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

Clinical and Experimental Emergency Medicine 2019년 6권 3호 p.196 ~ 203
 ( Monahan Ken ) - Vanderbilt Medical Center Division of Cardiovascular Medicine

 ( Pan Margaret ) - Vanderbilt Medical Center School of Medicine
 ( Opara Chinonso ) - Vanderbilt Medical Center School of Medicine
 ( Yiadom Maame Yaa A. B. ) - Vanderbilt Medical Center Department of Emergency Medicine
 ( Munoz Daniel ) - Vanderbilt Medical Center Division of Cardiovascular Medicine
 ( Holmes Benjamin B. ) - Vanderbilt Medical Center Division of Cardiovascular Medicine
 ( Stephen Davis ) - Vanderbilt Medical Center Division of Cardiovascular Medicine
 ( Swiger Kristopher J. ) - Vanderbilt Medical Center Division of Cardiovascular Medicine
 ( Collins Sean P. ) - Vanderbilt Medical Center Department of Emergency Medicine

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.

키워드

Emergency service, hospital; Chest pain; Acute coronary syndrome
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