Clin Exp Emerg Med.  2019 Sep;6(3):196-203. 10.15441/ceem.18.066.

Potential impact of cardiology phone-consultation for patients risk-stratified by the HEART pathway

Affiliations
  • 1Division of Cardiovascular Medicine, Vanderbilt Medical Center, Nashville, TN, USA. ken.monahan@vanderbilt.edu
  • 2School of Medicine, Vanderbilt Medical Center, Nashville, TN, USA.
  • 3Department of Emergency Medicine, Vanderbilt Medical Center, Nashville, TN, USA.

Abstract


OBJECTIVE
Bedside consultation by cardiologists may facilitate safe discharge of selected patients from the emergency department (ED) even when admission is recommended by the History, Electrocardiogram, Age, Risk factors, Troponin (HEART) pathway. If bedside evaluation is unavailable, phone consultation between emergency physicians and cardiologists would be most impactful if the resultant disposition is discordant with the HEART pathway. We therefore evaluate discordance between actual disposition and that suggested by the HEART pathway in patients presenting to the ED with chest pain for whom cardiology consultation occurred exclusively by phone and to assess the impact of phone-consultation on disposition.
METHODS
We performed a single-center, retrospective study of adults presenting to the ED with chest pain whose emergency physician had a phone consultation with a cardiologist. Actual disposition was abstracted from the medical record. HEART pathway category (low-risk, discharge; high-risk, admit) was derived from ED documentation. For discharged patients, major adverse cardiac events were assessed at 30 days by chart review and phone follow-up.
RESULTS
For the 170 patients that had cardiologist phone consultation, discordance between actual disposition and the HEART pathway was 17%. The HEART pathway recommended admission for nearly 80% of discharged patients. Following cardiologist phone-consultation, 10% of high-risk patients were discharged, with the majority having undergone a functional study recommended by the cardiologist. At 30 days, discharged patients had experienced no episodes of major adverse cardiac events or rehospitalization for cardiac reasons.
CONCLUSION
For patients presenting to the ED with chest pain, cardiology phone-consultation has the potential to safely impact disposition, primarily by facilitating functional testing in high-risk individuals.

Keyword

Emergency service, hospital; Chest pain; Acute coronary syndrome

MeSH Terms

Acute Coronary Syndrome
Adult
Cardiology*
Chest Pain
Electrocardiography
Emergencies
Emergency Service, Hospital
Follow-Up Studies
Heart*
Humans
Medical Records
Retrospective Studies
Risk Factors
Troponin
Troponin
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