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A dedicated cardioversion unit for the treatment of atrial fibrillation. Reducing costs by optimizing processes
C Knackstedt1, M Becker, K Mischke
1Department of Cardiology, University Hospital Maastricht, Maastricht, The Netherlands.
Insights
Optimizing workflows for atrial fibrillation (AF) patients undergoing transesophageal echocardiography (TEE) and electrical cardioversion (ECV) significantly reduced procedure times and costs by over 50%. This streamlined approach enhances outpatient care efficiency.
Area of Science:
- Cardiology
- Medical Workflow Optimization
- Health Economics
Background:
- Atrial fibrillation (AF) is a prevalent cardiac arrhythmia requiring interventions like transesophageal echocardiography (TEE) for thrombus exclusion and electrical cardioversion (ECV) to restore sinus rhythm.
- Patients often undergo these procedures with hospital admission, impacting resource utilization and costs.
- This study focuses on optimizing the workflow for AF patients undergoing ECV in an outpatient setting.
Purpose of the Study:
- To prospectively evaluate the impact of workflow optimization on procedural time and costs for AF patients undergoing ECV.
- To assess the effectiveness of establishing a dedicated cardioversion unit (CU) for streamlining TEE and ECV procedures.
- To identify key factors contributing to time and cost reductions in outpatient AF management.
Main Methods:
- A dedicated cardioversion unit (CU) was established to centralize ECV-related procedures.
- Three settings were compared: usual care, optimized process 1 (TEE+ECV in one sedation), and optimized process 2 (TEE+ECV with point-of-care blood testing).
- Procedural time and all associated costs (material, human resources, infrastructure) were meticulously recorded and analyzed for 115 AF patients.
Main Results:
- Procedural time decreased significantly from 480±105 minutes in the usual care setting to 205±85 minutes in the optimized process 2 setting (p < 0.001).
- ECV-associated costs were substantially reduced from 683±104 € to 299±63 € (p < 0.001).
- The combined TEE and ECV in a single sedation, along with point-of-care testing within the CU, were identified as primary drivers of efficiency gains.
Conclusions:
- Establishing a specialized cardioversion unit (CU) can achieve over 50% reduction in procedural time and costs for AF patients.
- Integrating transesophageal echocardiography (TEE) and electrical cardioversion (ECV) under a single sedation event is a key optimization strategy.
- Point-of-care (POC) blood testing within the CU further contributes to significant time and cost savings, enhancing outpatient AF management.
Background:
Atrial fibrillation (AF) is the most frequent arrhythmia seen in man. Many patients are admitted to the hospital to undergo transesophageal echocardiography (TEE) for thrombus exclusion and subsequent electrical cardioversion (ECV) under deep sedation to restore sinus rhythm. The present study investigated prospectively how workflow optimization can contribute to reducing time and costs in AF patients scheduled for ECV in an outpatient setting.
Methods:
A cardioversion unit (CU) was established and equipped to perform all ECV-associated procedures. Between November 2007 and January 2009, ECV was performed in 115 patients in an outpatient setting. Three different settings were tested for ECV: (1) usual care (n = 19): preparation/follow-up in the outpatient clinic, blood testing in the central hospital laboratory (CHL), TEE in the echocardiography laboratory, and ECV in the intensive care unit; (2) optimized process 1 (n = 41): preparation/follow-up, TEE + ECV during one sedation in the CU, blood testing in the CHL; (3) optimized process 2 (n = 55): preparation/follow-up, TEE + ECV and point of care (POC) blood testing in the CU. All procedure-related costs were listed and classified according to material, human resources, and infrastructure.
Results:
From setting 1 to 3, there was a significant decrease in procedural time from 480 ± 105 min to 205 ± 85 min (p < 0.001). Likewise, ECV-associated costs could be reduced from 683 ± 104
Conclusion:
Establishing a CU for AF enables a more than 50% reduction in procedural time and costs. A combination of TEE and ECV in one sedation and POC testing in the CU were the major contributors to this time and cost reduction.
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