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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock

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The Cardiac Direct Access Clinic: Improving Urgent Access while Reducing Unnecessary Emergency Department and

Mohan Sonu Chandra¹, Rishi Wadhera², Rebecca Angoff³

¹Research Fellow, Brigham and Women's Hospital Department of Men's Health, Aging, and Metabolism, Harvard Medical School, Boston, MA, USA.

NEJM Catalyst Innovations in Care Delivery

|July 7, 2026

Summary

A new Cardiac Direct Access Clinic improved patient care and financial performance by reducing emergency department (ED) visits for urgent cardiac symptoms. This model offers rapid evaluation and short-stay care, enhancing patient experience and financial sustainability.

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A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings

A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings

Published on: November 9, 2016

Area of Science:

Cardiology
Healthcare Management
Health Services Research

Background:

Emergency department (ED) crowding and limited inpatient capacity lead to delays in care for patients with urgent cardiac conditions.
Long wait times for outpatient cardiology services exacerbate these issues, impacting timely diagnosis and treatment.

Purpose of the Study:

To assess the operational, clinical, and financial outcomes of a novel, non-ED-based Cardiac Direct Access Clinic.
To evaluate the effectiveness of this model in providing rapid specialty evaluation and short-stay cardiac care.
To summarize key implementation strategies for establishing such a clinic.

Main Methods:

Utilized administrative data and contribution-margin analyses to evaluate clinic performance.
Assessed patient flow, including same-day referrals, discharges, overnight unit management, and inpatient admissions.
Analyzed patient experience scores and financial data, including costs and contribution margins.

Main Results:

The clinic saw 11,121 patients, with 4239 same-day referrals from the ED. Of these, 59% were discharged home, 39% managed in the overnight unit, and 7% admitted to inpatient floors.
The 30-day ED return rate for patients discharged from the overnight unit was 6.4%.
Patient experience scores were significantly higher for the clinic (84.7) compared to the ED (56.9).
The clinic generated an estimated US$2.4 million annual contribution margin, demonstrating financial sustainability.

Conclusions:

The Cardiac Direct Access Clinic model effectively provides rapid evaluation and short-stay care for urgent cardiac conditions, reducing ED burden.
Key enablers for success include centralized prior-authorization, regulatory approval for alternative care spaces, and established diversion pathways.
This model offers a financially sustainable solution to improve patient access and experience in cardiology care.