title: Clinical Interventions to Reduce Preventable Hospital Readmission After Percutaneous Coronary Intervention.
abstract: Hospital readmissions are common and costly and, in some cases, may be related to problems with care processes. We sought to reduce readmissions after percutaneous coronary intervention (PCI) in a large tertiary care facility through programs to target vulnerabilities predischarge, after discharge, and during re-presentation to the emergency department. During initial hospitalization, we assessed patients' readmission risk with a validated risk score and used a discharge checklist to ensure access to appropriate medications and close follow-up for high-risk patients. We also developed patient education videos about chest discomfort and heart failure. After discharge, we established a new follow-up clinic with cardiology fellows. A computerized system was developed to automatically notify cardiologists when patients presented to the emergency department within 30 days of PCI to enhance patient access to cardiology care in the emergency department. Early cardiologist assessment and assistance with triage was encouraged, and the emergency department used a risk stratification algorithm derived from a local database of patients to triage patients presenting with chest discomfort after PCI. We tracked the number of patients readmitted after PCI to our hospital. With our interventions, from 2011 to 2015, the index hospital readmission rate has declined from 9.6% to 5.3%. This program could provide tangible structural changes that can be implemented in other healthcare centers, both reducing the cost of care and improving the quality of care for patients with PCI.
authors.affiliation: From the Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (V.K.T.); Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (E.T.); Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (R.W.Y.); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (R.W.T., A.M.); and Massachusetts General Physicians Organization, Harvard Medical School, Boston, MA (S.K.R., E.C., T.G.F., J.H.W.).
authors.forename: Varsha K
authors.initials: VK
authors.lastname: Tanguturi
authors.affiliation: From the Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (V.K.T.); Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (E.T.); Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (R.W.Y.); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (R.W.T., A.M.); and Massachusetts General Physicians Organization, Harvard Medical School, Boston, MA (S.K.R., E.C., T.G.F., J.H.W.).
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Temin
authors.affiliation: From the Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (V.K.T.); Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (E.T.); Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (R.W.Y.); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (R.W.T., A.M.); and Massachusetts General Physicians Organization, Harvard Medical School, Boston, MA (S.K.R., E.C., T.G.F., J.H.W.).
authors.forename: Robert W
authors.initials: RW
authors.lastname: Yeh
authors.affiliation: From the Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (V.K.T.); Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (E.T.); Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (R.W.Y.); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (R.W.T., A.M.); and Massachusetts General Physicians Organization, Harvard Medical School, Boston, MA (S.K.R., E.C., T.G.F., J.H.W.).
authors.forename: Ryan W
authors.initials: RW
authors.lastname: Thompson
authors.affiliation: From the Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (V.K.T.); Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (E.T.); Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (R.W.Y.); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (R.W.T., A.M.); and Massachusetts General Physicians Organization, Harvard Medical School, Boston, MA (S.K.R., E.C., T.G.F., J.H.W.).
authors.forename: Sandhya K
authors.initials: SK
authors.lastname: Rao
authors.affiliation: From the Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (V.K.T.); Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (E.T.); Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (R.W.Y.); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (R.W.T., A.M.); and Massachusetts General Physicians Organization, Harvard Medical School, Boston, MA (S.K.R., E.C., T.G.F., J.H.W.).
authors.forename: Aditi
authors.initials: A
authors.lastname: Mallick
authors.affiliation: From the Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (V.K.T.); Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (E.T.); Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (R.W.Y.); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (R.W.T., A.M.); and Massachusetts General Physicians Organization, Harvard Medical School, Boston, MA (S.K.R., E.C., T.G.F., J.H.W.).
authors.forename: Elena
authors.initials: E
authors.lastname: Cavallo
authors.affiliation: From the Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (V.K.T.); Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (E.T.); Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (R.W.Y.); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (R.W.T., A.M.); and Massachusetts General Physicians Organization, Harvard Medical School, Boston, MA (S.K.R., E.C., T.G.F., J.H.W.).
authors.forename: Timothy G
authors.initials: TG
authors.lastname: Ferris
authors.affiliation: From the Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (V.K.T.); Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (E.T.); Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (R.W.Y.); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (R.W.T., A.M.); and Massachusetts General Physicians Organization, Harvard Medical School, Boston, MA (S.K.R., E.C., T.G.F., J.H.W.). jwasfy@mgh.harvard.edu.
authors.forename: Jason H
authors.initials: JH
authors.lastname: Wasfy
mesh_terms: D000465:Algorithms; D016507:Cardiology Service, Hospital / Q000458:organization & administration*; D057189:Checklist; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D010353:Patient Education as Topic; D010359:Patient Readmission; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D015397:Program Evaluation; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D018570:Risk Assessment; D012307:Risk Factors; D012648:Self Care; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome; D014218:Triage
keywords: episode of care; inpatient; myocardial infarction; percutaneous coronary intervention; readmission