While the need to address disparities in care is well known, few strategies for reducing disparities have been studied systematically.
Increase acute myocardial infarction (AMI) heart attack patients’ participation in post-discharge rehabilitation.
Modified order set in electronic medical record (EMR) and made appointments for rehabilitation at the bedside before patient discharge.
Referral rates to cardiac rehabilitation are approximately 60 percent higher than the national average.
640 Jackson Street
St. Paul, MN 55101
Ph: (651) 254:3456
From the Experts:
“We are helping our patients transition more effectively to the outpatient setting. The slight changes we implemented will make a significant difference in patient outcomes.”
Gretchen Leiterman, M.B.A.
Vice President of Cardiovascular Services & Quality
Regions Hospital is a full-service, private hospital providing medical care, with special programs in heart, cancer, behavioral health, burn, emergency and trauma.
Clinical areas affected:
It took several months for the team to develop strategies to improve referral rates, secure buy-in, and work with the nurse practitioners and IT and EMR staff to implement.
Regional Manager of Cardiovascular Outreach Operations
Ph: (651) 254-2346
Patients who have recently experienced heart attacks (acute myocardial infarction) benefit from the counseling and lifestyle modifications offered in cardiac rehabilitation. Research has shown that minorities are less likely to receive the necessary procedures and treatment for cardiac care. Nationally, experts say that only 18 percent of all patients who have experienced an acute myocardial infarction received referrals for rehabilitation after discharge.
Reviewing the existing process of patient referrals and identifying potential hurdles of compliance, the team at Regions Hospital discovered that discharge order sets were often not triggering recommendations for cardiac rehabilitation, and if they were, the responsibility to schedule rehabilitation sessions rested solely with patients once they returned home. Unfortunately, this often meant that none were scheduled and the patient did not participate in the necessary post-discharge rehabilitation.
To address these challenges, the Regions team decided that altering the first part of the discharge process was key. Modifying the discharge process required changes in the hospital’s electronic medical record. The team worked with the cardiac care department chair to raise the issue that the EMR needed to be modified to automatically recommend referrals for cardiac rehabilitation. The cardiac care chair raised this issue with executive-level staff and secured their buy-in to implement the new policy. By working with the hospital’s IT staff, the team was able to ensure the discharge order sets for cardiac patients included a pre-checked order for referrals to rehabilitation.
Next, the team informed nurses of the change by posting flyers that instruct them to notify rehab staff if there is a discharge order for rehabilitation when this happens. Cardiac rehab staff are summoned to the patient’s bedside to schedule rehabilitation sessions. At this time, patients are given all the information about their appointment, including the date, time and directions.
Advice and lessons learned:
This simple change had no significant cost increase associated with it but had the effect of increasing cardiac rehabilitation referrals to levels well above the national average, which led to improved patient outcomes and reduced mortality rates.
Poor care coordination contributes to the issue of avoidable readmissions.Learn more
RWJF examines the types of competitive foods - foods and beverages schools offer outside of meal programs - available in our nation's school...
Progress and lessons learned from two programs that seek to advance the impact digital games can have on health.
Joint Commission Resources in Oak Brook Ill., oversaw development and testing of an online course and support materials to improve communica...
The rapid rise of antibiotic resistance can be tracked using ResistanceMap, an online tool that visually highlights regions of the country w...
Report examines, compares and contrasts Massachusetts and Utah health insurance exchanges.
Report examines issues states will face as they integrate Medicaid into the exchange.
This poll shows most Americans believe the quality of U.S. health care is average at best. More than half of American adults surveyed barely...
Want to improve health? Start with where we live, work, learn and play.
Health care reform may create incentives to spur the growth in HDHPs and CDHPs, a move that might help hold costs down?at least for a time.
The authors suggest repairing the health care system by realigning provider incentives, increasing the availability of information with whic...
While the ACA is aimed primarily at improving individual health by increasing access to health insurance, it also contains a number of provi...