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Impact of an Outpatient Cardiology-managed Urgent Access and Observation Unit on Hospital Admissions

Wallins, Joseph S. MD, MPH*,‡; Cajiao, Karen M. MD; McCarthy, Killian J. MB, BAO, BCh*; Estrada-Roman, Alisson MD; Gavin, Michael C. MD, MPH

doi: 10.1097/HPC.0000000000000186
Original Articles

Introduction: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

From the *Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA

Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA

Current address: Department of Medicine, Massachusetts General Hospital, Boston, MA.

Received for publication February 15, 2019; accepted April 4, 2019.

Reprints: Michael C. Gavin, MD, MPH, Beth Israel Deaconess Medical Center, Cardiovascular Division, 185 Pilgrim Road, Palmer 217, Boston, MA 02115. E-mail:

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