(P147) RESETTING THE BAR: INCREASING CARDIOVASCULAR REHABILITATION ENROLLMENT IN A TERTIARY CARDIAC CARE SETTING

Background/Purpose: Despite advances in cardiac treatment, cardiovascular disease remains a leading cause of mortality with patients at high risk of recurrent events and poor health outcomes. Out-patient cardiovascular rehabilitation (CR) is a secondary prevention program delivered by a multi-disciplinary team providing comprehensive education, exercise training and behavior change support with participation shown to reduce death and hospitalization by more than 20% and improve quality of life. Despite the evidence, CR enrollment rates remain low in Canada with an average of 36% of eligible patients referred and an average of 20% who enroll. Systematic referral systems integrated into electronic medical records (EMR) have increased referrals and have been a long-standing part of CR referral process within our institution. Even with this systems-based approach, monthly enrollment to CR remained between 32% -48%. A pilot project was developed which aimed to increase patient enrollment into CR.

METHODS/RESULTS: In June 2021, all in-patient physiotherapists (PT) began referring their surgical patients to CR using the EMR to the CR Triage Coordinator (TC). Referral included discussion with patients regarding the benefits of CR and promoting a healthy lifestyle, which is already an integral part of their care. The second stage of the pilot involved pillars of transitional care. Surgery patients received a CR appointment scheduled by the TC prior to their discharge day. This change allowed that first appointment to appear directly within the discharge information (After Visit Summary) and the bedside RN would highlight this appointment along with other key discharge information. This two-stage pilot has led to an increase in our monthly enrollment rates ranging between 53% - 72%, including a 9% increase in the enrollment rate for women when compared to pre-pilot data. The evaluation revealed greater satisfaction among staff involved in the new process without any negative impact on patient attendance for their appointment.

CONCLUSION/IMPLICATIONS FOR PRACTICE: These institutional changes for referral and enrollment to CR are now the standard of care for all post-surgery patients. They have resulted in a significant increase in the enrollment rate specifically the involvement of women who have typically lower rates of CR participation. The pilot also demonstrated a lean process and does not impact the workload of clinicians and are easily integrated into clinical care. Next steps will be to extend this seamless transitional process to non-surgical cardiology patients in hopes to further improve CR enrollment.