Implementation and impact analysis of a transitional care pathway for patients presenting to the emergency department with cardiac-related complaints
Abstract Background Cardiac-related complaints are leading drivers of Emergency Department (ED) utilization. Although a large proportion of cardiac patients can be discharged with appropriate outpatient follow-up, inadequate care coordination often leads to high revisit rates or unnecessary admissio...
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| Format: | Article |
| Language: | English |
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BMC
2018-08-01
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| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12913-018-3482-2 |
| _version_ | 1818012763336736768 |
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| author | Gabriel E. Soto Elizabeth A. Huenefeldt Masey N. Hengst Arlo J. Reimer Shawn K. Samuel Steven K. Samuel Stephen J. Utts |
| author_facet | Gabriel E. Soto Elizabeth A. Huenefeldt Masey N. Hengst Arlo J. Reimer Shawn K. Samuel Steven K. Samuel Stephen J. Utts |
| author_sort | Gabriel E. Soto |
| collection | DOAJ |
| description | Abstract Background Cardiac-related complaints are leading drivers of Emergency Department (ED) utilization. Although a large proportion of cardiac patients can be discharged with appropriate outpatient follow-up, inadequate care coordination often leads to high revisit rates or unnecessary admissions. We evaluate the impact of implementing a structured transitional care pathway enrolling low-risk cardiac patients on ED discharges, 30-day revisits and admissions, and institutional revenues. Methods We prospectively enrolled eligible patients presenting to a single-center Emergency Department over a 12-month period. Standardized risk measures were used to identify patients suitable for early discharge with cardiology follow-up within 5 days. The primary endpoints were rates of discharge from the ED and 30-day ED revisit and admission rates, with a secondary endpoint including 30-day returns for myocardial infarction. A cost analysis of the program’s impact on institutional revenues was performed. Results Among patients presenting with cardiac-related complaints, rates of discharge from the ED increased from 44.4 to 56.6% (p < 0.0001). Enrollment in the transitional care pathway was associated with a reduced risk of cardiac-related ED revisits (RR 0.22, p < 0.0001), all-cause ED revisits (RR 0.30, p < 0.0001), and admission at second ED visit (RR 0.56, p = 0.0047); among enrolled patients, the 30-day rate of return with a myocardial infarction was 0.35%. No significant reductions were seen in 30-day cardiac-related and all-cause revisits in the 12-months following transitional care pathway implementation; however, there was a significant reduction in admissions at second ED visit from 45.6 to 37.7% (p = 0.0338). An early gender disparity in care delivery was identified in the first 120 days following program implementation that was subsequently eliminated through targeted intervention. There was an estimated decline in institutional revenue of $300 per enrolled patient, driven predominantly by a reduction in admissions. Conclusions A structured transitional care pathway identifying low-risk cardiac patients who may be safely discharged from the ED can be effective in shifting care delivery from hospital-based to lower cost ambulatory settings without adversely impacting 30-day ED revisit rates or patient outcomes. |
| first_indexed | 2024-04-14T06:24:29Z |
| format | Article |
| id | doaj.art-94501e790f45415eb59101e232f10dac |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-04-14T06:24:29Z |
| publishDate | 2018-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-94501e790f45415eb59101e232f10dac2022-12-22T02:07:53ZengBMCBMC Health Services Research1472-69632018-08-0118111010.1186/s12913-018-3482-2Implementation and impact analysis of a transitional care pathway for patients presenting to the emergency department with cardiac-related complaintsGabriel E. Soto0Elizabeth A. Huenefeldt1Masey N. Hengst2Arlo J. Reimer3Shawn K. Samuel4Steven K. Samuel5Stephen J. Utts6SoutheastHEALTHSoutheastHEALTHSoutheastHEALTHKearny County HospitalMontefiore Medical CenterCityMDAustin GastroenterologyAbstract Background Cardiac-related complaints are leading drivers of Emergency Department (ED) utilization. Although a large proportion of cardiac patients can be discharged with appropriate outpatient follow-up, inadequate care coordination often leads to high revisit rates or unnecessary admissions. We evaluate the impact of implementing a structured transitional care pathway enrolling low-risk cardiac patients on ED discharges, 30-day revisits and admissions, and institutional revenues. Methods We prospectively enrolled eligible patients presenting to a single-center Emergency Department over a 12-month period. Standardized risk measures were used to identify patients suitable for early discharge with cardiology follow-up within 5 days. The primary endpoints were rates of discharge from the ED and 30-day ED revisit and admission rates, with a secondary endpoint including 30-day returns for myocardial infarction. A cost analysis of the program’s impact on institutional revenues was performed. Results Among patients presenting with cardiac-related complaints, rates of discharge from the ED increased from 44.4 to 56.6% (p < 0.0001). Enrollment in the transitional care pathway was associated with a reduced risk of cardiac-related ED revisits (RR 0.22, p < 0.0001), all-cause ED revisits (RR 0.30, p < 0.0001), and admission at second ED visit (RR 0.56, p = 0.0047); among enrolled patients, the 30-day rate of return with a myocardial infarction was 0.35%. No significant reductions were seen in 30-day cardiac-related and all-cause revisits in the 12-months following transitional care pathway implementation; however, there was a significant reduction in admissions at second ED visit from 45.6 to 37.7% (p = 0.0338). An early gender disparity in care delivery was identified in the first 120 days following program implementation that was subsequently eliminated through targeted intervention. There was an estimated decline in institutional revenue of $300 per enrolled patient, driven predominantly by a reduction in admissions. Conclusions A structured transitional care pathway identifying low-risk cardiac patients who may be safely discharged from the ED can be effective in shifting care delivery from hospital-based to lower cost ambulatory settings without adversely impacting 30-day ED revisit rates or patient outcomes.http://link.springer.com/article/10.1186/s12913-018-3482-2Care coordinationContinuity of patient careInterdisciplinary communicationEmergency departmentPatient dischargeCardiovascular services |
| spellingShingle | Gabriel E. Soto Elizabeth A. Huenefeldt Masey N. Hengst Arlo J. Reimer Shawn K. Samuel Steven K. Samuel Stephen J. Utts Implementation and impact analysis of a transitional care pathway for patients presenting to the emergency department with cardiac-related complaints BMC Health Services Research Care coordination Continuity of patient care Interdisciplinary communication Emergency department Patient discharge Cardiovascular services |
| title | Implementation and impact analysis of a transitional care pathway for patients presenting to the emergency department with cardiac-related complaints |
| title_full | Implementation and impact analysis of a transitional care pathway for patients presenting to the emergency department with cardiac-related complaints |
| title_fullStr | Implementation and impact analysis of a transitional care pathway for patients presenting to the emergency department with cardiac-related complaints |
| title_full_unstemmed | Implementation and impact analysis of a transitional care pathway for patients presenting to the emergency department with cardiac-related complaints |
| title_short | Implementation and impact analysis of a transitional care pathway for patients presenting to the emergency department with cardiac-related complaints |
| title_sort | implementation and impact analysis of a transitional care pathway for patients presenting to the emergency department with cardiac related complaints |
| topic | Care coordination Continuity of patient care Interdisciplinary communication Emergency department Patient discharge Cardiovascular services |
| url | http://link.springer.com/article/10.1186/s12913-018-3482-2 |
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