Implementing change: evaluating the Accelerated Chest pain Risk Evaluation (ACRE) project
- 4 September 2017
- journal article
- Published by AMPCo in The Medical Journal of Australia
- Vol. 207 (5), 201-205
- https://doi.org/10.5694/mja16.01479
Abstract
To evaluate hospital length of stay (LOS) and admission rates before and after implementation of an evidence-based, accelerated diagnostic protocol (ADP) for patients presenting to emergency departments (EDs) with chest pain. Quasi-experimental design, with interrupted time series analysis for the period October 2013 - November 2015. Setting, participants: Adults presenting with chest pain to EDs of 16 public hospitals in Queensland. Implementation of the ADP by structured clinical re-design. Primary outcome: hospital LOS. ED LOS, hospital admission rate, proportion of patients identified as being at low risk of an acute coronary syndrome (ACS). Outcomes were recorded for 30 769 patients presenting before and 23 699 presenting after implementation of the ADP. Following implementation, 21.3% of patients were identified by the ADP as being at low risk for an ACS. Following implementation of the ADP, mean hospital LOS fell from 57.7 to 47.3 hours (rate ratio [RR], 0.82; 95% CI, 0.74-0.91) and mean ED LOS for all patients presenting with chest pain fell from 292 to 256 minutes (RR, 0.80; 95% CI, 0.72-0.89). The hospital admission rate fell from 68.3% (95% CI, 59.3-78.5%) to 54.9% (95% CI, 44.7-67.6%; P < 0.01). The estimated release in financial capacity amounted to $2.3 million as the result of reduced ED LOS and $11.2 million through fewer hospital admissions. Implementing an evidence-based ADP for assessing patients with chest pain was feasible across a range of hospital types, and achieved a substantial release of health service capacity through reductions in hospital admissions and ED LOS.Keywords
Funding Information
- Queensland Government Department of Health
- Healthcare Improvement Unit
This publication has 12 references indexed in Scilit:
- Use of the Theoretical Domains Framework to evaluate factors driving successful implementation of the Accelerated Chest pain Risk Evaluation (ACRE) projectImplementation Science, 2016
- National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the management of acute coronary syndromes 2016The Medical Journal of Australia, 2016
- Effectiveness of EDACS Versus ADAPT Accelerated Diagnostic Pathways for Chest Pain: A Pragmatic Randomized Controlled Trial Embedded Within PracticeAnnals of Emergency Medicine, 2016
- Cost and outcomes of assessing patients with chest pain in an Australian emergency departmentThe Medical Journal of Australia, 2015
- Performance of the 2‐hour Accelerated Diagnostic Protocol Within the American College of Radiology Imaging Network PA 4005 CohortAcademic Emergency Medicine, 2015
- The HEART Pathway Randomized TrialCirculation: Cardiovascular Quality and Outcomes, 2015
- Comparison of Three Risk Stratification Rules for Predicting Patients With Acute Coronary Syndrome Presenting to an Australian Emergency DepartmentHeart, Lung and Circulation, 2013
- Introduction of an accelerated diagnostic protocol in the assessment of emergency department patients with possible acute coronary syndrome: The Nambour Short Low‐Intermediate Chest pain projectEmergency Medicine Australasia, 2013
- 2-Hour Accelerated Diagnostic Protocol to Assess Patients With Chest Pain Symptoms Using Contemporary Troponins as the Only BiomarkerJournal of Invasive Cardiology, 2012
- The answer is 17 years, what is the question: understanding time lags in translational researchJournal of the Royal Society of Medicine, 2011