Four years after the opening of the Cardiac Direct Access Unit (CDAc), BIDMC's unique urgent care cardiac service, both patients and referring physicians report positive experiences. A reduction in admissions has also been seen in data from the first year of operation.
When a patient presents in the office with cardiac chest pain or is in rapid ventricular response from atrial fibrillation, physicians have the option of referring to the CDAc, instead of sending the patient to the emergency room. "As soon as I call the CDAc, there’s a doctor at the other end of the line to provide advice right away. I can then fax over the patient's EKG or other records and get feedback on next steps. This is such an efficient service and a great resource for my patients," said PCP Nicolas Nguyen, MD.
A Streamlined Process
In most cases, referring physicians will be instructed to send their patient directly to the CDAc, located on BIDMC's West Campus. "As soon as the call comes in, we alert our staff that a patient is on the way," explains CDAc Director Michael Gavin, MD, MPH. "The patient is seen by the cardiologist right away, and tests can be administered right within the unit, including labs, echocardiography and cardiac stress tests."
Following the patient's CDAc visit, the cardiologist sends results to the PCP, including results from any tests that were performed, including echocardiography and cardiac stress tests. "Notes are available same day to providers through OMR," adds Gavin.
While the majority of patients will be discharged the same day, overnight observation is available in the 6-bed unit, which is covered by a cardiac nurse practitioner 24 hours a day. If needed, direct transfers can be arranged to the hospital's inpatient cardiology service. The CDAc also offers referring physicians an access clinic for patients who don't need to be seen the same day, but can be seen within one week.
Less Costly Care
During the first year in operation, CDAc saw just over 700 patients, many of whom had congestive heart failure concerns, chest pain or atrial fibrillation." he says. "Overall, 60 percent of patients who were evaluated in the CDAc were discharged the same day without observation. Patients were able to see a cardiologist, undergo whatever diagnostic cardiac testing was needed and then leave." Importantly, patients' insurance co-pays for their CDAc visits were equal to a single outpatient visit.
Admission Rates for CDAc and Unmatched Controls
(Observation or Admission)
Smulowitz et al. West J Emerg Med (2017) , Blecker et al. Am J Heart J (2014)
Wallins JS, Cajiao KM, McCarthy KJ, Estrada-Roman A, Gavin MC., Crit Pathw Cardiol. 2019 Sep;18(3) 113-120.
Furthermore, notes Gavin, by having CDAc services available, space is freed up in the ED for patients with life threatening conditions like trauma and acute stroke. "We've also shown that our rates of admission are much lower than national averages for these acute cardiac conditions and for congestive heart failure, in particular," he adds.
In addition to streamlined cardiac care, the CDAc provides patients with a significant savings of time and money. Patients are billed for CDAc visits just as they would be for a visit to the Outpatient Clinic. "This eliminates a co-pay for a potentially expensive ER visit," says Gavin. "Many patients have told us that being able to avoid long wait times and stress of an emergency room visit has been invaluable," says Gail Lopez, RN, CDAc Nurse Manager.
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