Clinic time required to manage cardiac implantable electronic device patients: a time and motion workflow evaluation

Abstract Background The population with cardiac implantable electronic devices (CIEDs) is growing, creating workload for device clinics to manage these patients. However, the CIED follow-up workflow is poorly understood. This study sought to characterize the workflow and staff time for CIED patient management. Methods A time and motion workflow evaluation was performed in 6 U.S. CIED clinics, which manage an average of 4,217 patients. Each task involved in CIED management was repeatedly timed, including all manufacturers, during 1 business week at each clinic. Mean staff time for a remote transmission and an in-person visit were calculated, including all clinical and administrative (e.g: scheduling, documentation) activities related to the encounter. Annual staff time for follow-up of 1 patient was modeled using CIED transmission data for the 6 clinics, guidelines for CIED follow-up, and published literature. Results 124 clinic visits and 1,374 remote monitoring activities were observed. Staff time required per remote transmission ranged from 12.1–13.4 minutes (depending on the CIED type), and time per visit was 43.4–51.0 minutes. Including all remote and in-person follow-ups, the estimated total staff time per year to manage one pacemaker, ICD, CRT, and ICM patient was 2.3, 2.4, 2.4, and 9.3 hours, respectively (Table 1). Conclusion CIED clinic workflow is complex and requires significant staff time. Remote monitoring is an efficient complement to in-office visits, allowing for continuous follow-up of patients. Future research should examine heterogeneity in clinic processes to identify the most efficient workflow. Estimated Annual Staff Time Workflow Activity Pacemaker ICD CRT ICM Remote transmissions: Staff time per average transmissions (mins) 13.4 12.1 12.2 12.9 Staff time per non-actionable transmission (mins) 11.8 10.5 10.7 11.7 Staff time per actionable transmission (mins) 17.8 16.7 16.3 15.9 Number of transmissions per year 3.7 4.6 5.1 38.9 Annual staff time for remote transmissions per patient (hrs) 0.8 0.9 1.2 8.3 In-person clinic visits: Patient in-clinic time per visit (mins)* 36.5 35.4 23.5 24.1 Staff time per visit (mins)** 50.1 51.0 43.4 45.8 Number of visits per year 1.8 1.7 1.7 1.3 Annual staff time for clinic visits per patient (hrs) 1.5 1.4 1.2 1.0 Total annual per patient staff time (hrs) 2.3 2.4 2.4 9.3 Abbreviations: CRT, cardiac resynchronization therapy; ICD, implantable cardioverter-defibrillator; ICM, insertable cardiac