Pacemaker Follow-up Done in Nursing and Special Care Homes Lorna McConnel, Nurse Manager/Process Improvement Facilitator, Clinic D Electro-diagnostics, Ambulatory Care, The Moncton Hospital, Horizon Health Network Jean Robinson, RCT, ECG Department, The Moncton Hospital, Horizon Health Network

Intent/Goal/Aim Rather than patients transport to hospital via ambulance or nursing home vehicle, the Registered Cardiology Technologist (RCT) travels to the Nursing Homes or Special Care Homes to perform a 5-10 minute routine pacemaker follow-up in the patient’s room. Multiple pacemaker patients in the same care home are seen on the same day.

Problem/Issue Patient refusal to pacemaker follow-up due to obstacles Stakeholder feedback concerns: Lack of communication Rushed follow-up Transport delays/cancellations Other patient appointments bumped Disorientation/confusion for patients Patient mobility issues Missed appointments Family unable to attend appointment Parking challenges for family Potential health hazards for patients

Measurement METRIC Aug-15 Total # of patients in data base 84 # patients seen 79 # patients refused follow-up 5

Intervention/Actions Pre questionnaire, conversations and communication memo to stakeholders and organization Cost analysis of current services Briefcase Cell phone Patient trial done in Nursing Home with family at bedside Cardiologist available for troubleshooting No additional staffing resources or shifts required (RCT already scheduled to work) Patients organized for follow-up 1 week in the Fall and 1 week in late Spring: - - to avoid winter conditions and summer vacations limits number of trips and time away from hospital

Impact/Outcomes METRIC Aug-15 Oct-15 May-16 TARGETS Results Jun 2016 Total # of patients in data base 84 80 # patients seen 79 51 54 105 # patients refused follow-up 5 # of Nursing/Special Care Homes visited   16 29 23 45 # of day trips made by RCT 6 10 11 cost for RCT $160 $255 < $3800 $415 Potential savings (Due to no Ambulance NB transfer) $97,716 $103,464 $200,000 $201,180 # calls made to Cardiologist by RCT

Lessons Learned/Challenges If staffing was an issue on certain days then RCT would reschedule community visits. Discovered some patients were transported by ambulance or nursing home vehicle to Amherst . Collaboration with physician and patients/families resulted in easy agreement and transfer of care to RCT, so patients no longer need transportation to Amherst. The neighbouring hospital, Dr. George Dumont Hospital, also have pacemaker patients residing in Nursing/Special Care Homes. Collaboration ongoing to enhance services. With very little effort and cost, this initiative has huge benefits that can be recognized by other health care facilities. It poses the question: What other services can be offered to vulnerable populations using the same concept