Nambour General Hospital was selected as a pilot site to implement a clinical redesign by introducing the recently researched ADAPT Protocol into practice. Consistent with the research, the new clinical process safely identified approximately 20 per cent of patients at low risk of ACS who could be discharged home for outpatient exercise stress test (EST). Published outcomes include an average ED length of stay reduction of 81 minutes for patients presenting to ED with possible cardiac chest pain, resulting in increased compliance to the National Emergency Access Targets (NEAT). No major adverse cardiac events were reported.
(Introduction of an accelerated diagnostic protocol in the assessment of emergency department patients with possible acute coronary syndrome: The Nambour Short Low‐Intermediate Chest pain project).
An evaluation of the ACRE project (Implementing change: evaluating the Accelerated Chest pain Risk Evaluation (ACRE) project, 2017) was published in the Medical Journal of Australia showing reduction of emergency department length of stay and fewer hospital admissions. The release in financial capacity resulting from these reductions was estimated at $13.5 M.
Improved Assessment of Chest pain Trial (ImpACT) Rollout
The Improved Assessment of Chest pain Trial (ImpACT) (2017) was published in the Medical Journal of Australia and showed safe, effective risk stratification and management for patients presenting to the Emergency Department (ED) with suspected acute coronary syndrome (ACS).
The ImpACT protocol safely allows low risk patients to be discharged with no further testing, and intermediate risk patients to undergo accelerated care (ECG and TnI at 0 and 2 hours, followed by inpatient objective testing). It does not change the care of high risk patients.
At the announcement of the new troponin assay in September 2018, the ImpACT protocol had been rolled out to 9 sites. Preliminary results showed improved care and management of patients presenting to the ED with suspected ACS.
ImpACT Aboriginal and Torres Strait Islander Research Project
It is acknowledged by the researchers of the original ImpACT study that Aboriginal and Torres Strait Islander patients were underrepresented. The increased burden of cardiovascular disease among these populations is well known, but there is a lack of evidence around exactly how this affects their risk stratification. The ImpACT Aboriginal and Torres Strait Islander Research Project aims to describe the risk stratification and outcomes for Aboriginal and Torres Strait Islander people assessed with the ImpACT protocol.
The study is being conducted in partnership with the ACRE Project Team (sponsored by the Queensland Health Clinical Excellence Division), the Australian Centre for Health Services Innovation (AusHSI) and Cairns Hospital. The research team acknowledges and pays respect to the Traditional Owners and the Aboriginal and Torres Strait Islander Elders, People, Consumers, and Staff, past and present, on whose land we carry out research.
The research has received formal support from the following organisations:
- Wuchopperen Health Service Limited
- Gurriny Yealamucka Health Service Aboriginal Corporation
- Apunipima Cape York Health Council
- Aboriginal and Torres Strait Islander health management unit, Cairns and Hinterland Hospital and Health Service