After a major hospital adopted several institutional changes to better manage patients after percutaneous coronary intervention (PCI), readmission rates fell by nearly half, an internal analysis found.
Hospital readmits at Boston’s Massachusetts General Hospital declined from 9.6% in 2011 — the year the changes were first implemented — to 5.3% in 2015, according to a group there led by Jason H. Wasfy, MD, MPhil.
They attributed the reduction to their program, which included the following elements:
- Patient education videos on chest pain after PCI
- Use of a risk score and discharge checklist during initial hospitalization
- A new follow-up clinic staffed with cardiology fellows
- Automatic notifications for cardiologists when patients present to the emergency room within 30 days of PCI
- Early assessment when PCI recipients go to the emergency department (triage assisted by a cardiologist and a risk stratification algorithm)
“This program could provide tangible structural changes that can be implemented in other healthcare centers, both reducing the cost of care and improving the quality of care for patients with PCI,” the investigators reported online in Circulation: Cardiovascular Quality and Outcomes.
They acknowledged that it wasn’t easy.
“For example, with electronic notifications when patients present to the emergency department, physicians are now encouraged to see patients more rapidly than they may have previously. In addition, medical residents are not used to a discharge checklist or prescribing videos for their patients to watch at home,” according to Wasfy’s group.
Changing the workflow required time and a large team effort, they also noted, writing that they “worked with nurses, medical residents, pharmacists, and information technology specialists to create and implement these interventions in full over 1 year.”
Wasfy disclosed his unpaid membership in the Cardiac Conditions Working Group of the US Department of Health and Human Services Learning and Action Network.
Circulation: Cardiovascular Quality and Outcomes
Tanguturi V, et al “Clinical interventions to reduce preventable hospital readmission after percutaneous coronary intervention” Circ Cardiovasc Qual Outcomes 2016; DOI: 10.1161/CIRCOUTCOMES.116.003086.