دورية أكاديمية
أعرض في EDS

Effect of Implementation of HEART Chest Pain Protocol on Emergency Department Disposition, Testing and Cost.

التفاصيل البيبلوغرافية
العنوان: Effect of Implementation of HEART Chest Pain Protocol on Emergency Department Disposition, Testing and Cost.
المؤلفون: Bylund WE; Naval Medical Center Portsmouth, Department of Emergency Department, Portsmouth, Virginia., Cole PM; Naval Medical Center Portsmouth, Department of Emergency Department, Portsmouth, Virginia., Lloyd ML; Naval Medical Center Portsmouth, Department of Emergency Department, Portsmouth, Virginia., Mercer AA; Naval Medical Center Portsmouth, Department of Emergency Department, Portsmouth, Virginia., Osit AK; Naval Medical Center Portsmouth, Department of Emergency Department, Portsmouth, Virginia., Hussain SW; Naval Medical Center Portsmouth, Department of Emergency Department, Portsmouth, Virginia., Lawrence MW; Naval Medical Center Portsmouth, Department of Emergency Department, Portsmouth, Virginia., Gaspary MJ; Naval Medical Center Portsmouth, Department of Emergency Department, Portsmouth, Virginia.
المصدر: The western journal of emergency medicine [West J Emerg Med] 2021 Feb 04; Vol. 22 (2), pp. 308-318. Date of Electronic Publication: 2021 Feb 04.
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: Department of Emergency Medicine, University of California, Irvine Country of Publication: United States NLM ID: 101476450 Publication Model: Electronic Cited Medium: Internet ISSN: 1936-9018 (Electronic) Linking ISSN: 1936900X NLM ISO Abbreviation: West J Emerg Med Subsets: MEDLINE
أسماء مطبوعة: Publication: <2011>- : Irvine, CA : Department of Emergency Medicine, University of California, Irvine
Original Publication: Orange, CA : California Chapter of the American Academy of Emergency Medicine
مواضيع طبية MeSH: Emergency Medical Services*/methods , Emergency Medical Services*/organization & administration , Emergency Medical Services*/standards, Acute Coronary Syndrome/*diagnosis , Chest Pain/*diagnosis , Clinical Protocols/*standards , Emergency Service, Hospital/*organization & administration, Acute Coronary Syndrome/therapy ; Diagnosis, Differential ; Female ; Hospitalization/statistics & numerical data ; Humans ; Male ; Middle Aged ; Quality Improvement ; Retrospective Studies
مستخلص: Background: Symptoms concerning for acute coronary syndromes (ACS) such as chest pain and dyspnea are some of the most common reasons for presenting to an emergency department (ED). The HEART score (history, electrocardiogram, age, risk factors and troponin) was developed and has been externally validated in an emergency setting to determine which patients with chest pain are at increased risk for poor outcomes. Our hospital adopted a HEART score-based protocol in late 2015 to facilitate the management and disposition of these patients. In this study we aimed to analyze the effects of the adoption of this protocol. Prior studies have included only patients with chest pain. We included both patients with chest pain and patients with only atypical symptoms.
Methods: This was a retrospective chart review of two cohorts. We identified ED charts from six-month periods prior to and after adoption of our HEART score-based protocol. Patients in whom an electrocardiogram and troponin were ordered were eligible for inclusion. We analyzed data for patients with typical symptoms (chest pain) and atypical symptoms both together and separately.
Results: We identified 1546 charts in the pre-adoption cohort and 1623 in the post-adoption cohort that met criteria. We analyzed the first 900 charts in each group. Discharges from the ED increased (odds ratio [OR[1.56, P<.001), and admissions for cardiac workup decreased (OR 0.46, P <.001). ED length of stay was 17 minutes shorter (P = .01). Stress testing decreased (OR 0.47, P<.001). We estimate a cost savings for our hospital system of over $4.5 million annually. There was no significant difference in inpatient length of stay or catheterization rate. When analyzing typical and atypical patients separately, these results held true.
Conclusion: After adoption of a HEART score-based protocol, discharges from the ED increased with a corresponding decrease in admissions for cardiac evaluations as well as cost. These effects were similar in patients presenting without chest pain but with presentations concerning for ACS.
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تواريخ الأحداث: Date Created: 20210415 Date Completed: 20210625 Latest Revision: 20220402
رمز التحديث: 20221213
مُعرف محوري في PubMed: PMC7972363
DOI: 10.5811/westjem.2020.9.48903
PMID: 33856317
قاعدة البيانات: MEDLINE
الوصف
تدمد:1936-9018
DOI:10.5811/westjem.2020.9.48903