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

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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
PubMed

Insights

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.

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.

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