Implantable cardiac monitors (ICM): quality assurance audit outcomes of an innovative specialist nurse led service

Background/Objective: A Cardiac Rhythm Management (CRM) nurse-led service was developed in 2015 utilising Medtronic Reveal LINQ ICM devices and advanced remote monitoring technology. Advances in technology have allowed for implantation in a procedure room by CRM specialist nurses. Following implant, all patients received remote monitoring equipment and access to a nurse-led telephone helpline. Daily assessment, management of patient transmissions and follow-up care by scheduled telephone appointments were coordinated by the CRM nurse team. Outcomes were compared from the nurse-led service versus traditional pathway over the preceding 5 years.

Results: Over a 12-month period 125 ICMs were implanted. Referral to ICM implant reduced from 49 to 35 days. Implant to definitive diagnosis reduced from 270 to 56 days. The conversion rate from ICM to PPM was 20/125 (16%); 50% AV node disease; 50% sino-atrial node disease. Catheter laboratory time saved: 94 hours.

Appointment time was reduced from 4 hours to 1 hour. No complications occurred. Audit of patient experience demonstrated high levels of satisfaction with the nurse-led service.

Conclusion: The development of a CRM nurse-led ICM service with use of remote monitoring have resulted in significant reductions in referral to ICM implant time; ICM implant to diagnosis times; a higher than average diagnostic yield for pacing indication and high levels of patient satisfaction. Performing ICM implants in a procedure room has resulted in cost reduction, improved utilisation of catheter laboratory slots and consultant time for more complex procedures. This model is a viable cost effective option for all stakeholders.