Expedited Triage for Outpatients Referred to Cardiology for Chest Pain: A Model to Improve Access

Cardiovascular disease remains the leading cause of death in the US, especially in the veteran population. Prompt evaluation is crucial for clinical outcomes, but demand for services often exceeds the healthcare system’s capacity. The extended outpatient wait time for patients with chest pain prompted the development and implementation of a Chest Pain Consult at Ralph H Johnson VA Medical Center. A cardiology fellow reviews the consult and performs a phone interview with the patient within 48 hours of the referral. The fellow either refers the patient for further testing or discharges back to primary care. This retrospective cohort study compared access before and after the implementation of the expedited Chest Pain Consult. We analyzed 107 patients (52 pre- and 55 post-implementation). When comparing the pre- and post-implementation groups, we detected a statistically significant reduction in time intervals between referral to initial physician contact, non-invasive testing, and resolution. A decrease in the interval between referral and left heart catheterization was not statistically significant. Chest Pain Consults led to faster ischemic evaluation for veterans. The expedited Chest Pain Consult can be a model for other healthcare institutions to accelerate access for patients with symptoms of cardiovascular disease.