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
General Concepts
...ions Programmer - A manufacturer-specific d...
...onsiderations...
...with CIEDs, RM is recommended as part of the s...
...ith CIEDs on RM, routine surveillance...
...th CIEDs on RM with a device capab...
RM payment/reimbursement mo...
...patients with CIEDs on RM, it is reco...
Administrative and Nonclinical Staff
Administrative and Nonclinical Sta...
...tient enrollment techniq...
...th an ILR, enrollment in an RM program is rec...
...with a CIED, it can be beneficial to init...
...updating manufacturer websites...
...re of patients with CIEDs on RM who undergo d...
...ues to optimize patient connectivity...
For the care of patients with CIEDs on RM who l...
Staffing of Remote Monitoring Clinics
...fing of Remote Monitoring Clinic...
...taffing requirements for RM...
...he care of patients with CIEDs on RM, a team-b...
...the care of patients with CIEDs on RM, i...
...re of patients with CIEDs on RM, it is rec...
...or the care of patients with CIEDs on RM, i...
...ialing and qualifications for RM...
...e care of patients with CIEDs on RM, it...
...patients with CIEDs on RM, it is recommended tha...
...taffing Challenges With Remote Monit...
...15 HRS Expert Consensus Statement on R...
Technical Considerations in Remote Monitoring
...al Considerations in Remote Monitoring...
...3. Example of a Timeline for Patients With CIEDs...
...vices with noncontinuou...
...ts with CIEDs on RM in the absence of continuou...
...atients with CIEDs on RM in the absence of c...
...e-based RM
...ients with CIEDs in centers without onsi...
...patients with CIEDs in centers with on...
...gure 4. Traditional Personal 1:1 vs Site-based R...
...strative Example of Unscheduled CIED In...
Alert-based Remote Monitoring
...-based Remote Monitori...
...rt-based RM...
...patients with CIEDs and a component with...
...ts with pacemakers (PMs) on RM with consistent an...
In patients with ICDs on RM with consi...
Programming Considerations for Optimal Remote Monitoring
...ogramming Considerations for Optimal Remote...
...anufacturer and device-specific knowled...
...e of patients with CIEDs on RM, it...
...able 2. Remote Monitoring System Differen...
...Recommendations by Device TypeColors correspo...
...g for clinical indications with different t...
...CIEDs on RM, it is recommended that...
...patients with ICDs on RM, it is recommended that...
...s with CIEDs on RM, it is reasonable to remote...
...with CIEDs on RM with CRT, it is reasonabl...
...with CIEDs on RM with atrial arrhythmia monito...
...with ICDs on RM, it is reasonable that...
...r the care of patients with CIEDs on RM, i...
...ecial programming considerations...
...atients with ILRs on RM, it is recom...
...ith ILRs on RM, it is recommended that...
...ents with ILRs on RM and frequent undersensing an...
...n patients with ILRs on RM for unexp...
...ents with ILRs on RM for cryptogenic stroke, it is...
...ients with ILRs on RM with consistent c...
Managing Alerts
...anaging Al...
...Red and Yellow Alerts for PMs and ICDs a M...
...high-priority alerts...
...th CIEDs on RM, it is recommended tha...
...considerations to minimize inappro...
...ts with CIEDs on RM from whom sufficient cl...
...or the care of patients with CIEDs on RM,...
...re 8. Remote Monitoring Alerts That Should B...
...eline recommendations for alert...
...the care of patients with CIEDs on RM...
...igure 9. Minimizing Alerts for Non...