Unpacking telemonitoring work: Workload and telephone calls to patients in implanted cardiac device care

Objective: Telemonitoring of cardiac implantable electronic devices (CIEDs) has many advantages. However, telemonitoring involves clinical work that is often overlooked or considered a burden, such as the work performed during telephone contact with patients. The objective of this study was to scrutinize telephone calls to and from patients to understand the clinical workload in CIED remote monitoring. The focus was on time spent, type of work, and the content of telephone contact with patients. Methods: A combined quantitative and qualitative observational study was conducted at a large CIED remote monitoring center. The unit 'encounter' was used to describe either a telephone call between patient and clinician and/or a complete review of a CIED data transmission. The time spent on different encounters was measured, the telephone call content was identified and described, and the different types of clinical work were described. Results: A total of 260 encounters were analyzed. Encounters that involved patient telephone contact were more time consuming. Telephone calls were mostly about the home monitoring box, CIED transmission data, and symptoms. In most telephone calls, two or more topics appeared. Five types of clinical work were performed: inclusion work, coordination work, diagnostic work, education work, and comfort work. Inclusion work and diagnostic work were the dominant types. Discussion: Patient telephone contact in CIED telemonitoring is typically described as a "burden". This study unpacks the contents and functions of telephone calls between patients and clinicians and suggests that the function of telephone contact should be recognized as integral, rather than burdensome, to the clinical work in CIED telemonitoring.