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While no one has quite cracked the code for patient participation in post-event cardiac rehab, the team at Beaumont Hospital, Dearborn, is making headway.
A few years ago, in-hospital patient contact hovered around 50% prior to discharge and outpatient participation ran true to the industry standard of around 20%. Hoping to improve participation rates, cardiac rehab at Beaumont Hospital, Dearborn worked to include “referral to Phase II cardiac rehab” in the post-PCI, CABG, SAVR, and TAVR physician order sets. Each morning, the team dedicates staff time to review those referrals, then staff visits the patients at bedside. There the team member can discuss the benefits of cardiac rehab services; determine the patient’s interest in participating; find out which site is most convenient for the patient, and, most importantly, hand-deliver a physician referral and cardiac rehab program information for next steps. These initiatives increased inpatient contact rates to consistently greater than the 90% BMC2 threshold.
“We’re very intentional about patient contact,” said Jennifer Dykstra, an exercise physiologist and manager of cardiac rehab at Beaumont Hospital, Dearborn. “We also receive great support from the nurse practitioner in the cath lab who works with same-day discharge patients, Sara Heisler-Young. She consistently discusses cardiac rehab with those patients, who we may otherwise miss.”
Although the team was successfully touching base with the cardiac inpatients, they found they were only capturing 40-50% of the patients who selected Beaumont Dearborn as their desired cardiac rehab site. Upon analysis, they found they were waiting too long to contact the patients after discharge and weren’t persistent enough with follow-up to get these patients enrolled. The program now has specific staff assigned to follow through on each patient. Call dates, orientation dates, class assignments and actual start dates are all logged in a shared drive, which is overseen by the manager and discussed with the staff weekly.
Once in the program, each cardiac rehab participant is assigned to a specific care manager for consistent and reliable care. All clinicians are trained through Wellcoaches School of Coaching. They utilize these coaching skills to encourage behavioral change personalized to each participant to improve their health and well-being. There is also a registered dietitian/exercise specialist on staff, Tom Depper, who consults with the participants regularly during exercise therapy and one-on-one, bringing his unique enthusiasm to the process of diet management.