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

• Published in: Medical decision making 2021-07, Vol.41 (5), p.559-572
• Main Authors: Harahsheh, Ashraf S., Hamburger, Ellen K., Saleh, Lena, Crawford, Lexi M., Sepe, Edward, Dubelman, Ariel, Baram, Lena, Kadow, Kathleen M., Driskill, Christina, Prestidge, Kathy, Bost, James E., Berkowitz, Deena
• Format: Article
• Language: English
• ISSN: 0272-989X; 1552-681X
• DOI: 10.1177/0272989X21991445

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.