School of Medicine and Health Sciences Poster Presentations

Title

Implications of using a risk-stratification score on chest pain admissions

Document Type

Poster

Abstract Category

Quality Improvement

Keywords

HEART score, Chest pain, Risk

Publication Date

Spring 5-1-2019

Abstract

Background: Chest pain is a common cause for ED presentation, with over 8 million visits annually in the US. Patients undergo liberal testing in an effort to prevent a missed cardiac event. This workup results in overuse of resources costing $10-13 billion annually. This quality improvement (QI) project focuses on patients who undergo no objective cardiac testing during their hospital stay, as a group, who may represent inappropriate admissions. It is hypothesized that these patients may be identified by the HEART score, as low-risk, and benefit from early ED discharge. Methods: This project is a pre- and post-protocol intervention design set in a 371-bed urban academic hospital. A total of 3,225 charts were reviewed, 1,673 pre- and 1,552 post-intervention, between a 2-month intervention. The final analysis included 562 pre- and 631 post-intervention patients. The mean admission HEART score and length of ER stay were calculated between the two groups. Attending admission rates were compared to determine whether a statistical difference existed amongst providers evaluating chest pain. Differences were determined utilizing independent t-tests, with a p-value of 0.05. Results : There was a significant decrease in admissions after implementation of the HEART score. In the subset of patients who were admitted, there was no statistically significant change in the percentage of patients who underwent objective testing. And of the discharged patients, there was no significant difference in the number of readmissions within 30 days. Conclusions: Using the HEART pathway and providing patient resources on care options correlated with a significant decrease in hospital admissions without increasing readmissions.

Open Access

1

Comments

Presented at Research Days 2019.

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Implications of using a risk-stratification score on chest pain admissions

Background: Chest pain is a common cause for ED presentation, with over 8 million visits annually in the US. Patients undergo liberal testing in an effort to prevent a missed cardiac event. This workup results in overuse of resources costing $10-13 billion annually. This quality improvement (QI) project focuses on patients who undergo no objective cardiac testing during their hospital stay, as a group, who may represent inappropriate admissions. It is hypothesized that these patients may be identified by the HEART score, as low-risk, and benefit from early ED discharge. Methods: This project is a pre- and post-protocol intervention design set in a 371-bed urban academic hospital. A total of 3,225 charts were reviewed, 1,673 pre- and 1,552 post-intervention, between a 2-month intervention. The final analysis included 562 pre- and 631 post-intervention patients. The mean admission HEART score and length of ER stay were calculated between the two groups. Attending admission rates were compared to determine whether a statistical difference existed amongst providers evaluating chest pain. Differences were determined utilizing independent t-tests, with a p-value of 0.05. Results : There was a significant decrease in admissions after implementation of the HEART score. In the subset of patients who were admitted, there was no statistically significant change in the percentage of patients who underwent objective testing. And of the discharged patients, there was no significant difference in the number of readmissions within 30 days. Conclusions: Using the HEART pathway and providing patient resources on care options correlated with a significant decrease in hospital admissions without increasing readmissions.