Background
A small percentage of the population represents a disproportionate number of attendances
at emergency departments (ED). “Frequent presenters” to ED with chest pain do not
always fit into established pathways for acute myocardial events. With accelerated
“rule out” protocols, patients are often discharged from the ED after short lengths
of stay. This research will evaluate the effectiveness of a phone based care-coordination
pilot designed to meet the needs of patients attending ED with cardiac and non-cardiac
chest pain.
Methods
A longitudinal, single-arm interventional study with retrospectively recruited control
group. Ninety-five patients were enrolled as the intervention group; 97 patients were
retrospectively identified as controls. These patients had re-presented with chest
pain within 6 months of a cardiac event, or attended hospital within 12 months two
or more times with chest pain and/or complex needs. Intervention group patients were
holistically assessed then phone-coached to support self-management of chest pain
over 6 months. Following descriptive and univariate analysis, multivariate analysis
was conducted to adjust for noted differences between the intervention and control
groups.
Results
Thirty-day representation to ED was significantly less for the intervention group
(14.1%) compared to controls (27.7%). After adjusting for baseline differences, intervention
patients were more than two-fold less likely to re-present compared to controls (OR = 0.42, 95%CI: 0.19–0.96). After adjustment for baseline differences, the savings in
subsequent inpatient costs was $1588 per person, as a result of intervention, patients
were less likely to have inpatient readmissions (16.3%) compared to controls (20.2%),
although this was not statistically significant (p = 0.588).
Conclusion
A phone based care-coordination pilot with targeted interventions has the potential
to reduce ED presentations and hospital readmissions among patients representing with
chest pain.
Keywords
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Article info
Publication history
Published online: April 19, 2017
Accepted:
March 6,
2017
Received in revised form:
March 1,
2017
Received:
January 14,
2017
Identification
Copyright
© 2017 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
