Getting to the Heart of the Matter: A Triage Model to Improve Utilization of Cardiology Consultative Services

Joseph K Agor; Mustafa Y Sir; Kalyan S Pasupathy; David A Foley; Christopher G Scott; Muhamad Y Elrashidi; Nathan P Young; Paul M McKie

doi:10.1016/j.mayocpiqo.2019.08.003

Getting to the Heart of the Matter: A Triage Model to Improve Utilization of Cardiology Consultative Services

Mayo Clin Proc Innov Qual Outcomes. 2019 Oct 22;3(4):476-482. doi: 10.1016/j.mayocpiqo.2019.08.003. eCollection 2019 Dec.

Authors

Joseph K Agor¹, Mustafa Y Sir², Kalyan S Pasupathy², David A Foley³, Christopher G Scott⁴, Muhamad Y Elrashidi⁵, Nathan P Young⁶, Paul M McKie³

Affiliations

¹ School of Mechanical, Industrial, and Manufacturing Engineering, Oregon State University, Corvallis.
² Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.
³ Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
⁴ Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN.
⁵ Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN.
⁶ Department of Neurology, Mayo Clinic, Rochester, MN.

Abstract

Objective: To assess the impact of a triage system of emergency department (ED) referrals for outpatient cardiology appointments.

Patient and methods: We implemented a triage system of ED referrals for outpatient cardiology appointments among patients with a cardiovascular chief complaint deemed safe to leave the ED but needing outpatient follow-up. There were 303 and 267 unique patients in the pre-triage implementation and post-triage implementation cohorts, respectively. We collected retrospective billing data to assess ED return visits, hospitalizations, cardiology outpatient visits, and cardiovascular testing. The pre-triage implementation cohort included patients with an ED visit date between January 1, 2014, and December 31, 2014. The post-triage implementation cohort included patients with an ED visit date between July 1, 2015, and June 30, 2016.

Results: The triage model reduced the number of ED-referred cardiovascular service appointments by 73.0% (195 of 267 patients). Additionally, the "no-show" rate for appointments decreased from 17.8% (54 of 303 patients) to 7.9% (21 of 267 patients). There was no increase in ED return visits or unplanned hospitalizations in the posttriage cohort. Finally, the triage model was not associated with an increase in resource-intensive cardiovascular testing (eg, imaging stress tests or computed tomography).

Conclusion: Triage of ED referrals for outpatient cardiovascular service appointments reduced cardiology appointment utilization with no impact on return ED visits, hospitalizations, or cardiovascular testing.

Keywords: CV, cardiovascular; ED, emergency department.