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Showcasing Best Practice In Syncope
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Jersey Heart Team delivers enhanced integrated multidisciplinary care for islanders with blackouts
Mrs Kelly Anne Kinsella, Mrs Kari Pitcher, Miss Charlotte Herdman, Mrs Catherine Fryer, Mrs Angela Hall, Dr Andrew Mitchell, Dr Pierre Le Page
Jersey Heart Team, Jersey, Channel Islands
Physiologist-led implantable loop recorder (ILR) insertion commenced locally in 2019. Initial motivation for its introduction was to free-up the consultant cardiologist’s time and theatre slots for complex cases. However, important unanticipated benefits have been recognised. The most important being an improved patient journey and patient-centred care. When an ILR is indicated, the care of the patients is taken over by a clinical physiologist, who implants the device and remotely monitors the patient.
Clinical physiologists provide device technical support, consultation after symptom activation and general follow-up for these patients. This approach is enabled by the development of a greater connection with the arrhythmia specialist nurses (who run the transient loss of consciousness [TLoC] clinic). This has reduced the amount of ILR data the consultant cardiologist reviews. If a patient requires device upgrade, a clinical physiologist will be present in theatre and will carry out patient follow-up care. Thus, the same specialist cares for them throughout their patient journey.
An 81-year-old gentleman, with a history of hypertension and spinal stenosis, presented to the Emergency Department following an episode of blackout whilst walking his dog.
• Day 11: Patient was assessed in the nurse-led TLoC clinic. Patient reported similar episodes of syncope with head injuries and episodes of presyncope whilst sitting but with no prodrome. Episodes were happening every six weeks. The examination was normal, with the 12-lead ECG showing no evidence of atrioventricular (AV) block. No significant postural drop in blood pressure. Transthoracic echocardiogram showed satisfactory left ventricular function and no valve abnormalities were noted. The cardiologist agrees periodic recurrent symptoms warrant ILR. Senior clinical physiologist implanted the ILR. The patient was monitored remotely by the clinical physiologists.
• Day 21: Automated event, via remote monitor, records six seconds of asystole with patient symptom activation due to presyncope. Cardiologist recommends device upgrade.
• Day 42: Pacemaker is implanted by a consultant cardiologist and programmed by the senior clinical physiologist who implanted the patient’s ILR.
The introduction of dedicated TLoC and a clinical physiologist-led ILR implantation service has resulted in a more efficient use of resource and an improved patient journey. The Jersey Heart Team continues to consider new ways of working to best utilise resources and improve our patient care. Our multidisciplinary team approach ensures the best person to provide care for the patient does so.