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Original article
Improvement in patient and physician notification of cardiac rhythm device report transmissions
  1. Richard J Czosek,
  2. James Brown,
  3. Diane Proctor,
  4. Paula Koch,
  5. Michelle Martin,
  6. Mary Rust,
  7. Jeffrey B Anderson
  1. Department of Pediatric Cardiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
  1. Correspondence to Dr Richard J Czosek; richard.czosek{at}cchmc.org

Abstract

Background Cardiac rhythm devices (CRD) require complex management to identify potential device or patient issues. While easy to obtain, report processing is complex and time consuming. In our population, a majority of reports were performed outside of institutional protocols and no method for electrophysiology (EP) notification for unscheduled reports existed. These process breakdowns led to potential issues with safety and associated loss of work efficiency.

Objective Our aim was to decrease the percentage of reports without EP notification from 30% to 10% over a 9-month time period.

Methods We created a detailed process map of in-office and home device reporting. Failure mode and effects analysis (FMEA)/Pareto charts were used to determine the mechanistic underpinnings of notification failures and identify areas for process improvement. Multiple interventions were implemented using the Plan-Do-Study-Act (PDSA) technique. Process run charts and control charts were used to evaluate ongoing changes.

Results Our FMEA identified failures related to (1) lack of physician understanding of the device reporting system, (2) lack of an easy to use method of EP notification and (3) lack of patient understanding of report notification. Pareto charts identified the most frequent failures to be associated with specific cardiology subspecialties as well as reports sent from home. We performed multiple interventions including(1) creation of an easy to use method of EP notification used by patients and medical staff, (2) physician education and (3) patient education. Compared with baseline reporting, there was a decrease from 30% to <10% of device reports obtained without EP notification. This process improvement additionally resulted in a 34% reduction in time required for device processing.

Conclusions Development of a unified EP reporting system and quality improvement methodology resulted in improved CRD report notification and improved efficiency for staff. These process changes resulted in improvement across differing cardiac subspecialty providers and patients.

  • control charts/run charts
  • continuous quality improvement
  • healthcare quality improvement
  • pdsa
  • quality improvement

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjoq-2017-000155

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    Footnotes

    • Contributors All authors directly contributed to significant aspects of study design, implementation, statistical analysis and manuscript creation/revision.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Data sharing not available.