Clinical effectiveness of a cardiology outpatient management plan to reduce inefficiency in consultations

ABSTRACT

Objectives: Longer delays in carrying out complementary tests in cardiology services have resulted in patients arriving for consultation without these tests being performed (inefficient consultations). To ameliorate this situation, a management-based intervention was designed, optimizing the available resources and modifying the appointment system. Therefore, our objective was to determine the effectiveness of this intervention to reduce the number of inefficient consultations and improve the clinical care process.

Methods: A non-randomized experimental study comparing two periods (pre- and post-intervention) was designed, analyzing a total of 473 outpatients attending cardiology consultations in a Spanish region in February 2014 (pre-intervention) and 441 patients attending cardiology consultations in November 2014 (post-intervention). The outcome of management measures aimed at optimizing coordination in outpatient care to reduce inefficient consultations was analyzed. After the visit, treatment modifications, requests for new examinations or tests, outpatient discharges, and new diagnoses were evaluated.

Results: In the pre-intervention period, 37.2% of the patients had not had the tests performed, while in the post-intervention period, this figure dropped to 10.7% (p < 0.001). When the patients had all the tests completed, there was an increase in the number of new examinations (p < 0.001), outpatient discharges (p < 0.001) and new diagnoses (p = 0.004). Treatment modifications were not significant (p = 0.223).

Conclusions: The intervention proved effective, clinically relevant, and statistically significant in reducing the proportion of inefficient consultations, thereby enabling continuation of the clinical care process.

KEYWORDS:

• Cardiology Service
• diagnostic Tests
• organization and Administration
• referral and Consultation

Acknowledgments

The authors thank Maria Repice and Ian Johnstone for their help with the English version of the text.

Declaration of interest

No potential conflict of interest was reported by the authors.

Declaration of financial/other relationships

The contents of the paper and the opinions expressed within are those of the authors, and it was the decision of the authors to submit the manuscript for publication. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Data sharing

The data that support the findings of this study are available from the corresponding author, APB, upon reasonable request.

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.