Authors: (including presenting author): :
Seto NY Sybil(1), Kwan KY(2), Leung YW(1)(2), Leung CY(1), Wong CH(1), Lau TK Alexson(2), Chung TS (2), Chu KL(3), Tse KC(4), Szeto L Dione(4)
Affiliation: :
(1)Division of Cardiology, Department of Medicine, Tseung Kwan O Hospital (2)Division of Cardiology, Department of Medicine and Geriatrics, United Christian Hospital (3)Department of Anaesthesiology and Pain Medicine, United Christian Hospital (4)Department of Anaesthesiology and Operating Theatre Services, Tseung Kwan O Hospital.
Keyword 2: :
Peri-operative
Keyword 3: :
Consultation
Introduction: :
Cardiac Implantable Electronic Devices (CIEDs) are trustworthy treatment for cardiac arrhythmias. Electromagnetic interference (EMI) during surgical or interventional procedures may potentially compromise CIEDs’ function such as unintended pacing inhibition or inappropriate defibrillator shocks, both of which pose significant risks to patient safety. According to CDARS data, Kowloon East Cluster (KEC) currently has approximately 2100 patients with CIEDs. Each year, about 200 operations require peri-operative CIEDs assessment and reprogramming in KEC, some are cluster-based surgical programs. Cross-hospital CIEDs consultation have been increased. Cluster-based CIED consultation service is crucial to streamline peri-operative workflow.
Objectives: :
Enhance patient safety by establishing standardized, evidence based guidelines for anesthesiologists, surgeons, physicians, and nurses in the peri-operative management of patients with CIEDs. Reduce unplanned consultations and streamline interdisciplinary communication to minimize peri-operative inpatient stay and avoid delays in surgery.
Methodology: :
Since 2018, PACE-SAFE has been developed among Department of Anesthesia and Division of Cardiology in United Christian Hospital addressing the growing demand for peri-operative care for patients with CIEDs. It was extended to Tseung Kwan O Hospital in 2024. Plan: Multidisciplinary team was established in 2018, comprising with key stakeholders such as doctors and nurses from both Department of Anesthesia and Division of Cardiology. Do: Our team conducted a prevalence survey to identify service gaps, performed literature reviews, and adopted international guidelines to align with local practice. A standardized workflow for “pre-ordered” CIED reprogram was developed and disseminated through relevant committees and knowledge sharing platforms. Check: Outcomes were evaluated by consolidating data in 2019-2023 and feedback from major users and stakeholders. Act: The guidelines were revised based on the feedback collected and updated international recommendations. Cluster-based PACE-SAFE has been established to reduce cross-department/ hospital referrals.
Result & Outcome: :
In 2021–2025, PACE-SAFE has reduced ~70% cardiac doctor consultations for CIEDs peri-operative reprogramming and minimized unnecessary delay in operations. Pre-ordered reprogram setting by PACE-SAFE has facilitate same day admission and thus reducing 200 hospital bed days annually. PACE-SAFE has consistently ensured patient safety without adverse events since its implementation and has received positive feedback from anesthesia and surgical teams. Our cardiac nursing team is now tackling ~30 consultations per year, and 30–50 enquiries related to device type, potential EMI risks, and referral logistics. Our Cluster-based program has demonstrated reduction in cross department/hospital referrals and smoothen patient journey. Our team are proud that we could overcome multiple obstacles and become the first cluster in Hospital Authority to set up such complex cluster base nurse-led service.
