EMR alert system, training boosts cardiac rehab referrals from 12% to 75%

Researchers established a system of alerts based on electronic medical records to identify patients who qualify for cardiac rehabilitation at the Hospital of the University of Pennsylvania in Philadelphia. In just nine months, the program boosted referral rates from 12 percent to 75 percent.

Elizabeth Jolly, RN, BSN, MBA, will present results of the study at American College of Cardiology's NCDR Annual Conference in Orlando.

"If a provider thought a patient would benefit from cardiac rehab, [he/she] would hand the patient a handwritten prescription but didn't have the tools to get them there," said Jolly, interventional cardiology transitions coordinator at the Hospital of the University of Pennsylvania. "At a big institution like ours, we have so many patients that it's not always evident who qualifies for cardiac rehab. Now we know in real-time. We started bringing cardiac rehab into our conversations with patients and adding it to discharge documentation and conversations following discharge as well. Now this is part of our daily workflow."

Jolly and colleagues worked with more than 40 cardiac rehab facilities in the Philadelphia area, to ensure they would accept patients from the hospital and endorse the referral process. They also worked with cardiac teams, including bedside nurses, advanced practice providers and physicians, to notify patients of the benefits of rehab prior to discharge.

The hospital's average cardiac rehab referral rate was 12 percent in the 21 months before implementing Jolly’s program. After implementation, it increased to 75 percent within nine months.

"Cardiac rehab gives patients an opportunity to get back to or begin exercising safely under the guidance of a specialist and helps them understand medications they've been placed on," Jolly said.

 The researchers worked with two other hospitals in the Penn health system to learn the importance of cardiac rehab. One hospital boosted its referral rate from 4.2 percent to 24.8 percent and the other upped it from 4 percent to 25.4 percent.