Safety and efficiency of emergency department interrogation of cardiac devices

Abstract

ObjectivePatients with implanted cardiac devices may wait extended periods for interrogation in emergency departments (EDs). Our purpose was to determine if device interrogation could be done safely and faster by ED staff.MethodsProspective randomized, standard therapy controlled, trial of ED staff device interrogation vs. standard process (SP), with 30-day follow-up. Eligibility criteria: ED presentation with a self-report of a potential device related complaint, with signed informed consent. SP interrogation was by company representative or hospital employee.ResultsOf 60 patients, 42 (70%) were male, all were white, with a median (interquartile range) age of 71 (64 to 82) years. No patient was lost to follow up. Of all patients, 32 (53%) were enrolled during business hours. The overall median (interquartile range) ED vs. SP time to interrogation was 98.5 (40 to 260) vs. 166.5 (64 to 412) minutes (P=0.013). While ED and SP interrogation times were similar during business hours, 102 (59 to 138) vs. 105 (64 to 172) minutes (P=0.62), ED interrogation times were shorter vs. SP during non-business hours; 97 (60 to 126) vs. 225 (144 to 412) minutes, P=0.002, respectively. There was no difference in ED length of stay between the ED and SP interrogation, 249 (153 to 390) vs. 246 (143 to 333) minutes (P=0.71), regardless of time of presentation. No patient in any cohort suffered an unplanned medical contact or post-discharge adverse device related event.ConclusionED staff cardiac device interrogations are faster, and with similar 30-day outcomes, as compared to SP.

Utilization of a Read‐only Pacemaker and Defibrillator Interrogator in the Emergency Department and Hospital

“…Earlier studies have demonstrated that CIED interrogation results in a low (~10%) rate of reprogramming 2,3. ED disposition is frequently delayed because of questions surrounding CIED functionality 4. The current accepted practice for CIED evaluation is to have the device interrogated by an IBHRE‐certified professional, often a company representative.…”

“…The current accepted practice for CIED evaluation is to have the device interrogated by an IBHRE‐certified professional, often a company representative. Because these representatives can be based hours away from hospitals, requesting their services can result in substantial delays in care 4. In addition, inpatient physicians are wary to admit patients whose devices may require immediate intervention and also resist “admissions for interrogation” because these often require no action.…”

“…2,3 ED disposition is frequently delayed because of questions surrounding CIED functionality. 4 The current accepted practice for CIED evaluation is to have the device interrogated by an IBHRE-certified professional, often a company representative. Because these representatives can be based hours away from hospitals, requesting their services can result in substantial delays in care.…”

“…Because these representatives can be based hours away from hospitals, requesting their services can result in substantial delays in care. 4 In addition, inpatient physicians are wary to admit patients whose devices may require immediate intervention and also resist "admissions for interrogation" because these often require no action. Thus, we performed a retrospective chart review to determine the rate at which interrogation of pacemakers and defibrillators identified a need for immediate device reprogramming.…”

“…Alternatively, any provider can safely utilize read-only interrogators after minimal training, and their use significantly decreases delays in care. 4,7 Our review adds to the current literature because it was conducted in a community hospital system with limited access to professionals trained to use CIED programmers outside of business hours or on holidays and weekends. If interrogations are required outside of business hours or on holidays and weekends, CIED company representatives may take several hours to arrive.…”