Abstract 346: Initial Results from a Cardiac Curbside Program
Background: Improving value in outpatient cardiology care is an important goal. Some clinical questions for cardiologists involve interpretation of imaging data, and do not require in-person evaluation by a cardiologist. Creating a formal mechanism to process these questions outside the traditional framework of an in-office consult might reduce cost, improve access, and enhance patient satisfaction.
Methods: We offered referring doctors at the Massachusetts General Hospital the opportunity to request cardiac “curbside” consults, with a formal mechanism for the cardiologist to annotate the electronic medical record with recommendations. This pilot started on January 13. We tracked volume of referrals by week before and after the new option became available. We compared traditional gastroenterology consults (excluding screening colonoscopy requests) over the same time period as a control. The volume of consults for cardiology and gastroenterology before and after the intervention was compared with a Fisher exact test.
Results: During the first two weeks of the pilot, 14 cardiac curbsides were requested. Of those, 1 was rejected by the cardiologist, and 1 eventually led to a traditional office visit. In a 15 week lead in period before the new mechanism, 2384 gastroenterology consults were requested and 1329 cardiology consults were requested. In the 2 weeks after the intervention, 359 gastroenterology consults were requested and 203 traditional cardiology consults were requested. In the 15 week lead in period, the ratio of traditional cardiology consults to gastroenterology consults was 0.557. After the intervention, the ratio of traditional cardiology consults to gastroenterology consults was 0.565 (p = 0.888).
Conclusions: In the initial phase of a cardiac curbside pilot, demand for curbsides accounted for about one-tenth of total referral volume. The volume of traditional cardiology consults has not yet declined at this early stage. Such interventions have the potential to improve efficiency and value.
Author Disclosures: J.H. Wasfy: None. S.K. Rao: None. E.M. Isselbacher: None. T.G. Ferris: None.
- © 2014 by American Heart Association, Inc.