Cardiac Rehab physician referrals

[Stanford]

I am an RN in cardiac rehab and we are having a difficult time with physicians referring pt's to rehab. The percent of all local and appropriate candidates that were referred was 11% last year! We have sent letters the EVERY physician in the health system regarding research on why cardiac rehab is so beneficial to pt's that have had an event. And nothing has seemed to changed. The majority of our consults come from CABG pt's due to the fact it's on the standard order sheet. We would love to see the younger pt's having MI's and stents in addition to the CABG pt's. Is anyone else having the same experience? If not, what have you done to increase your volume of pt's in cardiac rehab?

[dianah, ASN]

I work in a Cath Lab, not cardiac rehab, but cardiac rehab has been on my mind a lot lately, for our post-intervention pts (at this point we refer PCIs and CABGs out).

I have previous experience trying to educate primary care ppl to order BUN and Cr at the same time they order a CT scan or IVP, and also to have them hold the pt's Metformin the day before the exam (old school, that was ).

This education took, literally, two years.

Don't be discouraged if you don't have droves of referrals after sending out one letter. Really!

Just one letter will not do it.

Find other clever ways to present what you offer.

Most will have to be mailings, yes.

But focus on diff't advantages with each mailing.

Think about hiring the services of a marketing firm, or at least getting their input as to how to "sell" your product, for that is what you need to do.

As important as all the literature is in presenting the good outcomes, the initial impact of your brochures (or whatever you use) should have a 'wow' factor, not just a huge article.

(and, granted, I don't know what you have used in the past)

Yes, physicians 'should' know how important this is.

But often they're so focused on the immediate, they don't think long-term.

Is rehab well reimbursed?

THAT would be a big plus.

Would be nice if the request came from the pts themselves.

I suppose you can't put tantilizing brochures in the MD's office, eh?

Or in the Cath Lab waiting room (for families)?

Perhaps another approach to consider is to educate the public: local newspaper ads, signs on the sides of a bus, or on a bench.

Attend health fairs or local 'market nights' and hand out flyers.

Submit articles to nat'l magazines for lay ppl as well as to journals the MDs read.

Any way you can schedule time with the MDs, to present what you offer?

Sometimes associating a friendly face and a personality with a service will affect how the service is viewed/regarded.

I hope others who work in Cardiac Rehab will weigh in with helpful suggestions; wish I had more to offer you!

Good luck to you!

[carachel2]

Oh yes...this seems to be a universal program. For the life of me, I cannot figure it out since research shows overhwlemingly that patients who are referred to cardiac rehab rank a much higher level of satisfaction with their physician. But I digress. Here are things our cardiac rehab team has done in the past:

1. Had our "star" patients write a "thank you" letter to their referring physician. We X'ed out the names of course and then put these letters on a really nice professional looking poster that was displayed in the Dr's lounge. The Dr's who DID refer a lot of paitents took this as fuel for the fire and gave their colleagues a hard time for not referring more.

2. Our marketing department made up GREAT looking tri-fold brochures that included a prescription/referral area on the back of the brochure. Once a week for like 4 months we took a new packet of brochures ALONG WITH LUNCH to a local PCP office, cardiologist or internal medicine office. Although we rarely got the undivided attention of the Dr's themselves, we DID get lots of time with their main RNs and talked to them about the referral process, which diagnoses were covered, etc. In my opinion, having the office staff educated about the process is one of the most effective tools.

3. Those same tri-fold brochures are placed all over the hospital.

4. We continue to drop in to the physician's offices with more brochures just to maintain our presence. Also, any time they refer a new patient we send a thank-you letter along with detailed progress reports at 6 weeks and then when the patient graduates.

5. Capturing the young stent audience is really hard. They are out the door sometimes before a staff member can even be up to the unit to talk to them. Very frustrating. You need to have a staff member whose schedule is clear from 7-10 in the a.m. so that person can just make rounds before those patients are discharged.

6. We had small stickers printed up and placed on the units. The staff RNs could place the sticker on the chart on the Dr's order sheets for all patients who were appropriate. The stickers said something like this: Physician: Please note...this patient is qualified for Phase II cardiac rehab. Please check this box and the appropriate staff will initiate the process. This helped a lot and we got a LOT more orders.

7. Finally, you need a dedicated staff member to really really push for Cardiac Rehab to be on all standard order sets for post-stent patients.

Hope this helps!

[carachel2]

I wanted to add that for the staff member who rounds on the post PTCA patients in the hospital, they don't have to have an order to see that patient.

Of course, you can't do the whole cardiac teaching that should be done BUT you can tell the patient "some physicians do not order cardiac rehab. However, research consistently shows that cardiac rehab is DEFINITELY beneficial for patients and improves X, X and X. Even if it is not ordered for you, you CAN REQUEST it be ordered from you. Your Family Practice MD, Internal medicine MD OR your cardiologist can order it for you. Here is the form (hand the patient the lovely trifold brochure with the Rx box on the back!)....take it to your first follow-up visit and tell your Dr. you are interested in the program."

Another effective tool was inviting all of the post-stent patients to our cardiac rehab orientation class which is FREE. Now usually the patients who are about to start the program attend the orientation class . We opened up the class to any patient who was interested, however and wow...we really got more patients that way. They can meet our staff, see what we have to offer, take a tour of the facility and *most* importantly they can meet fellow patients and feel a sense of connection.

[Stanford]

Thank you for your suggestions. The main problem is the physician has to order a cardiac rehab consult and they are not doing that. We can't see any patient without a consult. We are trying to encourage the doctors to keep us in mind.

[carachel2]

Thank you for your suggestions. The main problem is the physician has to order a cardiac rehab consult and they are not doing that. We can't see any patient without a consult. We are trying to encourage the doctors to keep us in mind.

Don't let the Dr's tell you that you can't see the patients. You DO have to have an order if you are going to do a whole schpiel and do the cardiac teaching or ambulate them or whatever. You do NOT, however, have to have an order to go in and say hello, introduce yourself and give the patient a brochure.

Also, pretty darn soon the docs are going to get paid according to how closely they follow evidence based guidelines. They won't be able to get away with just arbitrarily deciding a patient doesn't need cardiac rehabiltiation.

I would meet individually with brochures in hand with each of the docs and ask what your team can do better to assure that these patients are not missed.

[platon20]

Is this really about whats best for patient care? Or is this about trying to make money for the cardiac rehab center?

Reminds me of the glut of cardiac cath labs who ROUTINELY CATH/STENT 40 year old patients with stable angina and only 50% stenosis. Its a money making scam, nothing more.

[drmcminn]

I am currently in the predicament of not having enough patients in rehab. Our problem is related to HIPPA violations. can't see patients without an order. Nurses and staff cannot tell me about a patient without an order. It all falls on the fact that the doctor does not sign an order to let me even know who the patient is. I thank you for your help. I am currently writting a letter to be sent to the physicians in my area and am planning to drop by their offices. I would love it if it were a policy that Cardiac Rehab be consulted for education on all MI's, Stent's, Valve's, Stable Angina pt's, and CABG's. Our physicians just have the floor nurse walk the patients and don't even order anything rehab related.

[drmcminn]

Isn't it a HIPPA violation to even find out what diagnosis they have or who they are? Guess it wouldn't if we gave information to everyone though.