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
...eral Concepts...
.... Definitions Programmer - A manu...
...considerations...
...ents with CIEDs, RM is recommended as p...
...with CIEDs on RM, routine surveillance of lead fun...
...nts with CIEDs on RM with a device c...
...yment/reimbursement m...
...re of patients with CIEDs on RM, it is recomm...
Administrative and Nonclinical Staff
...ative and Nonclinical Staff...
...ent enrollment techn...
...patients with an ILR, enrollment in an...
...atients with a CIED, it can be beneficia...
Managing and updating manufacturer w...
...care of patients with CIEDs on RM who undergo de...
...ques to optimize patient connectiv...
...care of patients with CIEDs on RM who lo...
Staffing of Remote Monitoring Clinics
...ffing of Remote Monitoring Clinic...
...ing requirements for...
...e of patients with CIEDs on RM, a te...
...of patients with CIEDs on RM, it is...
For the care of patients with CIEDs o...
...of patients with CIEDs on RM, it is reasonable fo...
Staff credentialing and qualificat...
...or the care of patients with CIEDs...
...of patients with CIEDs on RM, it is recommended...
...1. Staffing Challenges With Remote Mo...
...015 HRS Expert Consensus Statement on RM vs...
Technical Considerations in Remote Monitoring
...hnical Considerations in Remote Moni...
...ample of a Timeline for Patients With CIEDs o...
...vices with noncontinuou...
...tients with CIEDs on RM in the absence of co...
In patients with CIEDs on RM in the absence of c...
...ite-based...
...ients with CIEDs in centers without onsite device...
For patients with CIEDs in centers with o...
...ional Personal 1:1 vs Site-based RM With...
...igure 5. Illustrative Example of Unscheduled...
Alert-based Remote Monitoring
...sed Remote Monitoring...
Alert-based R...
...CIEDs and a component with a safety advisory,...
...nts with pacemakers (PMs) on RM with...
...ICDs on RM with consistent and continuous con...
Programming Considerations for Optimal Remote Monitoring
Programming Considerations for Optimal R...
...anufacturer and device-specif...
...e of patients with CIEDs on RM, it is recom...
...Monitoring System Differences Between Ma...
...Alert Recommendations by Device TypeColors co...
...or clinical indications with different ty...
...nts with CIEDs on RM, it is recommended th...
...h ICDs on RM, it is recommended that the ICD...
In patients with CIEDs on RM, it is...
...s with CIEDs on RM with CRT, it is rea...
...h CIEDs on RM with atrial arrhythmia monitori...
In patients with ICDs on RM, it is reasonable...
...e care of patients with CIEDs on RM,...
...ramming considerations for ILRs...
...with ILRs on RM, it is recommended...
In patients with ILRs on RM, it is recommended th...
...n patients with ILRs on RM and frequent un...
In patients with ILRs on RM for unexplained synco...
...ents with ILRs on RM for cryptogenic stroke, it...
In patients with ILRs on RM with consisten...
Managing Alerts
Managing A...
Figure 7. Red and Yellow Alerts for PMs an...
Defining high-priority alerts
...atients with CIEDs on RM, it is recommende...
...amming considerations to minimize inappropriate...
...with CIEDs on RM from whom sufficient cl...
...of patients with CIEDs on RM, it is reason...
...Remote Monitoring Alerts That Should Be Co...
...meline recommendations for alert mana...
...of patients with CIEDs on RM, it is recommen...
...9. Minimizing Alerts for Nonactionable Events...