Heart Rhythm Management
Summary
My main objective of this fellowship was to gain practical skills in assessment and symptom management for heart rhythm patients. In gaining this knowledge and understanding the process of heart rhythm management and specifically catheter ablation in more detail I have been able to support patients and colleagues more effectively as a Heart Rhythm Triage Coordinator (HRTC).
Having greater proficiency in advanced rhythm analysis, improved understanding of symptom management with multiple arrhythmia types, and a greater understanding of cardiac catheter ablation therapy I have made improvements in my knowledge base. I have been able to take this and revise resource materials to reflect updated practice guidelines and develop strategies to share this information with patients and colleagues.
I have worked with our heart rhythm team members on updating resource materials for patients and make these resources more accessible. With some of the challenges of the COVID-19, the time was right to revise these materials on the Southlake website. Our nursing and allied health colleagues within the organization as well as across the region we service have also benefited. As part of my project, with assistance from my colleagues, we have successfully launched Regional RN Grand Rounds. This has been presented virtually with a variety of topics. I was able to present topics relative to heart rhythm as well we engaged NPs across our Cardiac Program to present topics related to Cardiac Resynchronization Therapy, Cardiac Physiology, and Chest Tubes. Beyond this, many presentation topics are being developed for future presentations related to cardiac care.
I also focused on working towards strategies in accessing reliable information related to complication rates with our procedures. With the challenges related to COVID-19 accomplishing this became challenging as the management focus had been redirected. This said we have continued to work on updating our software systems in part to better communicate with referring physicians and hopefully capture more real-time data related to post procedures issues.
I plan on continuing work with our HRP for ongoing program development, improve patient satisfaction, implementation of innovative technologies, and improving current processes to make the patient experience better.
The clinical knowledge that I have gained relates to advanced rhythm analysis, ongoing symptom management, and a greater understanding of catheter ablation therapy. Understanding the standards of treatment and decision-making has helped me gain competencies within heart rhythm management.
Much of heart rhythm management surrounds quality of life (QoL) for this patient population, especially when it can often interfere with day-to-day activities and can be quantified by symptom burden of the patient1. Living with an arrhythmia and never knowing when you may become symptomatic, often creates fear amongst patients2. Having a greater understanding of heart rhythm management and treatment options have provided me with the ability to support and provide this client population with tools to improve QoL and make improved health choices.
My role as an HRTC is related to arranging electrophysiology (EP) procedures for our patients. Spending time in the EP lab has given me a greater insight into these highly complex procedures that many of our patients wait weeks and months for3. I had the ability to shadow some of our physicians within their clinics to also gain a better perspective by reviewing and identifying patients that require early interventions, complex symptom management and identify when additional optimization may be required to better support the patient. It also provided me with the ability to improve communication skills, offer ongoing health teaching and help to define realistic expectations for treatment planning. The knowledge I have gained has also assisted in improving quality assurance (QA) related to mortality and morbidity cases as well as complication rates and ways to improve tracking methods and processes.
Outcomes
Largely the outcomes related to the heart rhythm client population pertained to improving access and the quality of resource material. Prior to this fellowship, our team provided education sessions to our client population in a group setting and this was specifically geared to our Atrial Fibrillation group awaiting a Pulmonary Vein Isolation (PVI) procedure. Though PVI is the primary procedure that we do in our EP lab there is a multitude of other procedures in the realm of heart rhythm that we provide. Though the COVID-19 pandemic made some of our work extremely challenging it was also a great catalyst for change and pushed forward the need to update and develop materials that could be accessed by our patients easily. With key players in the Heart Rhythm Program including our Medical Director Dr. A. Verma, Mentors, Staff, and Patient Family Advisors I was able to push forward updated resources including handbooks on a variety of topics related to heart rhythm procedures, presentations, and links to additional patient resources.
The long-term outcomes I had started to strategize were related to patient satisfaction by increasing communication to patients along their journey to catheter ablation as well as improving processes related to wait times. These long-term outcomes I had developed in my original application prior to the pandemic. Restrictions in the first and third waves of the pandemics on elective activity made this extremely challenging to work towards. After wave one our team looked for ways to improve and develop our program to increase procedural activity as our wait times for our AF patients had grown from 9mths to 15-18mths. Once wave three hit and elective procedural activity were again placed on hold we are faced with further challenges related to wait times, our team will need to review and further challenge ourselves to work towards strategies on reducing these wait times with long-term sustainable goals.
The outcomes related to colleagues/staff, the organization, and stakeholders were mainly related to education resources and relationship building across the region served in the Cardiac Program at Southlake. In the initial planning, I had intended to provide small-group sessions to cardiac staff within Southlake. As discussions went on with our NP group and our arrhythmia RNs we felt it of great importance to reach out to our regional centers to provide greater insight. As we connected with our regional partners that we service we found that there was a great desire to receive and improve on a knowledge gap with aspects of arrhythmia as well as many other areas of cardiac care service that we provide as an organization.
We did an initial pilot with Georgian Bay General Hospital and had great feedback. This process has become about information sharing. With our success in the fall, we opted to expand across the region to the following centers we service including Georgian Bay General (Midland), Stevenson Memorial (Alliston), Markham Stouffville (Markham and Uxbridge sites), Mackenzie Health (Richmond Hill), Royal Victoria Regional Health Centre (Barrie), Collingwood General & Marine (Collingwood), Muskoka Algonquin Health (Bracebridge & Huntsville sites), Orillia Soldiers Hospital (Orillia), and Headwaters Health Centre (Orangeville). We also included several inpatient areas within Southlake Regional Health Centre including ER, Cardiology Program, CV Surgery program, Medical ICU, and our Corporate Educators. This initiative shows great long-term potential for information sharing regarding up-to-date practice guidelines for our regional partners, education, and process changes. Although this was not the initial proposed plan, it has become the biggest success to be achieved within the fellowship.
Overall experience
This fellowship provided me an opportunity to gain additional knowledge in strategies related to the management of arrhythmia, the impacts on quality of life, and create improvements with resource materials for patients as well as information sharing amongst my colleagues. As an HRTC, I had gained a good understanding of aspects of heart rhythm management and was eager to gain more knowledge while gaining a stronger foundation on management strategies. In addition to this, it was important for me to share my knowledge with my colleagues and take some of the mystery out of heart rhythm.
My fellowship took me through some challenges but the overall result was a great success. The COVID-19 pandemic created a challenging journey, delaying my start date and pausing my fellowship activities for a 3-month timeframe while I was redeployed in the medical ICU. Despite this, my mentors and management teams were very supportive of my work on this journey. Although the pandemic caused many challenges to most of us in the aspect of healthcare, in some ways it was also a catalyst for change, forcing people to rethink their strategies on resource materials, how they serve their client populations and partners.
Our biggest success with this project was to Regional RN Grand Rounds. My Nurse Practitioner colleagues were able to engage our regional organizations to provide nurse and allied health teaching beyond heart rhythm alone. It captures a wide audience within Southlake and across the region we serve. It has become about information sharing across the region for nurses and allied health professionals.
As an HRTC, this fellowship has truly provided me with improved insight into heart rhythm management strategies, the ability to have more confidence in my role, my knowledge base, and the ability to better share this knowledge with others.
References:
Withers, K. L., Wood, K. A., Carolan-Rees, G., Patrick, H., Lencioni, M., & Griffith, M. (2015). Living on a knife edge-the daily struggle of coping with symptomatic cardiac arrhythmias. Health and quality of life outcomes, 13(1), 86.
Walfridsson, U. (2011). Assessing Symptom Burden and Health-Related Quality of Life in patients living with arrhythmia and ASTA: Arrhythmia-Specific questionnaire in Tachycardia and Arrhythmia (Doctoral dissertation, Linköping University Electronic Press).
Cardiac Care Network: Utilization report by date. 2021 https://wtisccnrs1.ccn.on.ca/BOE/BI. Access date: May 15, 2021
