NEW YORK (Reuters Health) – Doctors at one Boston hospital cut their readmission rate after percutaneous coronary intervention (PCI) from 9.6% to 5.3% over a four-year period, they say.
The initiative at the Massachusetts General Hospital, phased in between 2011 and 2015, included interventions during hospitalization (a readmission-risk assessment and a discharge checklist), after discharge (an urgent access clinic), and during re-presentation to the emergency department (a special triage protocol), as well as patient-education videos.
This program “could potentially provide evidence-based tactics that can be implemented in other healthcare centers, to both reduce the cost of care and improve the quality of care for patients after PCI,” the authors wrote online August 23 in Circulation: Cardiovascular Quality and Outcomes.
Before PCI, a readmission risk score is calculated based on age, sex, admission status, insurance status, and comorbidities. Besides raising awareness of a patient’s risk of readmission, the risk score aims to encourage greater scrutiny of bleeding avoidance strategies and of contrast use.
As the patient nears discharge, a discharge checklist smoothes the transition to outpatient care, with components including a prescription for sublingual nitroglycerin, confirmation of insurance coverage of prescribed antiplatelet agents, and a recommendation for timely follow-up, especially for patients at high readmission risk according to either the risk score or the clinician’s assessment.
Given evidence that close follow-up can reduce readmissions, the researchers encourage cardiologists to see patients within two weeks of discharge.
“We had noted that our clinic slots were full for months, so patients were often scheduled for follow-up far too long after PCI,” coauthor Dr. Jason H. Wasfy told Reuters Health by email. Therefore, to ease the way for recently discharged PCI patients to be seen for follow-up, they reorganized the cardiology fellows’ rotations to create an urgent-access “post-myocardial infarction” clinic.
“Critically,” Wasfy said, “no matter which cardiology fellow took care of the patient in the hospital, any patient could be served in this clinic. This flexibility improved outpatient access for our patients.”
Finally, a triage protocol was developed for the emergency department, to help distinguish patients with truly low-risk chest pain. Early assessment by cardiologists is a key component, so there is an automatic notification of the cardiologist if a patient re-presents to the emergency department within 30 days of PCI.
“This type of work is a wonderful way to improve quality and safety, while also reducing costs and unneeded utilization. So much of our work is the blocking and tackling of healthcare, making sure that patients are knowledgeable and empowered, and ensuring they have access to cardiologists, both in the outpatient offices and, if needed, in the emergency department,” Wasfy concluded.