John de Heide

Chapter 9 152 2. Methods 2.1 Study design This was a prospective, nonrandomized, single-center pilot study of consecutive patients undergoing an elective cardiac intervention at the Department of Clinical Electrophysiology of the Erasmus Medical Center between January and April 2013. The Erasmus Medical Center is a tertiary referral and teaching hospital in Rotterdam, The Netherlands. Patients had to be at least 18 years old and have had an elective cardiac implantable electrical device implantation or a catheter ablation of atrial fibrillation. Furthermore, they should have a mobile phone with an integrated camera function and be able to send an email by computer or mobile phone. Patients used their own phone. The study was reviewed by the medical ethics committee who approved the noninterventional character of this study (MEC-2012-593). All patients provided written informed consent. The study conforms with the principles outlined in the Declaration of Helsinki.7 The incentive for participation was a luxury ballpoint for filling out the questionnaire or outlining a hematoma. 2.2 Discharge Information On discharge, patients received specific instructions on regimens and warning signs regarding their surgical wound or puncture site(s). These written instructions were explained by both the nurse practitioner and staff nurse, including instructions on how to act in case of (possible) complications. Patients after device-related surgery should keep the wound dry until day 5 and remove the bandage on day 5. Regarding the puncture site, patients were asked to remove the adhesive plaster after 1 day if it was dry. Patients were explicitly requested to call the ward for advice in case of (suspected) complications, as is our standard of care, having easy access to a nurse practitioner. This service was available until their first outpatient clinic visit. Furthermore, standard care also incorporates a telephonic follow-up by a staff nurse 1 week after discharge. Patients undergoing device implantation were clinically assessed at day 10 to check their wound and the functioning of their device. Patients undergoing catheter ablation were seen at the outpatient clinic visit 3 months after ablation without having access to specific wound inspection.

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