Journal Article

179 Changing cardiac care: a 24/7 cardiac service for emergency care in the post pandemic era

Mohamed, Ahmed Nabil Ahmed Talaat, Patel, Nikhil, Shunmugam, Ragunath, Kalindjian, Jeremy, Edries, Mohamed Magdy Abdelrazik, Shubber, Salim, Church, Hazel

2022

Overview

IntroductionThe challenges of COVID-19 have exacerbated the burden of healthcare on the NHS. Cardiac care after discharge from the Emergency Department (ED) required patients to see their GP to initiate specialist pathways. Increased waits & difficulty in seeing primary care physicians led to delays, dissatisfaction, poor patient experience and potential risks to long-term health.A front-end cardiology service was developed with two elements: 1) In-hours Front End cardiology (IHFE) (0800–1700), 2) Out of Hours Front-end cardiology (OOHFE). This novel service was created to deliver a rapid cardiac opinion thus reducing waiting times and improving patient experience. This service encouraged ED physicians to refer directly to a Cardiology response team (CRT) in hours and using a bespoke digital referral system out of hours.MethodsPatients referred to Cardiology outpatient services were reviewed retrospectively. The patients who had presented to ED with same symptoms within the past 12 months were included in the Pre-front end (PreFE) group (n=100). Demographic information was collected as well as ED attendance date, clinic date, presenting complaint, investigations required and time to completion of investigations. These were compared to the cohort of patients in the post front end group (PostFE) which included patients seen by FE Cardiology service between the period of July 2020 and January 2022 (n=169).Results:100 patients (43 males) were included in the Pre-front end group, with presenting symptoms of chest pain (56%), palpitations (29%), pre-syncope (8%), and dyspnea (7%). 169 patients (87 males) were included in the post-front end group, with presenting symptoms of chest pain (54%), palpitation (40%), pre-syncope (3%), and dyspnea (3%). In the PreFE group the averages time to completed episode since referral was 129 days compared to 39 days in the PostFE group. 50 % of patients referred were safely discharged following review without the need for further investigation. There was a 90-day saving i.e., a 70% reduction in completion of patient episode.Abstract 179 Table 1Table showing time to first investigations and time to completed episode in Pre-FE and Post-FE groupsConclusionsThe 24/7 Front-end model has been a significant success in supporting cardiac patients presenting to the ED. Times to specialist review, patient investigations, diagnosis and treatment have been reduced by 70%. There was no appreciable difference between the IHFE and OOHFE demonstrating that 24/7 support for ED was achievable. We have seen major benefits by reducing Times to specialist review, patient investigations, diagnosis and treatment.Conflict of Interestnil

• Publisher: BMJ Publishing Group Ltd and British Cardiovascular Society,BMJ Publishing Group LTD
• Subject: Cardiology / COVID-19 / Dyspnea / Emergency department / Emergency medical care / Front-end Cardiology / Medical diagnosis / Medical referrals / Patients / Specialty review / Stable IHD/Prevention/Hypertension/Lipids