Abstract
Objective
The HAS-Choice pathway utilizes the HEART Score, an accelerated diagnostic protocol
(ADP), and shared decision-making using a visual aid in the evaluation of chest pain
patients. We seek to determine if our intervention can improve resource utilization
in a community emergency department (ED) setting while maintaining safe patient care.
Methods
This was a single-center prospective cohort study with historical that included ED
patients ≥21 years old presenting with a primary complaint of chest pain in two time periods. The
primary outcome was patient disposition. Secondary outcomes focused on 30-day ED bounce
back and major adverse cardiac events (MACE). We used multivariate logistic regression
to estimate the odds ratio (OR) and its 95% confidence interval (CI).
Results
In the pre-implementation period, the unadjusted disposition to inpatient, observation
and discharge was 6.5%, 49.1% and 44.4%, respectively, whereas in the post period,
the disposition was 4.8%, 41.5% and 53.7%, respectively (chi-square p < 0.001). The adjusted odds of a patient being discharged was 40% higher (OR = 1.40; 95% CI, 1.30, 1.51; p < 0.001) in the post-implementation period. The adjusted odds of patient admission was
30% lower (OR = 0.70; 95% CI, 0.60, 0.82; p < 0.001) in the post-implementation period. The odds of 30-day ED bounce back did not
statistically differ between the two periods. MACE rates were <1% in both periods,
with a significant decrease in mortality in the post-implementation period.
Conclusion
Our study suggests that implementation of a shared decision-making tool that integrates
an ADP and the HEART score can safely decrease hospital admissions without an increase
in MACE.
Keywords
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Article Info
Publication History
Published online: February 07, 2018
Accepted:
February 5,
2018
Received in revised form:
January 24,
2018
Received:
November 15,
2017
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
