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Potential impact of cardiology phone-consultation for patients risk-stratified by the HEART pathway
OBJECTIVE: Bedside consultation by cardiologists may facilitate safe discharge of selected patients from the emergency department (ED) even when admission is recommended by the History, Electrocardiogram, Age, Risk factors, Troponin (HEART) pathway. If bedside evaluation is unavailable, phone consul...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
The Korean Society of Emergency Medicine
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6774010/ https://www.ncbi.nlm.nih.gov/pubmed/31295990 http://dx.doi.org/10.15441/ceem.18.066 |
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author | Monahan, Ken Pan, Margaret Opara, Chinonso Yiadom, Maame Yaa A. B. Munoz, Daniel Holmes, Benjamin B. Stephen, Davis Swiger, Kristopher J. Collins, Sean P. |
author_facet | Monahan, Ken Pan, Margaret Opara, Chinonso Yiadom, Maame Yaa A. B. Munoz, Daniel Holmes, Benjamin B. Stephen, Davis Swiger, Kristopher J. Collins, Sean P. |
author_sort | Monahan, Ken |
collection | PubMed |
description | OBJECTIVE: Bedside consultation by cardiologists may facilitate safe discharge of selected patients from the emergency department (ED) even when admission is recommended by the History, Electrocardiogram, Age, Risk factors, Troponin (HEART) pathway. If bedside evaluation is unavailable, phone consultation between emergency physicians and cardiologists would be most impactful if the resultant disposition is discordant with the HEART pathway. We therefore evaluate discordance between actual disposition and that suggested by the HEART pathway in patients presenting to the ED with chest pain for whom cardiology consultation occurred exclusively by phone and to assess the impact of phone-consultation on disposition. METHODS: We performed a single-center, retrospective study of adults presenting to the ED with chest pain whose emergency physician had a phone consultation with a cardiologist. Actual disposition was abstracted from the medical record. HEART pathway category (low-risk, discharge; high-risk, admit) was derived from ED documentation. For discharged patients, major adverse cardiac events were assessed at 30 days by chart review and phone follow-up. RESULTS: For the 170 patients that had cardiologist phone consultation, discordance between actual disposition and the HEART pathway was 17%. The HEART pathway recommended admission for nearly 80% of discharged patients. Following cardiologist phone-consultation, 10% of high-risk patients were discharged, with the majority having undergone a functional study recommended by the cardiologist. At 30 days, discharged patients had experienced no episodes of major adverse cardiac events or rehospitalization for cardiac reasons. CONCLUSION: For patients presenting to the ED with chest pain, cardiology phone-consultation has the potential to safely impact disposition, primarily by facilitating functional testing in high-risk individuals. |
format | Online Article Text |
id | pubmed-6774010 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | The Korean Society of Emergency Medicine |
record_format | MEDLINE/PubMed |
spelling | pubmed-67740102019-10-09 Potential impact of cardiology phone-consultation for patients risk-stratified by the HEART pathway Monahan, Ken Pan, Margaret Opara, Chinonso Yiadom, Maame Yaa A. B. Munoz, Daniel Holmes, Benjamin B. Stephen, Davis Swiger, Kristopher J. Collins, Sean P. Clin Exp Emerg Med Original Article OBJECTIVE: Bedside consultation by cardiologists may facilitate safe discharge of selected patients from the emergency department (ED) even when admission is recommended by the History, Electrocardiogram, Age, Risk factors, Troponin (HEART) pathway. If bedside evaluation is unavailable, phone consultation between emergency physicians and cardiologists would be most impactful if the resultant disposition is discordant with the HEART pathway. We therefore evaluate discordance between actual disposition and that suggested by the HEART pathway in patients presenting to the ED with chest pain for whom cardiology consultation occurred exclusively by phone and to assess the impact of phone-consultation on disposition. METHODS: We performed a single-center, retrospective study of adults presenting to the ED with chest pain whose emergency physician had a phone consultation with a cardiologist. Actual disposition was abstracted from the medical record. HEART pathway category (low-risk, discharge; high-risk, admit) was derived from ED documentation. For discharged patients, major adverse cardiac events were assessed at 30 days by chart review and phone follow-up. RESULTS: For the 170 patients that had cardiologist phone consultation, discordance between actual disposition and the HEART pathway was 17%. The HEART pathway recommended admission for nearly 80% of discharged patients. Following cardiologist phone-consultation, 10% of high-risk patients were discharged, with the majority having undergone a functional study recommended by the cardiologist. At 30 days, discharged patients had experienced no episodes of major adverse cardiac events or rehospitalization for cardiac reasons. CONCLUSION: For patients presenting to the ED with chest pain, cardiology phone-consultation has the potential to safely impact disposition, primarily by facilitating functional testing in high-risk individuals. The Korean Society of Emergency Medicine 2019-07-12 /pmc/articles/PMC6774010/ /pubmed/31295990 http://dx.doi.org/10.15441/ceem.18.066 Text en Copyright © 2019 The Korean Society of Emergency Medicine This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/). |
spellingShingle | Original Article Monahan, Ken Pan, Margaret Opara, Chinonso Yiadom, Maame Yaa A. B. Munoz, Daniel Holmes, Benjamin B. Stephen, Davis Swiger, Kristopher J. Collins, Sean P. Potential impact of cardiology phone-consultation for patients risk-stratified by the HEART pathway |
title | Potential impact of cardiology phone-consultation for patients risk-stratified by the HEART pathway |
title_full | Potential impact of cardiology phone-consultation for patients risk-stratified by the HEART pathway |
title_fullStr | Potential impact of cardiology phone-consultation for patients risk-stratified by the HEART pathway |
title_full_unstemmed | Potential impact of cardiology phone-consultation for patients risk-stratified by the HEART pathway |
title_short | Potential impact of cardiology phone-consultation for patients risk-stratified by the HEART pathway |
title_sort | potential impact of cardiology phone-consultation for patients risk-stratified by the heart pathway |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6774010/ https://www.ncbi.nlm.nih.gov/pubmed/31295990 http://dx.doi.org/10.15441/ceem.18.066 |
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