1. Cardiac Rehabilitation Secondary Prevention Referral and process review
Hazel Mountford, Abbey Sawyer & Madeline Gaynor
Physiotherapy Department
Sir Charles Gairdner Hospital, Western Australia

2. Briffa et al 2011,ACSQHC 2014, Dalal et al 2015
Background
↑ Prevalence coronary heart disease & heart failure
Cardiac Rehabilitation Secondary Prevention (CRSP) is effective but <50% participation
In WA 43% of all cardiac events are recurrences
Acute Coronary Syndrome (ACS) Clinical Care Standard
SCGH hospital-based program ACS is 60% of referrals
Briffa et al 2011,ACSQHC 2014, Dalal et al 2015

3. Aim
To audit and compare the proportion of ACS patients referred to the SCGH hospital-based CR program in and

4. Sir Charles Gairdner Hospital (SCGH)
Tertiary hospital (>600 beds, 420,000 pts/yr)
1 Cath lab, 3 theatres, beds
Process: automatic referral for all ACS to CR Coordinator (CNC). Triages referrals: SCGH CR program, private program, community service, regional/other tertiary hospital
CR Multidisciplinary team: Nurses, Physiotherapists, Pharmacist, Dietician (private).

5. Method: audit design Retrospective audit and process evaluation
2015
ACS referral number data collection (retrospective):
Clinical codes
Admissions/Discharges
Number of referrals
Referral process review
2016
Implement recommended changes
Re-audit and monitor
2017

6. Results table1. 2015-16 2016-17 Total number of ACS patients
ACS referrals to CR Coordinator
N = 928
832 (89%)
N = 770
648 (84%)
Triage destination
Hospital-based CR program
240
29%
174
27%
Rural CR program
207
22%
172
26%
Community/other CR programs 73 9%
258
40%
Total number of ACS referrals to CR
520
63%
604
93%
Declined CR 92
11% 72
Incomplete data
220 95
15%*
* Chi square, p<0.05

7. Summary – results Referrals to any CR program improved from 63% to 93%
Missed/incomplete referrals was reduced from 27% to 15%

8. Discussion Main points from the re-audit data were:
More ACS patients from SCGH are referred to community CR programs compared to
We can infer a higher number of ACS patients were able to access CR in (distance/cost)
Incomplete data can go undetected. Audits are necessary to identify if you meet Clinical Care Standards
Efforts to standardise terminology on referrals and recognition referrals are data  decrease in referrals being missed/incomplete

9. Limitations:
Heart Failure and Cardiothoracic referrals were beyond the scope of this audit
Recommendation:
In the future, CR database (referrals) to link to hospital admission and discharge system
Audit attendance / uptake of CR by patients following referral to a program

10. SCGH ACS data
<90% referred
60% attend
75-80% complete

11. Acknowledgements No conflicts of interest to declare.
I was supported by:
Abbey Sawyer, Madeline Gaynor, Nola Cecins & Sue Jenkins, and SCGH Physiotherapy Department.
SCGH CR & HF teams.
No conflicts of interest to declare.

12. References
Australian Commission on Safety and Quality in Health Care. Acute Coronary Syndromes Clinical Care Standard. Sydney: ACSQHC, 2014.
Dalal HM, Doherty P and Taylor RS. Cardiac Rehabilitation. BMJ 2015; 351:h5000.
Briffa TG, Hobbs MS, Tonkin A, Sanfilippp FM, Ridout SC and Knuiman M. Population Trends of Recurrent Coronary Heart Disease Event Rates Remain High. Circulation: Cardiovascular Quality and outcomes. 2011; 4:

13. Appendice

14. FY ?
Our responsibility

15. Plus community cardiac rehab programs!
Three NEW hospitals
Fiona Stanley (20, 24 beds)
Midland SJOG (caths)
Joondalup (10, 8)

16. ACS management in WA Emergency/elective ACS treatment
Tertiary hospital
Private hospital
Cardiac Rehab & Secondary Prevention
Tertiary or secondary hospital program (catchment)
Community program (public health)
Private program (private health fund)
Rural and remote (Regional hospital or partial local service +/- tertiary hospital education/support)
Interstate and international

17. Terminology
“Exercise discussed… [name] reports walking the dog 20minutes twice a day… Agreed to referral to physiotherapist/Community program…”
“Agreed to referral to Albany CR program… Agreed to follow-up phone education…”
“Discussed benefits of exercise with [name]… patient declined referral to CR .. States he already exercises more than 30 minutes each day… and completed CR in 2012…”