Once you have your clinical team and partnerships established, you will need the physical infrastructure of space and equipment to enable your team to assess, educate, and counsel patients – all of the components of providing optimal AFIB care.
Space
To run a clinic with 4-6 appointment spots for new patients and 3-4 follow up spots, we utilized 4 examination rooms over a 5 hour period
Equipment
- Video: to provide patients with a standard foundation for education, we had all patients watch a web-based video. As such we needed computer screens with web access in each patient room. However, this could also be done with a portable device, such as a tablet, in a waiting area. The video helps to set the stage for further patient-specific teaching as relevant.
- Blood pressure device/BP TRU: As blood pressure is a significant contributer to AFIB-related stroke, and accurate measure of the patients resting blood pressure is key. The BP TRU device helped us to get an accurate reading on our patients who had BPs outside of the target range, particulary in those who did not have a diagnosis of hypertension prior to their first AFQCP visit. A vital signs machine with pulse oximetry is helpful in some of the more symptomatic patients.
- ECG machine: this needs to be readily available to determine if a patient is currently in AFIB or Flutter vs NSR. This is particularly helpful in situations where patients are complaining of symptoms to help determine symptom-rhythm correlation (or not).
- Blood Work: although not a piece of equipment per se, having access to someone to draw blood facilitated care in our experience. This made it easier on the patients in terms of minimizing visits, and the clinician in terms of ease of follow up of results.
- 1-855 phone: A key component of our care for the AFQCP is to give patients the ability to contact a clinician for acute questions or issues, particularly around symptoms. Currently, this service is only available on weekdays but our goal is to eventually create a sustainable model with 24-hour access. We managed this by obtaining a 1-855 number (1-855-AFIB-411 in our case) and then arranging for any calls to that number to self-select as an urgent issues or a non-urgent issue. Urgent issues then get forwarded to a cellphone that is carried by one of the AFQCP clinicians so that the patient speaks directly with the clinical team. Any non-urgent issues are forwarded to a voicemail box that gets reviewed on a daily basis, Monday to Friday.