A dedicated cardioversion unit for the treatment of atrial fibrillation. Reducing costs by optimizing processes

C. Knackstedt, M. Becker, K. Mischke, R. Pauling, H. P. Brunner-La Rocca, P. Schauerte*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

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. 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. 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 a,not sign to 299 +/- 63 a,not sign (p <0.001). 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.
Original languageEnglish
Pages (from-to)518-526
JournalHerz
Volume37
Issue number5
DOIs
Publication statusPublished - Aug 2012

Keywords

  • Atrial fibrillation
  • Electrical cardioversion
  • Outpatient clinic
  • Process optimization
  • Cost reduction

Fingerprint

Dive into the research topics of 'A dedicated cardioversion unit for the treatment of atrial fibrillation. Reducing costs by optimizing processes'. Together they form a unique fingerprint.

Cite this