Translation of Critical Pathways for Acute Coronary Syndrome into Admission Notes and Discharge Planning

Acute coronary syndrome (ACS) accounts for the majority of admissions to medical and cardiac services in U.S. hospitals. Guidelines for the management of ACS [1, 2] have been published by the American College of Cardiology (ACC) and the American Heart Association (AHA).

We have recently developed and published a unique pathway for the management of ACS [3] at St. Luke's Roosevelt Hospital—Columbia University College of Physician and Surgeons in New York City. Our updated pathway as described in Chapter 2 of this book is designed to optimize care for patients using clinical evidence models and to teach physicians-in-training consensus evaluation and management strategies. To facilitate implementation of our pathway to improve and standardize patient care when appropriate, we have developed user-friendly admission and discharge forms based on these pathways [4]. Residents who rotate through the cardiac care unit, the telemetry and the cardiac medical fl oors are required to complete these preprinted forms for admission and discharge of patients with ACS. These forms act as a reminder of key points of the pathway, as data collection devices, and most importantly as an agreement or “buy-in” on discharge between patients and their health care providers. The key points of the discharge form include a review of medications, side effects, smoking cessation, exercise, a follow-up appointment, and an understanding that they will be contacted by phone after discharge for follow-up of their condition.