 to 9.3 hours for ICMs. ConclusionsThe CIED patient management workflow is complex and requires significant staff time. Understanding process steps and time requirements informs the implementation of efficiency improvements, including remote solutions. Future research should examine heterogeneity in patient management processes to identify the most efficient workflow. https://cardio.jmir.org/2021/2/e27720 |
| spellingShingle | Amber Seiler Eliana Biundo Marco Di Bacco Sarah Rosemas Emmanuelle Nicolle David Lanctin Juliette Hennion Mirko de Melis Laura Van Heel Clinic Time Required for Remote and In-Person Management of Patients With Cardiac Devices: Time and Motion Workflow Evaluation JMIR Cardio |
| title | Clinic Time Required for Remote and In-Person Management of Patients With Cardiac Devices: Time and Motion Workflow Evaluation |
| title_full | Clinic Time Required for Remote and In-Person Management of Patients With Cardiac Devices: Time and Motion Workflow Evaluation |
| title_fullStr | Clinic Time Required for Remote and In-Person Management of Patients With Cardiac Devices: Time and Motion Workflow Evaluation |
| title_full_unstemmed | Clinic Time Required for Remote and In-Person Management of Patients With Cardiac Devices: Time and Motion Workflow Evaluation |
| title_short | Clinic Time Required for Remote and In-Person Management of Patients With Cardiac Devices: Time and Motion Workflow Evaluation |
| title_sort | clinic time required for remote and in person management of patients with cardiac devices time and motion workflow evaluation |
| url | https://cardio.jmir.org/2021/2/e27720 |
| work_keys_str_mv | AT amberseiler clinictimerequiredforremoteandinpersonmanagementofpatientswithcardiacdevicestimeandmotionworkflowevaluation AT elianabiundo clinictimerequiredforremoteandinpersonmanagementofpatientswithcardiacdevicestimeandmotionworkflowevaluation AT marcodibacco clinictimerequiredforremoteandinpersonmanagementofpatientswithcardiacdevicestimeandmotionworkflowevaluation AT sarahrosemas clinictimerequiredforremoteandinpersonmanagementofpatientswithcardiacdevicestimeandmotionworkflowevaluation AT emmanuellenicolle clinictimerequiredforremoteandinpersonmanagementofpatientswithcardiacdevicestimeandmotionworkflowevaluation AT davidlanctin clinictimerequiredforremoteandinpersonmanagementofpatientswithcardiacdevicestimeandmotionworkflowevaluation AT juliettehennion clinictimerequiredforremoteandinpersonmanagementofpatientswithcardiacdevicestimeandmotionworkflowevaluation AT mirkodemelis clinictimerequiredforremoteandinpersonmanagementofpatientswithcardiacdevicestimeandmotionworkflowevaluation AT lauravanheel clinictimerequiredforremoteandinpersonmanagementofpatientswithcardiacdevicestimeandmotionworkflowevaluation |