Background and Issues: Current AHA guidelines recommend prolonged cardiac monitoring in patients with cryptogenic stroke. Studies show that the more hours a patient is monitored, the more likely it is a-fib will be detected. At our institution, standard post-discharge monitoring in cryptogenic stroke patients is usually done with a 30 day cardiac event monitor that is managed by the patient and/or their caregiver. For patients discharged to acute inpatient rehabilitation (AIR) or skilled nursing (SNF) facilities it was often assumed that the facility would take responsibility for managing the monitor. However, these facilities had little to no educating regarding the maintenance of event monitors so this assumption frequently resulted in incomplete studies and even lost monitors.
Purpose: The goal was to improve 30 day event monitoring compliance in patient discharged to AIR and SNF facilities.
Methods: Our improvement process was twofold. 1. We developed a standardized method of ordering 30d event monitors that requires the ordering MD to identify a caregiver to receive education and be responsible for supporting the maintenance of the 30d event monitors for patients who cannot fully maintain the monitor themselves regardless of patient disposition. If a patient is discharged to AIR or SNF their caregiver will be a champion for monitor compliance, helping educate the facility and confirming that standard maintenance and documentation is occurring. 2. For the receiving facilities, we condensed the 30 page event monitor handbook into a single handout summarizing the basics regarding the daily replacement of electrodes and batteries, charging the monitor, recording symptoms and completing ADLs.
Results: In the seven months prior to project implementation, 6/15 (40%) patients discharged to AIR or SNF were monitored for <240h (10d worth of data), mean monitoring time= 395h. In the seven months after project implementation, 100% of patients (10/10) were monitored for >240h, mean monitoring time= 535h, a 35% increase.
Conclusion: Identifying an invested caregiver and providing even limited education to receiving facilities can significantly increase 30d event monitor compliance in stroke patients discharged to AIR or SNF facilities.