69 A Physiologist Led Loop Recorder Implantation Service in an Ambulatory Setting

Abstract

Our tertiary cardiac centre has developed a new ambulatory service for injectable loop recorder insertion based in a treatment room. Previously loop recorders were implanted in a dedicated pacing theatre by a consultant led team. The patient was kept nil by mouth prior to the procedure and were dressed in a theatre gown. The wound from the device was around 4 cm and was closed with sutures. The typical time in theatre was around 30 min. Patients were then observed for 2 h post procedure prior to discharge. A new injectable reveal device became available with reduced surgical trauma and scarring. We subsequently developed a new service run by senior cardiac physiologists without the need for medical staff to be present. The physiologists were initially trained in obtaining consent, surgical skills and device implantation. They were then supervised for the first 20 implants before continuing independently. We looked retrospectively at the first 100 cases. The service was run from a treatment room on a day ward and was entirely ambulatory. Oral antibiotics and local anaesthetic were prescribed by a doctor prior to the implant. The average case time was less than 10 min. Patients did not require fasting and were able to have the implant done in their own clothes. The wound is less than one cm and is closed with a surgical glue without the need for sutures. The patients were educated on use of the device and then discharged post procedure. The waiting time for the physiologist led service is significantly reduced with cases generally being done in under 2 weeks. Previously the waiting time for a consultant to implant a loop recorder was around 2 months. The adverse event rate is favourable with no implant site infections and 2 erosions. There have been no major adverse effects. The new service had freed up a considerable amount of theatre space and consultant time allowing a more efficient pacing service. The patient experience has been improved with a shorter time in hospital. The new device is more expensive than the previous loop recorder but the cost has been offset by the reduced staffing requirements and need for less equipment. We have demonstrated that implanting by non medical staff is safe, efficient and cost effective.