A Survey of Participants Satisfaction of a Nurse Practitioner-led Fast-track Outpatient Clinic for Rhythm and Conduction Disorder

Abstract

Background: Nurse-led outpatient clinics for acute and chronic disorders are increasingly growing but data on nurse-led fast-track clinic for rhythm and/or conduction disorders (FT-RCD) are lacking. Aims: With a nurse-led fast-track clinic for rhythm and/or conduction disorders we aimed to enhance accurate diagnostic course with high patient satisfaction. Methods: With the initiation of a nurse-led FT-RCD we evaluated timely diagnosis for patients with complaints of palpitation, syncope, presyncope and fatigue who were given rapid access to diagnostics. In all patients, a range of non-invasive cardiac investigations was performed including ECG, trans-thoracic echocardiography (TTE), laboratory analysis, exercise tolerance testing (ETT), ambulatory ECG monitoring and chest X-ray. General practitioner (GP) initiates the process by faxing a referring letter requesting fast track diagnostics for patients suspected of rhythm and/or conduction disorders. A questionnaire, appointments and schedule of various investigations are sent by the doctor's assistant (DA) to the patient. The nurse practitioners (NP) take medical history, perform physical examination and conduct an ETT. All results are reviewed by a cardiologist and final diagnosis is established.  Results: A total of 483 patients were investigated. Of those, 283 patients (58.6%) were reassured and discharged. The mean lead time (5.5 weeks) of FT-RCD to diagnosis was shorter compared with regular care (8 weeks), 31% reduction of time. Ten patients (10/483 = 0,20%) were analyzed by tilt table test for assessment of postural orthostatic tachycardia syndrome, eight patients (8/483 = 0,16%) were forwarded for analysis of obstructive sleep apnea syndrome and six patients (6/483 = 0,12%) were referred for electrophysiological studies. Survey was sent to participants after they attended the nurse-led clinic. A total of 233 attendees responded (48.2%). The nurse-led clinic was graded as good-excellent by 88% of respondents. Conclusions: The majority of referred patients to fast-track diagnostic facility are reassured and referred back to the primary care sector. Access to a nurse-led fast-track diagnostic facility considerably reduces diagnostic intervals with good to excellent satisfactory experience evaluated by patients.