Clinical Interventions to Reduce Preventable Hospital Readmission After Percutaneous Coronary Intervention

Abstract

Abstract-Hospital readmissions are common and costly and, in some cases, may be related to problems with care processes. We sought to reduce readmissions after percutaneous coronary intervention (PCI) in a large tertiary care facility through programs to target vulnerabilities predischarge, after discharge, and during re-presentation to the emergency department. During initial hospitalization, we assessed patients' readmission risk with a validated risk score and used a discharge checklist to ensure access to appropriate medications and close follow-up for high-risk patients. We also developed patient education videos about chest discomfort and heart failure. After discharge, we established a new follow-up clinic with cardiology fellows. A computerized system was developed to automatically notify cardiologists when patients presented to the emergency department within 30 days of PCI to enhance patient access to cardiology care in the emergency department. Early cardiologist assessment and assistance with triage was encouraged, and the emergency department used a risk stratification algorithm derived from a local database of patients to triage patients presenting with chest discomfort after PCI. We tracked the number of patients readmitted after PCI to our hospital. With our interventions, from 2011 to 2015, the index hospital readmission rate has declined from 9.6% to 5.3%. This program could provide tangible structural changes that can be implemented in other healthcare centers, both reducing the cost of care and improving the quality of care for patients with PCI. (Circ Cardiovasc Qual Outcomes. 2016;9:600-604.

Trends and variations in the prescribing of secondary preventative cardiovascular therapies for non-ST elevation myocardial infarction (NSTEMI) in Malaysia

“…Recommendations for improvement should include establishment of hospital-based approaches such as medication checklists [41]. Information technology should be integrated to support decision-making and allows in-hospital prescribing to be followed up at discharge [42].…”

Should We Care About Short-Term Readmissions After Percutaneous Coronary Intervention?

“…Similarly, as low-risk chest pain is often the presentation leading to readmission after PCI (13,14,23,24), improved triage of post-PCI patients to identify the appropriate diagnostic and treatment pathway for these individuals may hasten evaluation and lead to safe discharge from the emergency department. Tanguturi et al demonstrated that a multi-dimensional approach towards readmission reduction utilizing a validated questionnaire to identify patients at high risk for readmission after PCI with subsequent targeted interventions in this group resulted in an absolute decline in readmissions from 9.6% to 5.3% over a 4 year period at one institution (26). A discharge checklist was used to ensure high risk patients had the appropriate discharge medications and close follow-up (26).…”

“…Tanguturi et al demonstrated that a multi-dimensional approach towards readmission reduction utilizing a validated questionnaire to identify patients at high risk for readmission after PCI with subsequent targeted interventions in this group resulted in an absolute decline in readmissions from 9.6% to 5.3% over a 4 year period at one institution (26). A discharge checklist was used to ensure high risk patients had the appropriate discharge medications and close follow-up (26). These higher risk patients were additionally shown educational videos on chest discomfort and heart failure, and upon re-presentation to the emergency room, their outpatient cardiologist was notified electronically with early cardiology assessment encouraged, and triage decisions made according to a risk stratification algorithm developed (26).…”

“…A discharge checklist was used to ensure high risk patients had the appropriate discharge medications and close follow-up (26). These higher risk patients were additionally shown educational videos on chest discomfort and heart failure, and upon re-presentation to the emergency room, their outpatient cardiologist was notified electronically with early cardiology assessment encouraged, and triage decisions made according to a risk stratification algorithm developed (26). Thus, multidimensional targeted approaches may be successful at reducing readmission in this population.…”

Reprising Ramadan-Related Angina Pectoris: A Potential Strategy for Risk Reduction

“…We wish to thank our patient for consenting to this report and the many cardiovascular specialists who contributed to his recovery utilizing a novel risk stratification algorithm designed to reduce preventable readmissions after percutaneous coronary interventions [18]. …”