Practical Management of the Remote Device Clinic
Introduction
Introduction
Key Points
- Remote monitoring (RM) improves morbidity and mortality in the management of patients with cardiovascular implantable electronic devices (CIEDs).
- The number of CIEDs implanted on an annual basis has grown to approximately 1.7 million worldwide.
- This expert consensus statement provides evidence-based recommendations for all aspects of RM services.
Take-Home Messages
- For patients with CIEDs, RM is the standard of care.
- Prompt patient enrollment and maintenance of regular connectivity with long-term adherence to RM accomplished by individualized patient and caregiver education is essential to an effective RM program.
- Adequate staffing using both clinical and nonclinical personnel with appropriate patient-to-staff ratios and dedicated time to perform defined roles and responsibilities are essential for managing RM clinic workflows.
- Clinical staff in the RM clinic should be appropriately educated and/or certified and participate in ongoing quality assurance and improvement programs.
- Programming alerts specific to device type and indication with established mechanisms for promptly dealing with high-priority alerts can moderate increasing data volume and workload for RM programs.
- Communicating RM device results with patients, their health care providers, and the patient electronic medical record in a secure and confidential manner should be accomplished according to individual device clinic workflows.
- A relationship between RM clinics and device manufacturers for bidirectional exchange of ideas for staff training, patient education, patient care services, and management of safety advisories and recalls is imperative.
- Use of third-party resources may offer financial and practical benefits for dealing with increased device clinic volume.
- Pediatric patients with CIEDs on RM require scheduling similar to that for RM of adult patients but may have special needs requiring additional considerations.
- s) require immediate connectivity to RM with special programming needs based on the patient’s clinical indication for the ILR.
- Alert-based RM that relies on continuous connectivity allowing for extended time intervals between in-office device interrogations.
General Concepts
...eneral Concept...
...able 1. Definitions Programmer - A m...
...consideratio...
...h CIEDs, RM is recommended as part of t...
...patients with CIEDs on RM, routine surveillance o...
In patients with CIEDs on RM with a device capabl...
.../reimbursement models...
...patients with CIEDs on RM, it is recommen...
Administrative and Nonclinical Staff
...inistrative and Nonclinical Staf...
...tient enrollment techniques
...ents with an ILR, enrollment in an RM program is...
...with a CIED, it can be beneficial t...
...aging and updating manufacturer...
...r the care of patients with CIEDs on RM who...
...optimize patient connectivity...
...the care of patients with CIEDs on RM who los...
Staffing of Remote Monitoring Clinics
...ng of Remote Monitoring Clinics...
...requirements for RM...
...he care of patients with CIEDs on RM, a t...
...e of patients with CIEDs on RM, it is recommende...
...the care of patients with CIEDs on RM, it is reco...
...patients with CIEDs on RM, it is reasona...
...f credentialing and qualifications for RM
For the care of patients with CIEDs on RM, i...
...or the care of patients with CIEDs on RM, it is re...
...Staffing Challenges With Remote Monitoring...
...re 2. 2015 HRS Expert Consensus Statement on RM...
Technical Considerations in Remote Monitoring
...ical Considerations in Remote Monitoring...
...Example of a Timeline for Patients With C...
Devices with nonconti...
...h CIEDs on RM in the absence of continuous con...
...s with CIEDs on RM in the absence of continuous c...
...e-based RM...
...atients with CIEDs in centers without onsite d...
...ents with CIEDs in centers with onsit...
...re 4. Traditional Personal 1:1 vs Site-based...
...strative Example of Unscheduled CIED Inte...
Alert-based Remote Monitoring
...ased Remote Monitoring...
Alert-base...
...with CIEDs and a component with a safety advisor...
...pacemakers (PMs) on RM with consis...
...ith ICDs on RM with consistent and continuous...
Programming Considerations for Optimal Remote Monitoring
Programming Considerations for Optimal Remote Moni...
...cturer and device-specific knowled...
...he care of patients with CIEDs on RM, it i...
...Monitoring System Differences Between Manufactu...
.... Alert Recommendations by Device TypeCo...
...for clinical indications with different t...
...ents with CIEDs on RM, it is recommended that...
...n patients with ICDs on RM, it is r...
...th CIEDs on RM, it is reasonable to remotely mon...
...tients with CIEDs on RM with CRT, it is...
...ith CIEDs on RM with atrial arrhyth...
...nts with ICDs on RM, it is reasonable...
...he care of patients with CIEDs on RM, it is re...
...al programming considerations for ILRs...
...ith ILRs on RM, it is recommended that clinic...
...with ILRs on RM, it is recommended that programme...
...patients with ILRs on RM and frequent un...
...tients with ILRs on RM for unexpla...
...ILRs on RM for cryptogenic stroke, it i...
...patients with ILRs on RM with consistent connecti...
Managing Alerts
...anaging Alerts
...ed and Yellow Alerts for PMs and ICDs a Multipl...
...ining high-priority alerts...
...ents with CIEDs on RM, it is recommended that fo...
...siderations to minimize inappropriate alerts...
...n patients with CIEDs on RM from wh...
...or the care of patients with CIEDs on RM, it is...
...ote Monitoring Alerts That Should Be Considered â...
...meline recommendations for alert management...
...re of patients with CIEDs on RM, it is rec...
...mizing Alerts for Nonactionable Events...