Article Text

Download PDFPDF

See You in 7: improving acute myocardial infarction follow-up care
  1. Alex Batten1,
  2. Cassie Jaeger1,
  3. David Griffen2,
  4. Paula Harwood1,
  5. Karen Baur1
  1. 1Department of Cardiovascular Services; Project Management Office, Memorial Health System, Springfield, Illinois, USA
  2. 2Department of Emergency Medicine, Southern Illinois University School of Medicine, Springfield, Illinois, USA
  1. Correspondence to Dr Karen Baur; Baur.Karen{at}


Acute myocardial infarction (AMI) follow-up care is a crucial part of the AMI recovery process. The American College of Cardiology’s ‘See You in 7 Challenge’ advocates that all patients discharged with a diagnosis of AMI have a cardiac rehabilitation referral made and outpatient cardiac rehabilitation appointment scheduled to occur within 7 days of hospital discharge. A streamlined AMI cardiac rehabilitation referral and appointment scheduling process was not in place at this urban academic medical centre. To develop the streamlined processes, a Six Sigma project was initiated. Four months before the intervention, 1/38 patients with AMI (2.6%) were scheduled to have the initial outpatient cardiac rehabilitation appointment occur within 7 days of hospital discharge, with an average 18.7 days from hospital discharge to the scheduled initial outpatient cardiac rehabilitation appointment. To reduce the time to this initial appointment, availability of outpatient cardiac rehabilitation appointments was increased, additional staff were trained in appointment scheduling and insurance verification processes and appointments were scheduled prior to hospital discharge. After intervention, the number of patients scheduled to attend an outpatient cardiac rehabilitation appointment within 7 days of hospital discharge improved to 72/79 (91.1%) (two-proportion test, p<0.001). Days from hospital discharge to first scheduled outpatient cardiac rehabilitation appointment were reduced from 18.7 days to 6.3 days (a 66.3% reduction) (Mann-Whitney U test, p<0.01). Initial outpatient cardiac rehabilitation attendance within 7 days of hospital discharge increased from 1/38 (2.6%) to 42/79 (53.2%) (a 50.6% increase) (two-proportion test, p<0.001).

  • ambulatory care
  • healthcare quality improvement
  • Six Sigma
  • transitions in care

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

View Full Text

Statistics from


  • Contributors AB contributed to study concept and design, acquisition and analysis of data, drafting of the manuscript, critical revision of the manuscript and study supervision. CJ contributed to analysis of data, drafting of the manuscript and critical review of the manuscript. DG contributed to analysis and interpretation of data and critical review of the manuscript. PH contributed to study design, acquisition of the data and critical revision of the manuscript. KB contributed to study concept and design, interpretation of data, critical revision of the manuscript and study supervision.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.