Ian G Stiell1,2, Lisa Mielniczuk3, Heather D Clark4, Guy Hebert5, Monica Taljaard6,7, Alan J Forster7, George A Wells7,8, Catherine M Clement7, Jennifer Brinkhurst7, Erica L Brown7, Marie-Joe Nemnom7, Jeffrey J Perry5,7. 1. Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada. istiell@ohri.ca. 2. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada. istiell@ohri.ca. 3. Division of Cardiology, University of Ottawa Heart Institute, University of Ottawa, Ottawa, ON, Canada. 4. Division of Internal Medicine, Department of Medicine, University of Ottawa, Ottawa, ON, Canada. 5. Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada. 6. Clinical Epidemiology Program, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada. 7. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada. 8. University of Ottawa Heart Institute, University of Ottawa, Ottawa, ON, Canada.
Abstract
INTRODUCTION: Acute heart failure patients often have an uncertain or delayed follow-up after discharge from the ED. Our goal was to introduce rapid-access specialty clinics to ensure acute heart failure patients were seen within 7 days, in an effort to reduce admissions and improve follow-up care. METHODS: This prospective cohort study was conducted at two campuses of a large tertiary care hospital. We enrolled acute heart failure patients who presented to the ED with shortness of breath and were later discharged. Following a 12-month before period, we introduced rapid-access acute heart failure clinics staffed by cardiology and internal medicine. We allowed for a 3-month implementation period and then observed outcomes over the subsequent 12-month after period. The primary outcome was hospital admission within 30 days. Secondary outcomes included mortality and actual access to specialty care. RESULTS: Patients in the before (N = 355) and after periods (N = 374) were similar for age and most characteristics. Segmented autoregression analysis demonstrated there was a pre-existing trend to fewer admissions. Attendance at a specialty clinic increased from 17.8 to 42.1% (P < 0.01) and the median days to the clinic decreased from 13 to 6 days (P < 0.01). 30-days mortality did not change. CONCLUSION: Implementation of rapid-access clinics for acute heart failure patients discharged from the ED did not lead to an overall decrease in hospital admissions. It did, however, lead to increased access to specialist care, reduced follow-up times, without an increase in return ED visits or mortality. Widespread use of this rapid-access approach to a specialist can improve care for acute heart failure patients discharged home from the ED.
INTRODUCTION:Acute heart failurepatients often have an uncertain or delayed follow-up after discharge from the ED. Our goal was to introduce rapid-access specialty clinics to ensure acute heart failurepatients were seen within 7 days, in an effort to reduce admissions and improve follow-up care. METHODS: This prospective cohort study was conducted at two campuses of a large tertiary care hospital. We enrolled acute heart failurepatients who presented to the ED with shortness of breath and were later discharged. Following a 12-month before period, we introduced rapid-access acute heart failure clinics staffed by cardiology and internal medicine. We allowed for a 3-month implementation period and then observed outcomes over the subsequent 12-month after period. The primary outcome was hospital admission within 30 days. Secondary outcomes included mortality and actual access to specialty care. RESULTS:Patients in the before (N = 355) and after periods (N = 374) were similar for age and most characteristics. Segmented autoregression analysis demonstrated there was a pre-existing trend to fewer admissions. Attendance at a specialty clinic increased from 17.8 to 42.1% (P < 0.01) and the median days to the clinic decreased from 13 to 6 days (P < 0.01). 30-days mortality did not change. CONCLUSION: Implementation of rapid-access clinics for acute heart failurepatients discharged from the ED did not lead to an overall decrease in hospital admissions. It did, however, lead to increased access to specialist care, reduced follow-up times, without an increase in return ED visits or mortality. Widespread use of this rapid-access approach to a specialist can improve care for acute heart failurepatients discharged home from the ED.
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