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Promoting Judicious Primary Care Referral of Patients with Chest Pain to Cardiology: A Quality Improvement Initiative

Author

Listed:
  • Ashraf S. Harahsheh

    (Department of Pediatrics, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
    Children’s National Hospital, Washington, DC, USA)

  • Ellen K. Hamburger

    (Department of Pediatrics, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
    Children’s National Pediatricians & Associates, Washington, DC, USA)

  • Lena Saleh

    (Children’s National Hospital, Washington, DC, USA)

  • Lexi M. Crawford

    (Children’s National Hospital, Washington, DC, USA)

  • Edward Sepe

    (Department of Pediatrics, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
    Children’s National Pediatricians & Associates, Washington, DC, USA)

  • Ariel Dubelman

    (Children’s National Pediatricians & Associates, Washington, DC, USA)

  • Lena Baram

    (Department of Pediatrics, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
    Children’s National Pediatricians & Associates, Washington, DC, USA)

  • Kathleen M. Kadow

    (Children’s National Pediatricians & Associates, Washington, DC, USA)

  • Christina Driskill

    (Children’s National Pediatricians & Associates, Washington, DC, USA)

  • Kathy Prestidge

    (Children’s National Pediatricians & Associates, Washington, DC, USA)

  • James E. Bost

    (Department of Pediatrics, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
    Division of Biostatistics and Study Methodology, Children’s National Hospital, Washington, DC, USA)

  • Deena Berkowitz

    (Department of Pediatrics, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
    Children’s National Hospital, Washington, DC, USA)

Abstract

Objective To decrease referrals to cardiology of patients ages 7 to 21 years with low-probability cardiac pathology who presented to primary care with chest pain by 50% within 24 months. Study Design A multidisciplinary team designed and implemented an initiative consisting of 1) a decision support tool (DST), 2) educational sessions, 3) routine feedback to improve use of referral criteria, and 4) patient family education. Four pediatric practices, comprising 34 pediatricians and 7 nurse practitioners, were included in this study. We tracked progress via statistical process control charts. Results A total of 421 patients ages 7 to 21 years presented with chest pain to their pediatrician. The utilization of the DST increased from baseline of 16% to 68%. Concurrently, the percentage of low-probability cardiology referrals in pediatric patients ages 7 to 21 years who presented with chest pain decreased from 17% to 5% after our interventions. At a median follow-up time of 0.9 years (interquartile range, 0.3–1.6 years), no patient had a life-threatening cardiac event. Conclusion Our health care improvement initiative to reduce low-probability cardiology referrals for children presenting to primary care practices with chest pain was feasible, effective, and safe.

Suggested Citation

  • Ashraf S. Harahsheh & Ellen K. Hamburger & Lena Saleh & Lexi M. Crawford & Edward Sepe & Ariel Dubelman & Lena Baram & Kathleen M. Kadow & Christina Driskill & Kathy Prestidge & James E. Bost & Deena , 2021. "Promoting Judicious Primary Care Referral of Patients with Chest Pain to Cardiology: A Quality Improvement Initiative," Medical Decision Making, , vol. 41(5), pages 559-572, July.
    • Handle: RePEc:sae:medema:v:41:y:2021:i:5:p:559-572
    DOI: 10.1177/0272989X21991445
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