-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/2ec4ad7847696422ed4dc84e742eb12d.pdf?Expires=1712793600&Signature=GBnD0Qsu6eWObN2pcUNyyxUTsl23STCE5aYopjEuHfDiP5GNsIqzdpfvL-AR8gvh2-RrSTcwtFHguIvRRt41Og8yTVxpuO-LHLRyNsLJZJn2i2h%7ELYGakhhA%7EeOk%7EdNIOZ5-qS8n7vSE8WW5hl52QrG6zD9l8%7EWeK-V7k3fb8LEQZ4Bi7eZaDrjBciHQUBIi3hei0w5wACMXqHjwXwpb1mSR-Wr7quk1S6Oc6s3w2F-KopNOsHoYLq-G%7EEiFSqOsF3MuRlimXuGX%7ECVHdvweUGq%7EXhcj6EMuVuKKpiutPGVY7mEvypGzDK%7EbfwWorcAJnQhNfdYTn%7EuLLkzy47Wq-Q__&Key-Pair-Id=K6UGZS9ZTDSZM
aa0e3f743b47e571d99481cfd29c1566
PDF Text
Text
Initial Impact of a Cardiology-Managed Outpatient Observation Unit
Joseph S. Wallins, MD, MPH, Karen Cajiao, MD, Gail Lopez, RN, MS, Lynn Mackinson, RN, MS, Cynthia Phelan, RN, MS, Peter J. Zimetbaum, MD, Michael C. Gavin, MD, MPH
Beth Israel Deaconess Medical Center
Introduction/Problem
The Intervention
Direct medical costs for Cardiovascular disease in the US alone accounted for $318 Billion in
2015, and sixty percent of all health care costs are charged for inpatient and emergency care.1
There is significant variability in admission rates for common cardiovascular conditions and
low risk patients are often admitted to the hospital from the emergency department (ED)2
Use of observation units for cardiac care within the ED is associated with significantly lower
rates of hospital admissions, fewer tests, and lower costs per patient.3,4
However, discharging patients with common cardiac symptoms to their home without
observation remains infrequent at BIDMC (29% during the 2 year period 2010-2012)
Patients are referred to the CDAc unit on an emergent (same day) or urgent (< 7 day) basis.
All patients are seen by a cardiology attending and with a care team including cardiac nurse
practitioners and nurses
We performed a retrospective review of 629 consecutive patients referred to the CDAc unit between
November 2016 and June 2017.
Final disposition was determined using charge data. The 30-day return rate to an ED, hospital, or the
CDAc unit was determined by follow-up phone calls and chart review.
Results
Aim/Goal
The Team
Karen Cajiao, MD, Cardiology Research
Joseph S. Wallins, MD, MPH, Internal Medicine Residency
Peter J. Zimetbaum, MD, Clinical Chief, Cardiology
Michael C. Gavin, MD, MPH, Medical Director, CDAc
Gail Lopez, RN, MS, Nurse Director, CDAc
Lynne Mackinson, RN, MS, Clinical Nurse Specialist, CDAc
Cindy Phelan, RN, MS, Associate Chief Nurse, CVI
Gail Piatkowski, Decision Support
Sarah Moravick, MBA, Director, Innovations & Improvement
Lorraine Britting, NP, Clin. Dir. For Advanced Prac. in Card.
John DiGiorgio, Business Manager, Cardiology
Shweta Motiwala, MD, Advanced Heart Failure
1. Cardiovascular Disease: A Costly Burden for America. Projections through 2035. American Heart Association. 2017. Accessed via Heart.org. 2. Butler J, et al.
Frequency of low-risk hospital admissions for heart failure. Am J Cardiol. 1998 Jan 1;81(1):41-4.). 3. Goodacre et al. Randomized controlled trial and economic
evaluation of a chest pain observation unit compared with routine care BMJ 2004; 328 :254. 4. Madsen T., et al. Cardiology consultation reduces provocative testing
rates. Am J Emerg Med, 35 (2017), pp. 25-28
% of patients
The Cardiac Direct Access (CDAc) unit was opened in November, 2016, with the aim of
providing high quality, low cost care for patients presenting with common cardiac
symptoms
We hypothesized that cardiology-managed urgent care can reduce testing and observation
stays for appropriate cardiac patients.
Disposition of Patients Referred to the CDAc Unit
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
DC without observation
Referred to ED
Observation in CDAc
Admitted
N = 629
N = 396
N = 148
N = 94
N = 54
All patients
461
5
113
50
Emergent
252
5
103
36
Chest Pain
80
3
54
11
Arrhythmia
70
0
20
4
CHF
27
1
10
16
For more information, contact:
Michael C. Gavin, MD, MPH, mgavin2@bidmc.harvard.edu
�Initial Impact of a Cardiology-Managed Outpatient Observation Unit
Joseph S. Wallins, MD, MPH, Karen Cajiao, MD, Gail Lopez, RN, MS, Lynn Mackinson, RN, MS, Cynthia Phelan, RN, MS, Peter J. Zimetbaum, MD, Michael C. Gavin, MD, MPH
Beth Israel Deaconess Medical Center
Results Cont.
Lessons Learned
Patients were referred by non-cardiologists (n=403, 64%) and cardiologists (n=226,
36%).
The mean length of stay in CDAc unit observation was 22+/-13 hours.
Among the 574 patients discharged from the CDAc, 62 (11%) were seen in an ED
and/or hospitalized, while 31 (5.4%) were seen in the CDAc within 30 days.
Utilization of observation among patients referred urgently (same day) to the CDAc unit
is significantly lower than historical averages in the Emergency Department
Despite this return rates to the ED are infrequent
Most patients referred to the CDAc with chest pain are managed without observation.
Over one quarter of patients referred to the CDAc for chest pain are deemed not to need
a stress test
In global payment/shared savings payment models, these findings suggest that the
CDAc unit is a high value care delivery model
Management of Patients with Chest Pain
Next Steps
Expand data review to the first 12 months experience
Identify a matched cohort of similar cardiac patients referred to the Emergency
Department and compare utilization between the ED and the CDAc
Better define financial impact of the CDAc among BIDCO patients
Develop telemedicine offerings for our network Emergency Departments, Urgent Care
Centers, and large Primary Care Practices.
For more information, contact:
Michael C. Gavin, MD, MPH, mgavin2@bidmc.harvard.edu
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Michael C. Gavin (<a href="mailto:mgavin2@bidmc.harvard.edu">mgavin2@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Cardiology
Project Team
Karen Cajiao
Joseph S. Wallins
Peter J. Zimetbaum
Michael C. Gavin
Gail Lopez
Lynne Mackinson
Cindy Phelan
Gail Piatkowski
Sarah Moravick
Lorraine Britting
John DiGiorgio
Shweta Motiwala
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Initial Impact of a Cardiology-Managed Outpatient Observation Unit
Date
A point or period of time associated with an event in the lifecycle of the resource
2018
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
Safety
Timeliness