Nurse-Facilitated Elective Cardioversion Pathway Using Procedural Sedation

Aim: To analyse the outcome of a nurse-facilitated, patient-centred pathway for cardioversions aimed at providing improved access to rhythm specialists, faster and more personalised treatment, with a more cost-effective use of staff, equipment and hospital space. Using fentanyl and midazolam would allow a comfortable and safe procedure without involving the anaesthesia team. Method: A proposal for a new pathway was developed to allow consistency of treatment from referral to discharge and follow-up. Cardioversions were overseen by an electrophysiologist. Staff training was provided and patient information and relevant sedation guidelines were updated. We analysed the outcome of our first 20 patients (group A) and compared the results with a random non-matched cohort of anaesthetic-led cardioversions (group B). Results: Mean (SD) time from referral to treatment was 23 (22.2) days compared with 134 (125.7) in group B (p < 0.003). One patient in group A felt the shock. No interventions for airway or haemodynamic support were required in group A, whereas nine patients in group B received interventions such as bag/mask ventilation and correction of bradycardia/hypotension. Successful cardioversion was achieved in 18 from group A and 17 from group B. Mean length of stay was 280 (106.1) minutes for group A and 293 (59.3) for group B (p = NS). Conclusion: A streamlined nurse-facilitated cardioversion pathway allowed rapid access to more specialised and tailored treatment. In this small cohort less haemodynamic compromise was observed and length of stay was not affected.