Patient satisfaction, safety and efficacy of nurse-led compared to physician-led implantation of cardiac monitors

Barbara Steinhauer; Sophie Dütschler; Jasmin Spicher; Sarah Aerschmann; Nicole Ambord; Joanna Bartkowiak; Serlha Tawo; Gregor Thalmann; Helge Servatius; Fabian Noti; Jens Seiler; Samuel Baldinger; Andreas Haeberlin; Antonio Madaffari; Hildegard Tanner; Tobias Reichlin; Laurent Roten

doi:10.1093/eurjcn/zvad103

Patient satisfaction, safety and efficacy of nurse-led compared to physician-led implantation of cardiac monitors

Eur J Cardiovasc Nurs. 2023 Oct 18:zvad103. doi: 10.1093/eurjcn/zvad103. Online ahead of print.

Authors

Barbara Steinhauer¹, Sophie Dütschler¹, Jasmin Spicher¹, Sarah Aerschmann¹, Nicole Ambord¹, Joanna Bartkowiak¹, Serlha Tawo¹, Gregor Thalmann¹, Helge Servatius¹, Fabian Noti¹, Jens Seiler¹, Samuel Baldinger¹, Andreas Haeberlin^{1

2}, Antonio Madaffari¹, Hildegard Tanner¹, Tobias Reichlin¹, Laurent Roten¹

Affiliations

¹ Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
² Sitem Center for Translational Medicine and Biomedical Entrepreneurship, University of Bern, Switzerland.

PMID: 37851866
DOI: 10.1093/eurjcn/zvad103

Abstract

Aims: Implantation of an implantable cardiac monitor (ICM) is a simple procedure, but adds significant and increasing workload to the arrhythmia service. In 2020, we established a nurse-led ICM implantation service. We aimed to analyze patient satisfaction, adverse events during implant and ICM re-interventions with nurse-led ICM implantation (N-Implant) compared to physician-led ICM implantation (P-Implant).

Method and results: From January 2020 to December 2021 we included all consecutive patients implanted with an ICM in a prospective registry. We collected data on patient characteristics, implant procedure and follow-up. Patients were interviewed by phone four weeks after ICM implantation.Of 321 patients implanted with an ICM (median age 67 years; 33% women), 189 (59%) were N-Implants. More N-Implants were performed in the outpatient clinic compared to P-Implants (95% vs. 8%; p<0.001). Two N-Implant patients experienced vaso-vagal reaction during implantation (1%), whereas no adverse events occurred during P-Implant (p=0.51). 297 patients (93%) completed the questionnaire. Duration of pain was shorter and wound closure after 2 weeks better following N-Implant (p=0.019 and p=0.018). A minor bruise or swelling at the implant site was reported more frequently after N-Implant (p=0.003 and p=0.041). Patient satisfaction was excellent with both N-Implant and P-Implant (99% and 97%; p=0.16). After a median follow-up of 242 days (range 7-725 days), five ICMs (2%) were explanted prematurely, without differences among groups. Reasons for premature explants were local discomfort (n=2), infection, MRI and ICM malfunction.

Conclusion: Nurse-led ICM implantation has excellent patient satisfaction without compromising safety. N-Implant both expands nursing competencies and reduces physician workload.

Keywords: Nurse; adverse events; efficacy; implantable cardiac monitor; outpatient; patient satisfaction; safety.