Edinburgh Napier University

  Aims, objectives and background: The aim of this study, which was embedded into the ASPIRED randomised controlled trial (ISRCTN10278811), was to explore patient and clinician usability and acceptability of an enhanced (14-day) ambulatory ECG monitoring patch to manage and facilitate discharge of emergency department patients with unexplained syncope.

Method and Design: This qualitative study conducted between February 2023 and January 2024 consisted of 30 semi-structured telephone interviews (20 patients and 10 healthcare professionals) recruited from four hospitals (two in England and two in Scotland). Thematic analysis was employed to identify key themes which were mapped using the Theoretical Framework of Acceptability.

Results: Three overarching themes developed that mapped to six of the seven constructs within the theoretical framework of acceptability (Figure 1). The themes were: 1) Efficacy. Patients and clinicians felt that the remote intervention would increase patient reassurance. Clinicians perceived the intervention would improve clinical care pathways by overcoming delays for Holter monitors but that a standard protocol would be required to ensure appropriate intervention use. 2) Burden. Patients considered that the device was non- obstructive and easy to use. However, clinicians noted that although attaching the device was simple there would be associated time and resource costs (e.g. documentation). 3) Communication and education. Comprehensive verbal and written information were considered necessary to ensure that the intervention was usable by, and acceptable to, patients. Clinicians suggested additional training would be required. Additionally, they considered that feedback from patient monitoring would reinforce their decision making and improve clinician self-efficacy to use the device appropriately.

Conclusions: An immediate, enhanced (14-day) ambulatory ECG monitoring patch was positively received by patients and offered clinicians an acceptable route for monitoring emergency department patients with unexplained syncope. However future use should be controlled using standardised pathways to prevent inappropriate use.