title: Manpower and outpatient clinic workload for remote monitoring of patients with cardiac implantable electronic devices: data from the HomeGuide Registry.
abstract: BACKGROUND
  This study aimed to assess manpower and resource consumption of the HomeGuide workflow model for remote monitoring (Biotronik Home Monitoring [HM], Biotronik SE & Co. KG, Berlin, Germany) of cardiac implantable electronic devices in daily clinical practice.
  
  
  METHODS
  The model established a cooperative interaction between a reference nurse (RN) for ordinary management, and a responsible physician (RP) for medical decisions in each outpatient clinic. RN reviewed remote transmissions and alerts, addressing critical cases to the RP.
  
  
  RESULTS
  A total of 1,650 patients were enrolled in 75 sites: 25% pacemakers (PM), 22% dual-, 27% single-chamber implantable defibrillators (ICD), 2% PM with cardiac resynchronization therapy (CRT), and 24% ICD-CRT. During a median follow-up of 18 (10-31) months, 3,364 HM sessions were performed (74% by the RN, 26% by the RP) to complete 18,478 remote follow-ups. Median duration of remote follow-ups was 1.2 (0.6-2.0) minutes, corresponding to a manpower of 43.3 (4.2-94.8) minutes/month every 100 patients for nurses and 10.2 (0.1-31.1) for physicians (P < 0.0001). RN submitted 15% of remote transmissions to RP, who decided unscheduled follow-ups in 12% of the cases. The median manpower for phone calls was 1.9 (0.8-16.5) minutes/month every 100 contacted patients. There were 2.84 in-hospital visits/patient, 0.46 of which triggered by HM findings. A cumulative per-patient HM follow-up time of 15.4 minutes (20% of total follow-up time) allowed remote detection of 73% of actionable events.
  
  
  CONCLUSIONS
  HM implemented in the HomeGuide workflow model required <1 hour/month every 100 patients to detect the majority of actionable events with limited administrative workload.
authors: San Filippo Neri Hospital, Rome, Italy.
authors: Renato Pietro
authors: RP
authors: Ricci
authors: Loredana
authors: L
authors: Morichelli
authors: Antonio
authors: A
authors: D'Onofrio
authors: Leonardo
authors: L
authors: Calò
authors: Diego
authors: D
authors: Vaccari
authors: Gabriele
authors: G
authors: Zanotto
authors: Antonio
authors: A
authors: Curnis
authors: Gianfranco
authors: G
authors: Buja
authors: Nicola
authors: N
authors: Rovai
authors: Alessio
authors: A
authors: Gargaro
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities / Q000639:trends; D016208:Databases, Factual / Q000639:trends; D017147:Defibrillators, Implantable / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006280:Health Workforce / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory / Q000295:instrumentation / Q000379:methods* / Q000639:trends; D012042:Registries; D058998:Remote Sensing Technology / Q000295:instrumentation / Q000379:methods / Q000639:trends; D016526:Workload
keywords: implantable cardioverter-defibrillators; manpower; pacemakers; remote monitoring; resource consumption; telemedicine