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Gatekeeping in an inpatient rehabilitation facility to reduce morbidity and mortality due to cardiac disease: screening program using of BNP and ECG Auto-diagnosis.

Authors
  • Kano, Naoaki1, 2
  • Kato, Toyonori1
  • Tomohara, Takiko1
  • Futamura, Yukiko1
  • Yoshida, Shogo1
  • Okumura, Takahiro2
  • Maeda, Kengo2
  • Murohara, Toyoaki2
  • Oda, Koji1
  • 1 Kobayashi Memorial Hospital, Hekinan, Japan. , (Japan)
  • 2 Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan. , (Japan)
Type
Published Article
Journal
Nagoya journal of medical science
Publication Date
May 01, 2019
Volume
81
Issue
2
Pages
303–312
Identifiers
DOI: 10.18999/nagjms.81.2.303
PMID: 31239598
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

The Kaifukuki-Rehabilitation Ward (KRW) is a type of inpatient rehabilitation facility in Japan. In the KRW of our institute, mortality and frequency of emergency referrals in 2013 were rather high, 2.6% and 4.3%, respectively. We aimed to investigate the usefulness of an original gatekeeping system to reduce mortality and morbidity from cardiac complications, and to improve the quality of medical care in the KRW. A total of 370 consecutive patients admitted to the KRW of Kobayashi Memorial Hospital between 1 May 2015 and 31 March 2016 were enrolled in this prospective observational study. All patients underwent a screening evaluation in which we defined patients as being screen positive (SC-positive) if they had at least one of 20 diagnostic ECG codes and/or BNP level over 140 pg/dL at admission. A cardiologist provided weekly interventions to those among SC-positive patients who needed cardiac disease treatment during hospitalization. In all, 129 patients were classified as SC-positive (mean age 80 years, 124 [32%] male), and weekly intervention was needed in 28 patients, including start of cardiac medication in 17 cases. Mortality and frequency of emergency transfer due to cardiac disease during hospital stay were 0.3% and 0.3%, respectively. Our gatekeeping system involving a screening evaluation at admission and weekly intervention in selected patients by a cardiologist may be useful in reducing mortality and rate of transfer due to cardiac disease and may improve quality of medical care in KRWs.

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