Authors: (including presenting author): :
Leung YW(1), Chu KL(2), Yue CS(1), Kwan KY(1)
Affiliation: :
(1) Division of Cardiology, United Christian Hospital (2) Department of Anesthesia, United Christian Hospital
Introduction: :
Cardiac Implantable Electronic Devices (CIED) are effective treatments for cardiac arrhythmias, though may be triggered by electro-magnetic interference (EMI) during operation which may lead to inadvertent inhibition of pacemaker or even trigger life-threatening defibrillation inappropriately. According to CDARS data, there are 1800 CIED patients cumulatively in United Christian Hospital (UCH) and around 150 operations requiring assessment for peri-operative CIED reprograming annually. The demand is still expanding due to aging and technology advancement exposing more patients with sophisticate CIED program presenting for surgery.
Objectives: :
To improve patient safety through provision of guidance to anesthesiologists, surgeons, physicians and nurses in the management of patients with CIEDs undergoing surgery/interventions.
To reduce ad-hoc consultation, enhance communication among teams and avoid unnecessary delay in operations.
Methodology: :
Department of Anaesthesia and Division of Cardiology in UCH have started collaboration since 2018 to safeguard the expanding needs on peri-operative CIED care. We have followed the “plan, do, check, act” cycle on this project management.
Plan: Team formation in 2018, members including doctors and nurses from both Departments of Anesthesia and Division of Cardiology, and major stakeholders like surgeons and operation theatre staff.
Do: Our team has started from prevalence survey for gap analysis; accomplished literature reviews and modified international guidelines into local practice. Established workflow on “pre-ordered” CIED reprogram settings, followed by promulgation through different committees and knowledge sharing platforms.
Check: Reviewed the outcomes by consolidating data in 2019-2023; and collected feedback from major users and stakeholders.
Act: Revised the guideline based on feedback received and latest international guidelines. We are now planning for further re-promulgation and upgrading into cluster-based guideline to benefit more patients.
Result & Outcome: :
Over the last 5 years (2019-2023), PACE-SAFE has successfully reduced ~70% cardiac doctor consultation for peri-op reprogramming and minimized unnecessary delay for operation. Furthermore, PACE-SAFE also saved hospital bed days as patients could be admitted on day of operation by the pre-ordered reprogram settings (and avoid as 1st case) instead of being admitted one day before operation for peri-op consultation and prior-reprogramming. Furthermore, it ensured patient safety and attained high satisfaction from anesthesia and surgery teams without any adverse events since implementation. However, it requires cardiac nurse consultation for support (10-15/year) and enquiries (30-50/year, e.g. type of CIED, potential EMI and referring logistic). As PACED (Patient-centered And Cardiac-nursing Engaged Device) service and nurse clinic have been well established over 10 years, we plan to further promulgate these services at cluster level.
