Abstract
PROBLEM: Atrial fibrillation is the most common persistent arrhythmia in adults and carries an increased risk of thromboembolism and stroke. Electrical (DC) cardioversion is an effective treatment, but logistical difficulties in many institutions lead to problems providing a prompt service. This reduces the rate of long term success, delays relief of symptoms, and increases the burden on anticoagulation clinics. DESIGN: Prospective audit of introduction of a collaborative, nurse led DC cardioversion service in a day surgery unit. SETTING: Day surgery unit 5 km from an acute hospital in southeast London. KEY MEASURES FOR IMPROVEMENT: Waiting times, success of procedures, and complication rates. STRATEGIES FOR CHANGE: Collaborative working across traditional specialty boundaries; empowerment of patients within the process; using a nurse consultant as a single point of reference to coordinate the service. EFFECTS OF CHANGE: Sinus rhythm was restored in 131 (92%) of the first 143 patients treated. Three patients needed hospital admission; all were discharged uneventfully within 24 hours. No important complications occurred. Waiting times were reduced from 27 weeks to eight weeks for patients eligible for the service. LESSONS LEARNT: Elective DC cardioversion under general anaesthesia can be safely done by an appropriately trained nurse in a day surgery unit remote from an acute general hospital. This model of care is effective and can reduce waiting times and relieve pressure on acute beds and junior doctors.