title: Experience with a "hotline" service for outpatients on a ventricular assist device.
abstract: OBJECTIVE
  With the growing number of outpatients on ventricular assist devices (VADs), there is an increasing need for "home discharge programs." One important feature is a 24-hour telephone service. In our center, the perfusionists run a so-called "hotline" for all of our VAD patients. This study analyzes the hotline calls with regard to frequency, the reason for calling, and the type of action undertaken.
  
  
  METHODS
  Over a period of 5 years, 16 (12 EXCOR and 4 INCOR; Berlin Heart, Berlin, Germany) of 33 VAD patients (48%) were discharged and instructed to use the "hotline" service. All the calls received by the perfusionists were reviewed. We classified the calls into three levels according to the severity of the problem: Level (L) 1 = assistance provided by the perfusionist alone; L2 = calls requiring discussion with the surgeon on duty and/or visit to the outpatient clinic ahead of time; and L3 = immediate action and/or admission to the hospital.
  
  
  RESULTS
  Over a period of 2,890 outpatient days (7.9 years), a total of 26 calls were registered. There were 0.9 calls per 100 patient days and 1.6 calls per discharged patient. Out of the 26 calls, 14 calls (54%) were classified as L1, 8 (31%) as L2, and 4 (15%) as L3. The most frequent reasons for L1 or L2 calls were fibrin deposits in the EXCOR pump chamber (39%), followed by battery dysfunction (19%). L3 calls were related to dysfunction of the EXCOR driving units in three cases and to an EXCOR pump chamber disconnection, which the patient did not survive.
  
  
  CONCLUSIONS
  The institution of a hotline is an essential component of a VAD outpatient program. It provides a certain level of safety for the patient, although a residual risk remains.
authors.affiliation: Department of Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland.
authors.forename: Hector Rodriguez Cetina
authors.initials: HR
authors.lastname: Biefer
authors.affiliation: Department of Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland.
authors.forename: Simon Harald
authors.initials: SH
authors.lastname: Sündermann
authors.affiliation: Department of Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland.
authors.forename: Maximilian Yosri
authors.initials: MY
authors.lastname: Emmert
authors.affiliation: Department of Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland.
authors.forename: Peter
authors.initials: P
authors.lastname: Hasenclever
authors.affiliation: Department of Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland.
authors.forename: Mario Louis
authors.initials: ML
authors.lastname: Lachat
authors.affiliation: Department of Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland.
authors.forename: Volkmar
authors.initials: V
authors.lastname: Falk
authors.affiliation: Department of Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland.
authors.forename: Markus Johannes
authors.initials: MJ
authors.lastname: Wilhelm
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data; D005260:Female; D006333:Heart Failure / Q000601:surgery / Q000628:therapy*; D006353:Heart-Assist Devices / Q000706:statistics & numerical data; D015277:Hotlines / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies