Reducing avoidable chest pain admissions and implementing high-sensitivity troponin testing

[摘要] NHS accident and emergency departments see 0.5million patients presenting with a cardiac conditioneach year. The accurate assessment of chest painand subsequent diagnosis or exclusion of myocardialinfarction (MI) represent a significant challenge, withimportant consequences on patient outcome andhealthcare resources. We conducted a cross-sectionalanalysis of patients admitted with cardiac chest pain toa busy district general hospital in London. The criteriaused by physicians to admit patients for further cardiacinvestigations were measured against national guidanceon chest pain assessment and diagnosis of MI. We foundthat poor adherence to guidance, unsuitable patientpathways and inappropriate diagnostic tools at the pointof presentation led to unnecessary inpatient admissionsto the hospital. Quality improvement methods were usedwith the aim to reduce avoidable admissions to hospital inpatients presenting with chest pain. We describe a systemto implement new high-sensitivity troponin testing intolegacy chest pain pathways. This was achieved throughlocal education of National Institute for Health and CareExcellence (NICE) guidance, the use of patient pro formasand the creation of two new chest pain pathway arms toenable physicians to streamline patients for appropriateinpatient or outpatient care. As a result of these changes,we reduced non-compliance with NICE guidance by 83%and achieved a 42% reduction in avoidable chest painadmissions. Overall, the improvements made by thisproject were sustained over 2 years and saved £21 000per month in avoidable admissions.

[学科分类] 药学