Introduction: Patients with Medtronic devices presenting to emergency department (ED) need interrogation of the device. The manual interrogation via the on-call nurse or the representative may take time. This time will increase the cost per case and the overflow in the ED preventing newcomers to be seen in a timely fashion. CareLink express (CLE) technology allows an automatic interrogation in the ED that will be interpreted instantly electronically. The time and cost using CLE is evaluated in a midsize ED.

Methods: During a 10-month period there were 125 consecutive patients with Medtronic devices (69.5± 20 years old, 61.3% males) who came to ED for interrogation. The cost and length of stay in ED was compared between two groups. The study group includes patients with CLE (46 patients); the control group includes patients without CLE (79 patients). Endpoints measured were length of stay in ED in minutes and estimated cost of stay ($6/min cost factor is used according to National Database of Hospitals 2010).

Results: The demographics of the two groups were similar (67.9±2.48 vs. 70.3±1.83 years old; and 67.4% vs. 57% male). Comorbidities includes coronary artery disease, chronic kidney disease, diabetes, hypertension, dyslipidemia and history of coronary artery bypass grafting were also similar. The primary outcome showed statistically siginificant shorter length of stay in the CLE group (182.2±9.69 minutes) compared to the control group (229.8±9.19 minutes) (P=0.001). Subsequently, the cost of stay also was less in the CLE group ($1093.4±58.14) vs. the control group ($1378.7±55.16) (P=0.001). There was no difference in the interrogation findings (76.1% vs. 64.6% normal) and defibrilator shocks (10.9% vs. 8.9%). The inpatient admission decision was the same in both groups (43.5% vs. 53.2%). As expected, there was a trend of fewer patients in the CLE group that had reprogramming of the device (2.2% vs. 13.9%) (P = 0.055).

Conclusions: CareLink Express facilitates a shorter length of stay in the ED for patients with Medtronic devices and less cost to the patient without affecting the disposition decision.