Changing cardiac referral processes to opt-out rather than opt-in may significantly increase referral rates, according to research presented at ACC’s NCDR Annual Conference (NCDR.18) in Orlando.

The study, a collaboration between the Hospital of the University of Pennsylvania and the Penn Medicine Center for Healthcare Innovation, designed intelligent alerts based on ACC’s CathPCI Registry metrics and patient electronic medical record data to alert the Coronary Artery Disease Transitions Coordinator and Case Management Team every morning about which patients could qualify for cardiac rehab.

More than 40 cardiac rehab facilities in Philadelphia and surrounding counties were contacted to ensure they would take patients from the hospital and endorse this referral process. If a patient wanted to enroll in a cardiac rehab program, staff helped them choose a facility in their ZIP code region. The staff member then forwarded the referral to the cardiac rehab facility. The transition coordinator contacted patients within a week of discharge to ask about their plans and facilitated their enrollment into cardiac rehab.

The cardiac team – which included bedside registered nurses, advanced practice providers, physicians and case managers – was also educated on the benefits of cardiac rehab. Educational materials were provided to discharging nursing units to distribute to all patients after a heart attack or PCI. Staff discussed the benefits of cardiac rehab with eligible patients prior to discharge.

In the 21 months before implementing the program, the hospital’s average cardiac rehab referral rate was 12 percent. After the program was implemented, the cardiac referral rate increased to 75 percent in the following three quarters. In two other hospitals in the University of Pennsylvania health system, the full program was not implemented, but awareness of the importance of cardiac rehab was raised. In those hospitals, the cardiac rehab referral rate rose from 4.2 to 24.8 percent at one hospital and from 4 to 25.4 percent at the second hospital.

“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 lead researcher Elizabeth Jolly, RN, BSN, MBA. She noted that before the new program was implemented, there was no structured referral process for cardiac rehab at the hospital. “We started bringing cardiac rehab into our conversations with patients and adding it to discharge documentation and conversations following discharge as well,” she said. “Now this is part of our daily workflow.”

Keywords: ACC18, National Cardiovascular Data Registries, Coronary Artery Disease, Case Management, Workflow, Philadelphia, Myocardial Infarction, Patient Discharge, Registries, Patient Transfer, Referral and Consultation, Electronic Health Records, Documentation, Percutaneous Coronary Intervention

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