Key result
UK Health Research Authority framework differentiates research from service evaluation to guide appropriate governance.
Why the study?
Cardiac pathology causes many ED attendances, though many patients could be managed as urgent outpatients to avoid hospital admission.
Does an ambulatory rapid-access cardiology clinic safely manage patients with suspected cardiac pathology referred from the emergency department?
Does an ambulatory rapid-access cardiology clinic safely manage patients with suspected cardiac pathology referred from the emergency department?
An ambulatory rapid-access cardiology clinic safely managed 95% of ED referrals without hospital admission, with very low 90-day adverse event rates.
May support ambulatory rapid-access clinics for ED referrals; leaves open need for randomized confirmation of safety.
Cardiac pathology contributes to a significant proportion of emergency department (ED) attendances. Many could be managed as urgent outpatients and avoid hospital admission. We evaluated a novel rapidaccess general cardiology clinic to achieve this, implemented during the COVID-19 pandemic. We performed a retrospective review of baseline characteristics, investigations, final diagnoses, and 90-day safety (readmission, major adverse cardiovascular events [MACE], mortality) from electronic records and conducted a patient experience survey. There were 216 ED referrals made between 1 June and 30 October 2020. The median time to review was two days (interquartile range 1-5). At 90 days, there were three (1.4%) representations requiring admission, two (0.9%) MACE, and no deaths. There were 205 (95%) successfully managed without hospital admission. Among surveyed patients, 96% felt they had concerns adequately addressed in a timely manner. In conclusion, our rapid-access cardiology clinic is a safe model for outpatient management of a range of cardiovascular presentations to the ED.
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Tang et al. (2024) studied this question. The UK Health Research Authority provides a framework to differentiate between research, service evaluation, clinical audit, and health surveillance to determine appropriate governance requirements.
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