According to the American College of Cardiology's NCDR Annual Conference in Orlando, a technology-based programme that changes cardiac referral processes to opt-out rather than opt-in has significantly improved referral rates. In addition, the programme offers resources to both staff and patients that highlight the importance and significance of cardiac rehab.
Cardiac rehab programmes are designed to help improve cardiovascular health in patients who have suffered a heart attack, heart failure, heart surgery or angioplasty. Rehab programmes reduce the risk of death and readmissions and also improve the patient's quality of life.
Most cardiac rehab programmes include exercise counselling and training. Patients are also provided information regarding heart-healthy living which includes strategies for smoking cessation and stress reduction.
In order to evaluate cardiac rehab programmes, a study was conducted with patients who had a heart attack or stent replacement. Lead researcher Elizabeth Jolly, RN, BSN, MBA, interventional cardiology transitions coordinator at the Hospital of the University of Pennsylvania in Philadelphia in collaboration with the Penn Medicine Center for Healthcare Innovation designed intelligent alerts from patients' electronic medical records to alert the Coronary Artery Disease Transitions Coordinator and Case Management Team every morning about which patients could qualify for cardiac rehab. The study included 40 cardiac rehab facilities in Philadelphia and surrounding areas.
The research team contacted the facilities to make sure the patients were taken from the hospital and the referral process was properly endorsed. For patients who agreed to enroll into a cardiac rehab programme, the staff would help them find a nearby location and would forward the referral to that particular facility. Patients would be contacted within a week of discharge by a transition coordinator to ask them about the plan.
Jolly and her team educated the cardiac team about the benefits of cardiac rehab. The cardiac team included bedside registered nurses, advanced practice providers, physicians and case managers. Discharging nursing units were provided educational materials so that they could distribute them to patients after a heart attack or PCI. Benefits of cardiac rehab were discussed with eligible patients before they were discharged from the hospital.
The hospital's average cardiac rehab referral rate was 12 percent before the programme was implemented. This increased to 75 percent in the three quarters following implementation. The programme was partially implemented in two other hospitals in the University of Pennsylvania health system. Referral rates increased from 4.2 to 24.8 percent at one hospital and from 4 to 25.4 percent at the second hospital even after partial implementation.
"Cardiac rehab gives patients an opportunity to get back to or begin exercising safely under the guidance of a specialist and helps them understand medications they've been placed on," said Elizabeth Jolly. She highlighted that before this programme was implemented, healthcare providers who thought a certain patient would benefit from rehab would hand the patient a handwritten prescription. They did not have the tools to get them there though.
"At a big institution like ours, we have so many patients that it's not always evident who qualifies for cardiac rehab. Now we know in real time. We started bringing cardiac rehab into our conversations with patients and adding it to discharge documentation and conversations following discharge as well. Now this is part of our daily workflow," Jolly said.
Source: American College of Cardiology
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cardiovascular health, Cardiac Rehab, referral rates, heart-healthy living
According to the American College of Cardiology's NCDR Annual Conference in Orlando, a technology-based programme that changes cardiac referral processes to opt-out rather than opt-in has significantly improved referral rates.
