Introduction Implantable loop recorders (ILR) are predominantly implanted by cardiologists in the catheter laboratory. We developed a nurse‐delivered service for the implantation of LINQ (Medtronic; Minnesota) ILRs in the outpatient setting. This study compared the safety and cost‐effectiveness of the introduction of this nurse‐delivered ILR service with contemporaneous physician‐led procedures. Methods Consecutive patients undergoing an ILR at our institution between 1st July 2016 and 4th June 2018 were included. Data were prospectively entered into a computerized database, which was retrospectively analyzed. Results A total of 475 patients underwent ILR implantation, 271 (57%) of these were implanted by physicians in the catheter laboratory and 204 (43%) by nurses in the outpatient setting. Six complications occurred in physician‐implants and two in nurse‐implants (P = .3). Procedural time for physician‐implants (13.4 ± 8.0 minutes) and nurse‐implants (14.2 ± 10.1 minutes) were comparable (P = .98). The procedural cost was estimated as £576.02 for physician‐implants against £279.95 with nurse‐implants, equating to a 57.3% cost reduction. In our center, the total cost of ILR implantation in the catheter laboratory by physicians was £10 513.13 p.a. vs £6661.55 p.a. with a nurse‐delivered model. When overheads for running, cleaning, and maintaining were accounted for, we estimated a saving of £68 685.75 was performed by moving to a nurse‐delivered model for ILR implants. Over 133 catheter laboratory and implanting physician hours were saved and utilized for other more complex procedures. Conclusion ILR implantation in the outpatient setting by suitably trained nurses is safe and leads to significant financial savings.

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BACKGROUND The heterogenic nature of suicide and suicidal attempts, in prevalence, age distribution, sex distribution, mode of attempt, cause of attempt, psychiatric morbidity, is a well-recognized fact in recent literatures. Analysing those factors at regional and local levels to plan accordingly for prevention strategies is also an advocated strategy world over. This observational study on suicidal attempt was conducted in an attempt to report from our tertiary care institution. This study was planned to assess the case burden, age and sex distribution, modes of attempt, course and outcome, psychiatric referrals and opinions of suicidal attempts in a medical college hospital. METHODS This cross-sectional retrospective study was conducted at Government Dharmapuri Medical College Hospital. Case records of all suicidal attempts from January to March 2018 were taken up for study. The case records were analysed at medical records office. Information on demographic factors modes of attempt, course and outcome, psychiatric referrals were observed. Statistical analysis was done as necessary. RESULTS 627 cases have been admitted for suicidal attempts during the study period. Self-poisoning alone accounted for 21% of admissions in General Medicine Department. Majority of (45%) cases were in 20-30 years age group. Gender neutrality was observed overall. In age specific groups, females dominated in 13 to 19 years age group, males dominated in 41 to 60 years age group. 85% of the cases were reported from rural area. 69% female patients were married. 39% of cases had attempted with pesticide poisoning. 46% of cases have been referred for psychiatric consultation. Diagnosable mental disorders have been observed in 33% of referred cases. 7 to 10 % have ended up with fatal outcome. 55% of fatal outcomes were because of pesticide poisoning. CONCLUSIONS Age specific, issue based, regular, periodic, school and community based suicidal prevention programs would be helpful in reducing suicidal behaviours.

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