Cardiology consultation reduces provocative testing rates in an ED observation unit

Madsen, Troy; Smyres, Cameron; Wood, Talmage; Moores, Tamara; Fuller, Matthew; Davis, Virgil; Bernhisel, Kurt

doi:10.1016/j.ajem.2016.09.032

Cited by 4 publications

(1 citation statement)

References 23 publications

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“…The current trial was specifically designed to assess the Moreover, nearly all definitely unnecessary consulted patients (98.5%) were quickly discharged from the ED after cardiologic evaluation. Our main aim was to (11). In this observational study conducted with 1190 patients with chest pain, mandatory cardiology consultation significantly decreased the rates of provocative testing.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Cardiology Consultation Quality and Quantity Requested from Emergency Departments in Turkey

Kahraman¹,

Oskay²,

Guler³

et al. 2022

esmj

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Introduction: Emergency cardiac consultation is a very big part of cardiology practice and there is not any trial evaluating this subject qualitatively and quantitatively with different perspectives yet. We wanted to investigate this process in terms of correlation between emergency physicians and cardiologists. Methods: Patients who are consulted in a cross-sectional and prospectively 5 different public hospitals were included in the study. In order to examine the nature and intensity of the cardiology consultations and also the diagnostic compatibility, electrocardiography (ECG) and to investigate the adequacy of the first medical treatment were chi-square and correlation analyzes. A P value <0.05 was accepted as a statistical significance limit. Results: Totally 627 patients (502 patients by practitioners and 125 patients by emergency medicine specialists) were consulted to cardiology. The most common admission cause was chest pain (%47.8), and the most common cause of consultation was having no/weak idea about patient’s clinical diagnosis (%39.9). The diagnosis consistency of 48% of consulted patients by EMS was excellent while it was 32.1% in practitioners (p=0.001). Good and excellent ECG interpretation of EMS was 72.8% and it was 50.7% in practitioners (p<0.001). Good and excellent first medical treatment were 46.4% in EMS while it was 38,4 in practitioners (p=0.05). Nearly half of consultations (48.8%) were considered as definitely unnecessary or unnecessary by cardiologists. There was statistically significant correlation between the necessity of consultation and last decision (r=0.811, p<0.001). Conclusion: There is a big variability in emergency cardiac consultations from the standpoint of consultation necessity, ECG interpretation, first medical management quality and accurate diagnosis.

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Section: Discussionmentioning

confidence: 99%

Evaluation of Cardiology Consultation Quality and Quantity Requested from Emergency Departments in Turkey

Kahraman¹,

Oskay²,

Guler³

et al. 2022

esmj

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Cardiac Direct Access Unit: A novel effort to leverage access to cardiologists to reduce hospitalization admissions

Gavin

Zimetbaum

Tuttle

et al. 2017

The American Journal of Emergency Medicine

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Impact of an Outpatient Cardiology-managed Urgent Access and Observation Unit on Hospital Admissions

Wallins

Cajiao

McCarthy

et al. 2019

Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine

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Introduction: Alternatives to the emergency department (ED) for expedient and high-value team-based cardiology care for patients with chest pain, volume overload, palpitations, and other urgent, but not life-threatening cardiac conditions are lacking. Here, we report on the development of the Cardiac Direct Access Unit (CDAc), an ambulatory cardiology unit with exam rooms, observation bays, and an advanced heart failure clinic. Methods: Patients referred to the CDAc are seen same-day by an attending cardiologist in a space independent from the ED. We performed a retrospective review of 1146 consecutive patients referred to the CDAc in its first year of operation. Among patients who were referred for urgent same-day evaluation, 60.1% were discharged home without observation. Results: Among the patients observed or directly discharged from CDAc, 2.4% were readmitted within 30 days for a related symptom. The highest rate of readmission (7.5%) was for heart failure, which compares favorably with guidelines for readmission benchmarks. Conclusion: Our first year of data suggests that a cardiology-directed observation unit may serve as a high-value alternative to the ED for appropriately selected patients.

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Cardiology consultation reduces provocative testing rates in an ED observation unit

Cited by 4 publications

References 23 publications

Evaluation of Cardiology Consultation Quality and Quantity Requested from Emergency Departments in Turkey

Evaluation of Cardiology Consultation Quality and Quantity Requested from Emergency Departments in Turkey

Cardiac Direct Access Unit: A novel effort to leverage access to cardiologists to reduce hospitalization admissions

Impact of an Outpatient Cardiology-managed Urgent Access and Observation Unit on Hospital Admissions

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