Table 3.

Weighted results based on patients’ and nurses’ experiences of remote patient monitoring (RPM).

Weighted results		Clinical implications	Needed interventions for changed practice
Experiences and satisfaction
	Both patients and nurses had good experiences of RPM, but patients were more positive than the nurses.	Acknowledge dissatisfaction among nurses and identify obstacles to work with RPM.	Engage device manufactures to arrange online seminars and support for nurses involved in RPM.
	A few patients and nurses found RPM unnecessary.	Continue to offer RPM to patients with implantable cardioverter-defibrillator (ICD).	Provide education and motivational support for RPM to every patient that receives an ICD.
	Some nurses found it challenging to customize the correct alert settings for the individual patient, which resulted in a high number of transmissions.	Provide practical information to nurses about how and when to individualize alert settings.	Engage device manufacturers to arrange online seminars and support for nurses involved in RPM.
Security and safety
	Most patients experienced that RPM increased security, and this was in line with the nurses’ perceptions, since they knew there would be an alert in case of malfunction or arrhythmias.	Provide targeted written information about RPM to patients and nurses and highlight the security aspect.	Distribute a pamphlet with appropriate local information to patients and nurses new in RPM positions, in addition to the specific information from the manufacturer.
	Some patients highlighted that atrial fibrillation was not automatically reported by one specific RPM manufacturer, which affected the feeling of security.	Provide targeted written information about RPM to patients and give information about the data collection.	Distribute a pamphlet with information from the specific manufacturer and inform the patient about the possibility to perform a patient-initiated transmission in case of tachycardia.
Technical aspects
	Nurses found the technical equipment difficult for the patients to handle more often than did the patients.	Identify the patient’s perceptions about how the RPM operates.	Offer technical support given by the manufacturer and provide the patients with written contact information. Arrange for timely and repeated group information targeting technical issues for patients.
	Some patients had misconceptions about being continuously monitored in real time, 24/7.	Identify the patient’s perceptions about how the RPM operates.	Proactively bring up how and when the data are being transferred to the clinic and the importance of calling the emergency service center in case of a life-threatening illness.
	Having to learn all the different systems with different platforms and log-ins was difficult and stressful for nurses.	Offer nurses new in the RPM position a mentorship program covering technical aspects and solutions.	Engage device manufacturers to arrange online seminars and support for nurses involved in RPM. Ask device manufacturers to help set up networks with nurses working with the same platform.
	Nurses highlighted how time-consuming it was to trace and handle different technical problems and the time it takes trying to reach the patient by phone (ie, when the monitor lost contact with the server).	Provide targeted written information about RPM to patients and nurses and highlight the technical aspects.	Offer technical support given by the manufacturer and provide the patients with written contact information. Arrange for timely and repeated group information targeting technical issues for patients.
Emotional aspects
	Only few patients were worried or anxious about what the RPM entailed, while half of the nurses felt distressed by the responsibility that accompanied their work with RPM.	Identify the nurses’ perceptions about their workload when handling RPM.	Contact the device manufacturers and ask them to arrange online seminars and support for nurses involved in RPM. Define a written decision algorithm for the clinic in order to standardize the handling of transmissions.
	It was considered as a lack of safety by some patients when traveling and not bringing the home monitor.	Provide targeted written information about RPM and traveling routines to patients.	Distribute a pamphlet with appropriate local information, including a clear travel plan and how the individual patient is recommended to act during travel.
	Some patients felt that they had no one to talk to when questions arose and did not want to bother the nurse with a phone call, while others found it reassuring to have the possibility to call the ICD nurse when needed.	Acknowledge the emotional aspect of being an ICD recipient and identify those in need of extended support.	Proactively bring up the emotional aspect and offer emotional support. Provide written contact information for the clinic.
Organization of care
	Most of the patients described that it was positive not needing to travel to hospital for follow-up as often as before, but some patients considered the fewer number of office-based visits to the ICD clinic as a disadvantage, since they appreciated the face-to-face interaction.	Identify the patient’s needs and wishes for follow-up of the device.	Offer person-centered care with individual follow-up appointments and/or provide telephone-based support in between the office-based follow-ups. Provide repeated patient education about RPM and its management using a person-centered approach and by applying, for example, teach-back methodology.
	Patients wanted to receive information directly from their remote monitored device.	Use automated direct call messaging for follow-up in patients with a device. Encourage patients to log in to their medical record electronically (when appropriate) to access the notes from the latest remote follow-up.	Using specific apps in smartphones, patients may have the possibility to check the website with information about their own device and to communicate or chat online with the health care personnel involved in the care of the patient in the future.
	Some hospitals had not planned ahead before implementing RPM; they had no routines on how to document transmissions and lacked action plans on how to handle alerts.	Identify the workflow and perform meticulous care planning before the implementation of RPM.	Define a written decision algorithm for the clinic in order to standardize the handling of transmissions.
	Hospital managers and heads of departments did not recognize the time-consuming work nurses did when handling daily transmissions.	Acknowledge nurses’ workloads by giving the heads of departments insight into how the remote transmissions impact on the regular appointments.	Provide a supportive environment for RPM (ie, activities that do not involve direct patient interaction), since the most frequently reported barrier for not implementing RPM is found to be lack of reimbursement. To prevent dissatisfaction by the nurses, new working structures might be necessary.