Wallins Joseph S, Cajiao Karen M, McCarthy Killian J, Estrada-Roman Alisson, Gavin Michael C
From the Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA.
Current address: Department of Medicine, Massachusetts General Hospital, Boston, MA.
Crit Pathw Cardiol. 2019 Sep;18(3):113-120. doi: 10.1097/HPC.0000000000000186.
Alternatives to the emergency department (ED) for expedient and high-value team-based cardiology care for patients with chest pain, volume overload, palpitations, and other urgent, but not life-threatening cardiac conditions are lacking. Here, we report on the development of the Cardiac Direct Access Unit (CDAc), an ambulatory cardiology unit with exam rooms, observation bays, and an advanced heart failure clinic.
Patients referred to the CDAc are seen same-day by an attending cardiologist in a space independent from the ED. We performed a retrospective review of 1146 consecutive patients referred to the CDAc in its first year of operation. Among patients who were referred for urgent same-day evaluation, 60.1% were discharged home without observation.
Among the patients observed or directly discharged from CDAc, 2.4% were readmitted within 30 days for a related symptom. The highest rate of readmission (7.5%) was for heart failure, which compares favorably with guidelines for readmission benchmarks.
Our first year of data suggests that a cardiology-directed observation unit may serve as a high-value alternative to the ED for appropriately selected patients.
对于胸痛、容量超负荷、心悸及其他紧急但非危及生命的心脏疾病患者，缺乏能提供便捷且高价值的团队式心脏病护理的急诊科替代方案。在此，我们报告心脏直接接入单元（CDAc）的发展情况，这是一个拥有检查室、观察室和高级心力衰竭诊所的门诊心脏病单元。
转诊至CDAc的患者由主治心脏病专家在独立于急诊科的空间内当日接诊。我们对CDAc运营第一年连续转诊的1146例患者进行了回顾性分析。在被转诊进行紧急当日评估的患者中，60.1%未进行观察即出院回家。
在从CDAc观察或直接出院的患者中，2.4%在30天内因相关症状再次入院。再入院率最高的是心力衰竭（7.5%），与再入院基准指南相比情况良好。
我们第一年的数据表明，对于经过适当筛选的患者，心脏病学指导的观察单元可作为急诊科的高价值替代方案。
