PROJECT 

Acute Medical Assessment Unit Cardiac Monitoring Service

 

TEAM:

Dr. Orla Collins (Acute and Gerontology Consultant), RANP Acute Medicine team, Ms. Emily Bury, Ms. Aisling Kennedy, Ms. Laura Mitchell, Ms. Elaine Whyte

 

LOCATION:

Acute Medical Assessment Unit, St. Vincent’s University Hospital, D04T6F4

 

THE PROBLEM:

Prior to this project all patients presenting with syncope, TIA or minor stroke were streamed to the AMU for inpatient admission including cardiac monitoring. The presentations were up to 5 patients per day with each patient requiring a minimum of 24 hours cardiac monitoring using the inpatient telemetry system. Given the demand for telemetry, this often caused delays in accessing a telemetry unit, further increasing Length of Stay (LOS).

 

THE SOLUTION:

As part of the implementation of the AMAU syncope pathway, 5 r tests (external cardiac loop monitors) were procured. An R Test is a non-invasive cardiac monitor that continually analyses the ECG and retains information pertaining to relevant arrhythmias. The r test service facilitates same day discharge (SDD) of non-high risk syncope patients, inpatient cardiac monitoring for TIA and minor stroke when there is no telemetry monitoring, and prolonged outpatient cardiac monitoring increasing the identification of arrhythmias.

 

BENEFITS:

In the first year of implementation, the r test service facilitated SDD for 33% of syncope patients and reduced LOS from 3.2 to 1.5 days. SDD was also facilitated for 22% of TIA patients and the LOS for TIA and stroke reduced from 4 to 2.6 days. The average monitoring time was 3 days versus 1 day of telemetry monitoring prior to implementation. There was an arrhythmia yield of 23% for syncope patients, 15% of stroke patients and 10% of TIA patients.

 

PROJECT CONTACT DETAILS:

Emily Bury: ebury@svhg.ie;

Ph: 086 8112557