title: Cardiology clinic follow-up did not decrease return visits to the ED for chest pain patients.
abstract: BACKGROUND
  We initiated a program to rapidly rule out myocardial infarction and make an appointment (with no co-payment) with a cardiologist within 72 hours for patients with low-risk chest pain.
  
  
  OBJECTIVE
  The objectives of this study were to determine if the rate of return emergency department (ED) visits for chest pain decreased among patients who kept their appointments and to evaluate factors that impacted clinic no-show rates.
  
  
  METHODS
  The study was conducted at a safety net facility with 65 000 adult patient visits per year. This study was a retrospective review of patients with chest pain discharged from the ED with a scheduled cardiology clinic appointment between October 2008 and December 2009. We compared those who kept their clinic appointment with those who did not for repeat ED visits for 6 months after the study period. Multivariate analysis evaluated factors associated with keeping appointments.
  
  
  RESULTS
  Of 381 patients, 265 (70%) kept their appointments. Show rates did not differ based on age, sex, race, or language. Patients with commercial insurance were more likely to keep appointments than Medicare, Medicaid, and uninsured (OR, 51.3; 95% confidence interval [CI], 2.53-1041.64; P = .010). The 116 no-show patients averaged 0.39 return ED visits (95% CI, 0.15-0.63), and the 265 patients who kept their appointments averaged 0.28 (95% CI, 0.17-0.39). Two hundred twenty-nine patients who kept their appointment had no return ED visits, but 36 patients had 74 return ED visits. There was no difference in return ED visits between the 18 who had diagnostic cardiac testing (mean, 1.78; 95% CI, 1.60-3.06) and the 18 who did not (mean, 2.33; 95% CI, 1.20-2.36; P = .251).
  
  
  CONCLUSIONS
  This program did not reduce repeat ED visits. Patients with insurance were more likely to keep follow-up appointments.
authors.affiliation: Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, NE. Electronic address: aaron.barksdale@unmc.edu.
authors.forename: Aaron
authors.initials: A
authors.lastname: Barksdale
authors.affiliation: Department of Emergency Medicine, Truman Medical Center/University of Missouri-Kansas City School of Medicine, Kansas City, Mo.
authors.forename: Jeff
authors.initials: J
authors.lastname: Hackman
authors.affiliation: Department of Biomedical and health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, Mo.
authors.forename: Aaron
authors.initials: A
authors.lastname: Bonham
authors.affiliation: Department of Emergency Medicine, Truman Medical Center/University of Missouri-Kansas City School of Medicine, Kansas City, Mo.
authors.forename: Matt
authors.initials: M
authors.lastname: Gratton
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D001071:Appointments and Schedules; D002309:Cardiology / Q000706:statistics & numerical data*; D002637:Chest Pain / Q000628:therapy*; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D064876:Safety-net Providers