Emphasizing and Increasing Cardiac Rehabilitation Referrals in an Outpatient Cardiology Clinic

Abstract

Heart disease is the second leading cause of death in NC. Cardiac rehabilitation (CR) is a class Ia recommendation for patients who have experienced a myocardial infarction (MI), percutaneous coronary intervention (PCI), or cardiac surgery. CR participation decreases morbidity and mortality in eligible patients. Despite this recommendation, referral rates remain suboptimal. The purpose of this DNP project was to increase referrals to CR from a cardiology clinic through provider education and use of a screening tool. Educational content was generated using materials from the Million Hearts® initiative and presented at staff meetings and via one-on-one education. A screening tool was used to identify patients in need of a CR referral. Four plan-do-study-act cycles were completed to improve project implementation. Referrals to CR (n=138) increased by 43% over 10 weeks. Screening tool completion varied widely between weeks (M = 10.80, SD = 10.33). Diversity of referrals increased from mainly CABG and valve surgery patients to include more MI and PCI patients. Most providers were unaware that the consult to CR order from the inpatient setting did not transfer as a referral to the ambulatory setting. Therefore, providers assumed patients were referred at hospital discharge, when in fact they were not. Lack of an electronic referral from hospital discharge proved to be the biggest barrier to CR referrals. A CR nurse liaison and post-MI clinic would be most beneficial in standardizing and improving CR referrals.