Cardiovascular Rounds

The next 'surge' to prepare for? Cardiovascular care

by Fanta Cherif

As the U.S. Covid-19 epidemic slows down in parts of the country, EDs should begin to prepare for a second surge of patients: those who have not received CV care for on-going or emergent needs.

Your top resources for Covid-19 readiness

The postponement of elective procedures and decline in ST-elevation myocardial infarction (STEMI) volumes across the country indicate CV patients are delaying or are unable to access care for emergent and underlying conditions. This means that when these patients do finally present at EDs after the Covid-19 crisis abates they're likely to be sicker and require more advanced care.

Because the short- and long-term implications of Covid-19 are complicating existing care pathways, it is crucial for service line leaders to implement efficient processes for identifying, triaging, and caring for CV patients. But this may require renewed investment in traditional ED triage tools such as observation units, which, as one study shows, have substantial room for improvement.

In a prolonged and rapidly evolving crisis, programs need to adopt hardwired protocols and care pathways, along with investment in dedicated staffing to ensure patients receive the attention they need. Below are our top strategies on how to optimize CV short-stay management.

2 ways to optimize CV short-stay management

1. Establish pathways and protocols to expedite patient triage.

Risk stratification tools such as the HEART score make triage more efficient and minimize the amount of time patients spend in the ED. Standardized practices to improve patient management can decrease both lengths of stay and readmissions.

Here's how two hospitals are using this approach in action:

  • MemorialCare in Los Angeles, implemented the HEART pathway as a strategy to standardize care for patients with suspected acute coronary syndrome (ACS). As a result, the program reduced its 30-day ED return rate for patients receiving the HEART score by 70%. At other EDs, utilization of this pathway has contributed greatly to improvements in cardiac testing, early discharge, and decreased length of stay. Read more about MemorialCare here.

  • Baptist Health Lexington's CV physicians created atrial fibrillation (AF) care protocols to risk stratify and guide ED triage for patients appropriate for admission, discharge, or follow-up in on-site CV clinic. The implementation of these protocols led to a 32% reduction on AF admissions from the ED. Read more about Baptist Health Lexington on page 18 of our short-stay patient management book.

2. Dedicate staff to facilitating collaboration and efficient short-stay patient flow.

Investing in roles such as triage practitioners, patient partners, or bed managers can ensure responsiveness from providers throughout multiple departments, which can better inform clinical care decisions.

Here's how three hospitals are using this approach in action:

  • AtlantiCare in Southeastern New Jersey created a designated ED case manager to inform patient's CV providers of follow-up visits, which must occur within 72 hours. CV providers and ED case managers discuss each patient's progress and outcomes, which enhances each provider's ability to make clinically informed care decisions. Read more about AtlantiCare on page 16 of our short-stay patient management book.

  • Emory Healthcare in Atlanta invested in observation units in all hospitals throughout the system by developing inclusion criteria, care processes, and dedicated staff to improve efficiency and clinical quality. Learn more about Emory Healthcare on page 31 of our short-stay patient management book and read Emory's full observation unit care protocols here.

  • Mercy Health's observation unit in Youngstown, Ohio holds "patient flow rounds" where an RN, case manager, and social worker meet to discuss expectations for the day for each patient. These 30-minute rounds are useful to discuss patient challenges, comorbidities, previous and current placement, and expectations for admission or discharge. Additionally, the unit reviews patients on extended observation and determines next steps. With all hands on deck, patient flow rounds" improve provider coordination and patient throughput. Read more about Mercy Health on page 33 of our short-stay patient management book.

Your top resources for Covid-19 readiness

To help ensure the safety of your staff and patients, we've compiled our top resources on how to safely manage and prevent the spread of Covid-19.

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