Implementation and development of non-medical led Intra-Cardiac Monitoring implantation service
Authors: Campbell-Cole C , Horkan K , Sohal M , Li A N T H O N 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
People are living longer, in an ageing population where disease progression can be complex requiring longer-term management. Traditionally, patients are managed using a medically led model. However, the workforce is changing, and some roles are now transferred to non-medical practitioners of which intracardiac monitoring is one example.
Intra-Cardiac Monitoring (ICM) recommended for people experiencing syncopal episodes or sporadic palpitations proving difficult to capture with traditional monitoring. NICE (2020) recommends Reveal LinQ implant for monitoring suspected atrial fibrillation (AF) in patients suspected of cryptogenic stroke where no other cause is identified.
The Non-Medical Led ICM Service was developed in response to long waiting times following the Covid-19 pandemic. Advanced Clinical Practitioners (ACPs) who are non-medically trained were assessed by medical clinicians using a competency document and practical demonstration. ACPs exercise autonomy with complex decision-making, uncertainty, and varying risks, and have accountability for decisions (HEE 2017).

Objectives
This study considers the efficacy of the ACP in ICM implantation, evaluating the incidence of complications (bleeding, infection, haematoma, erosion, pain, and unexpected complications), impact on lengthy waiting times, and improving patients’ experiences

Development and Outcome /Purpose
Once trained the ACP developed service design, standard operating procedure (SOP) and clinical documentation to ensure governance and evidence-based practice for future practitioners. Admission letters were re-designed to include a video link of the procedure to reduce anxiety and awaken inquisitiveness so that all areas and questions were explored beforehand. Referrals were reviewed to ensure suitability as well as medication and allergy status.

Method
This was a retrospective analysis between January 2021 and October 2022. 269 successful procedures were performed by 3 ACPs. Data were collated and analysed for:

Complications and causes
Patients’ experiences, assessed with a questionnaire or verbal feedback
The ACP’s contribution to reducing the waiting

Results
Analysis of results showed that at the acute stage (within 24 hrs), 2 (&gt;1%) patients were treated for bleeding requiring suturing by a medically trained clinician; at 6 months (chronic) 3 patients (1.1%) had their implants removed due to pain or discomfort; at the longer-term stage (&gt;12 months), there were no procedural-related outcomes. The waiting list was reduced to 6 months at 11 months and 2 weeks at 21 months. The patient satisfaction score was approximately 96%.

Challenges and Future Plans
Audit of wound site for aesthetic review
Further development of administrative input to improve the process
Further audits including explant of ICM by ACPs
Audit with questionnaire comparing pre-and post-implant experience
Training of a wider pool of non-medical implanters