Tanguturi Varsha K, Temin Elizabeth, Yeh Robert W, Thompson Ryan W, Rao Sandhya K, Mallick Aditi, Cavallo Elena, Ferris Timothy G, Wasfy Jason H
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.).
Circ Cardiovasc Qual Outcomes. 2016 Sep;9(5):600-4. doi: 10.1161/CIRCOUTCOMES.116.003086. Epub 2016 Aug 23.
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.
医院再入院情况常见且费用高昂，在某些情况下，可能与护理流程问题有关。我们试图通过针对出院前、出院后以及再次前往急诊科时的脆弱环节的项目，来降低一家大型三级医疗设施中经皮冠状动脉介入治疗（PCI）后的再入院率。在初次住院期间，我们使用经过验证的风险评分评估患者的再入院风险，并使用出院检查表确保高危患者能够获得适当的药物治疗并得到密切随访。我们还制作了关于胸部不适和心力衰竭的患者教育视频。出院后，我们设立了一个由心脏病学研究员负责的新随访诊所。开发了一个计算机系统，当患者在PCI后30天内前往急诊科时自动通知心脏病专家，以增加患者在急诊科获得心脏病学护理的机会。鼓励心脏病专家尽早进行评估并协助分诊，急诊科使用从当地患者数据库得出的风险分层算法对PCI后出现胸部不适的患者进行分诊。我们跟踪了在我院接受PCI后再入院的患者数量。通过我们的干预措施，从2011年到2015年，索引医院的再入院率从9.6%降至5.3%。该项目可以提供切实可行的结构性变革，可在其他医疗中心实施，既能降低护理成本，又能提高PCI患者的护理质量。
