Authors (including presenting author) :
Leung YW (1,2), Kwan KY (2), Leung CY (1), Wong J (1), Yue CS (2)
Affiliation :
(1) Division of Cardiology, Tseung Kwan O Hospital, KEC
(2) Division of Cardiology, United Christian Hospital, KEC
Introduction :
Cardiovascular Implantable Electronic Devices (CIED) are effective treatments for cardiac arrhythmias and the needs are still expanding for aging also advancing technology. Nevertheless, the nature of indefinite CIED follow-up overloaded cardiac clinic with populations increased 25% within only 5 years in Tseung Kwan O Hospital (TKOH).
Objectives :
This is an evaluation on the outcomes of PACED (Patient-centered And Cardiac-nursing Engaged Device-services) in terms of quantity (service utilizations) and quality (complications and satisfaction) from data collected in 2022.
Methodology :
PACED is a pilot integrated model initiated in Kowloon East Cluster (KEC) to cater the expanding CIED populations, providing long-term CIED follow-up in TKOH from 2021 by trained specialty nurse; and developed more comprehensively in United Christian Hospital (UCH) since 2013 including pre-operative and ambulatory care support; early post-implantation wound care; patient empowerment; complications monitoring, also screening to enhance safety prior to MRI and peri-operative for their proliferating needs.
Result & Outcome :
PACED in KEC has provided independent nursing services to 350 patients with over 800 clinic attendance intermittently with doctor clinic. It alleviated doctor workload in CIED clinic for 1/3 in TKOH and almost half during early phase in UCH, and has possibly shortened other cardiac clinic waiting time in a consequence. It also provided ~50 screening and enquiries prior to MRI or peri-operative to enhance CIED patient safety and smoother the logistics to reduce related in-advance admission.
Besides independent wound care to over 200 post-implantation cases, PACED has further detected 26 complications for early physician’s management and avoided AED attendance in a consequence, for example: lead-displacement; new arrhythmia for early stroke prevention or symptoms for rate-control, etc.
Patients and their caregivers are highly appreciated and overall rated 3.93/4 for this service. Their concerns pre-operatively have been well addressed and being empowered on post-operative self-care by trained nurses. The average queuing time has been greatly reduced 90-minutes for each cases, and avoided over-crowded in clinic waiting area particularly important during prolonged pandemic.
PACED is a workable and possibly sustainable model for the accumulating CIED populations and indefinite service needs. We are planning to further widen the coverage and promulgate the model to other HA hospitals with similar needs. Coordination from central with supports in terms of model recognition, resources and training are all essential to achieve and sustain.
