Getting to the Heart of the Matter: A Triage Model to Improve Utilization of Cardiology Consultative Services

Abstract

Objective: To assess the impact of a triage system of emergency department (ED) referrals for outpatient cardiology appointments. Patient and Methods: We implemented a triage system of ED referrals for outpatient cardiology appointments among patients with a cardiovascular chief complaint deemed safe to leave the ED but needing outpatient follow-up. There were 303 and 267 unique patients in the pre–triage implementation and post–triage implementation cohorts, respectively. We collected retrospective billing data to assess ED return visits, hospitalizations, cardiology outpatient visits, and cardiovascular testing. The pre–triage implementation cohort included patients with an ED visit date between January 1, 2014, and December 31, 2014. The post–triage implementation cohort included patients with an ED visit date between July 1, 2015, and June 30, 2016. Results: The triage model reduced the number of ED-referred cardiovascular service appointments by 73.0% (195 of 267 patients). Additionally, the “no-show” rate for appointments decreased from 17.8% (54 of 303 patients) to 7.9% (21 of 267 patients). There was no increase in ED return visits or unplanned hospitalizations in the posttriage cohort. Finally, the triage model was not associated with an increase in resource-intensive cardiovascular testing (eg, imaging stress tests or computed tomography). Conclusion: Triage of ED referrals for outpatient cardiovascular service appointments reduced cardiology appointment utilization with no impact on return ED visits, hospitalizations, or cardiovascular testing.