‘Car park clinic’ for cardiac device follow-up deemed successful model during pandemic
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Key takeaways:
- A car park clinic for cardiac devices follow-up was associated with shorter visits and high patient satisfaction.
- Researchers said the model could be considered in the post-pandemic era.
For patients with implanted cardiac devices, a “car park clinic” model successfully minimized contact with health care staff during the COVID-19 pandemic while also providing high patient satisfaction and reducing appointment times.
“Cardiac devices require routine follow-up, increasingly transitioning to mobile data transfer; however, face‐to‐face review is still routine,” Andrew W. Teh, MBBS, PhD, of the department of cardiology at Austin Hospital in Melbourne, Victoria, Australia, and colleagues wrote in the study background. “Resources required for follow‐up has increased with increased implantation of cardiac devices with variations in workflow of their follow‐up. Goals of a cardiac device check include detection of battery depletion or device malfunctions, adjusting device settings and patient education.”
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In response to the pandemic, researchers at a tertiary hospital in Melbourne developed a car park clinic model for follow‐up with patients who had cardiac devices, with a goal of avoiding hospital entry and minimizing face-to-face encounters with health care providers. Patients remained in their car while their device was interrogated by staff in appropriate personal protective equipment. The staff placed interrogation wands through the car window and automated checks were performed (Carelink Express for Medtronic devices; Merlin on Demand for Abbott devices). Patients who required formal face-to-face visits were then referred directly to the cardiology department.
“We aimed to assess patient satisfaction and time efficiency of the clinic compared to face-to-face visits,” the researchers wrote.
For the study, researchers analyzed data from 591 patients who attended the car park clinic between September 2020 and November 2021. Among those, 46% completed a questionnaire to assess their satisfaction, rating their experience using a 5-point Likert scale. Entry and exit times were recorded by staff. Researchers also collected 176 responses for patients who attended the face-to-face clinic.
The mean age of patients was 79 years; 85% had permanent pacemakers, 12% had loop recorders, 2% had implantable cardiac defibrillators and 1% had cardiac resynchronization devices.
Among car park clinic respondents, 90% reported being “happy” to “very happy” with their experience and 96% reported feeling “safe” or “very safe.”
Researchers found that patients spent a significantly shorter total time in the car park clinic compared with the face-to-face clinic (mean, 17 minutes vs. 50 minutes; P < .001).
Face-to-face appointments included a mean 30-minute device check and wait times of 21 minutes on average. Among patients who attended both the car park and the face-to-face clinic, 34% preferred the car park clinic, 37% preferred face-to-face and 29% were neutral.
Two patients required referral to the cardiology ward for programming changes.
“The advanced age of our patient cohort who may prefer in-person review with a health care professional may explain the divided preference of clinic models,” the researchers wrote. “Additionally, we found a significant time saving for the car park clinic and expect this is due to avoiding car parking issues, ambulation to clinic (especially with gait aids) and waiting room times, which has negative association with satisfaction of outpatient clinic.”
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