Review of chest pain project reveals massive savings

Wednesday, July 15, 2020

A recent publication in the Journal of Clinical Medicine highlights some of the achievements of the Accelerated Chest pain Risk Evaluation (ACRE) Project.

Emergency Physician and ACRE Project Co-clinical Lead (with Cardiologist Dr Louise McCormack), Professor Louise Cullen said the CEQ-sponsored initiative was designed to implement the best method, based on evidence, to safely and efficiently assess patients presenting to hospital emergency departments with chest pain and suspected acute coronary syndrome (ACS).

‘Symptoms of chest pain, indicative of possible acute myocardial infarction [AMI, heart attack], are one of the most common causes for emergency department admissions worldwide but very few are ultimately diagnosed with AMI,’ Prof. Cullen said.

The ACRE Project Team worked with emergency, cardiology and general medical departments across Queensland to implement accelerated diagnostic protocols (ADPs) which enabled the safe, accelerated assessment of patients with chest pain.

However, midway through Stage II of the project, a new high sensitivity cardiac Troponin I [hs-cTnI] assay was introduced to all Queensland Health pathology laboratories.

‘We had to respond quickly by expanding project scope to ensure clinical utilisation of the new assay took full advantage of its analytical capabilities,’ Prof. Cullen said. ‘We focused on this aspect in the study.’

Prof. Cullen said the potential benefits of hs-cTn assay introduction needed to be balanced with possible unintended harms or the unnecessary utilisation of hospital resources. ‘Elevated troponin concentrations are seen in numerous clinical conditions other than AMI that are associated with myocardial injury,’ she said.

Consequently, the study examined the introduction of the new high sensitivity cardiac troponin assay including the impact on patients and health services. Researchers interrogated 124,357 episodes of care across 21 hospitals in Queensland and reported a 1.9-hour reduction in median hospital length of stay with no increase in diagnosis of AMI, invasive cardiac procedures or ward admissions.

‘It's estimated this length of stay saving equates to annual cost savings of approximately $9.2 million, or 8,290 bed days which is an amazing result,’ Prof. Cullen said.

‘This study demonstrates an example of how widespread clinical implementation of ADPs aligning with contemporary evidence can lead to significant health service improvement, particularly when this evidence is translated into clinical practice more quickly.’ For more information on the ACRE Project visit our Improvement Exchange.

ACRE Project Team

Pictured above: ACRE Project Team (L-R Laura Foran, Sarah Ashover, Louise Cullen, Louise McCormack and Tanya Milburn.

Last updated: 15 July 2020