ACRE - video transcript
Hi, my name is Louise Callen. I'm an emergency physician here at the Royal Brisbane and the emergency clinical lead for the ACRE project along with Will Parsonage, a cardiologist. The story you're about to see is about the implementation of grassroots research that was developed here in Queensland, being put into place widely across Queensland, to improve the care of our patients coming to the emergency department with chest pain. What we have done is reduced the lengthy delays, sometimes up to 17 years, of evidence getting into practice with the support of Clinical Excellence Queensland.
I'm Deane Welch we're in Rockonia in Rockhampton, we've been here since 2014, we retired here. You could be miles away from town, peaceful, very peaceful. I sort of look after the place here and do the gardening and look after the animals. And yeah, generally have a good time very active, very active person. I did get a couple of pains. In fact, I had about 15 pains which really said to me, there's something going on. And I thought it was the pain that I was getting, which was in my chest and radiating up into my temples and getting a headache. And I was thinking, that's something to do with my hiatus hernia which came unstuck and causing me pain again. So I get these pains, I'd sort of stopped for half an hour, and we'd go away and I'd go back to work again. But then one morning, I had a pain just stayed in my chest and didn't go anywhere. And I had to go and have a light out, which was the pain was that bad. I said to Evonne, we better call the ambulance. I think there's something going on here. So ambulance arrived, and they bundled me up quick as a flash and trundled me off up to A&E.
So ACRE is the accelerated chest pain risk evaluation project, which is designed to implement evidence based practice for improving the assessment of patients coming to the emergency department with chest pain and potentially having a heart attack.
Once I got to the hospital, I came across one of the A&E doctors, Dr. Jack because I have to say if it wasn't for Dr. Jack, I probably wouldn't be here. He said I know that it's something to do with your heart. He said I just know it. And he then said, come back tomorrow, I'll book you in for a stress test.
I'm one of the cardiac scientists working within the chest pain assessment service, we do stress tests for intermediate risk patients who present to the emergency department of Rockhampton Hospital with chest pain.
Deane presented through ED, all his tests were negative, came through up to us and had what they call an equivocal test. So it was neither negative or positive, was admitted to the emergency department, then to coronary care, and went to Brisbane for further investigation.
It's a really big problem this, we think that about 10% of patients presenting to adult EDs come with chest pain and possibly an acute coronary syndrome or heart attack. And yet, thankfully, only about 15 out of every 100 patients have this. We spent a lot of time though evaluating the people that don't have this to safely say that they can go home. So ACRE came about or we developed some local new research and some new evidence to show that there were better ways. One of the most common misconceptions is is that to have a heart attack, you've got to have crushing central chest pain going into your jaw and down into your arm. More than half the people who've got a heart attack don't present with those symptoms. So the whole process of assessments through ACRE that we have been advocating for all patients with all different types of symptoms that may ultimately end up being an acute coronary syndrome. You know, women diabetics, for example, often present atypically and its fundamentally important that we evaluate them in the same robust way.
Majority of patients who come through CPAS do have negative test results and can go home to their GP to take charge of their health that way.
Primary care is very important because it gives patients an opportunity to self manage and that's one of the biggest thing. Heart disease is Australia's, one of Australia's biggest burdens on healthcare and cost our healthcare system and if we can have patients, managing themselves and preventing or delaying the time in which those events may occur, they're going to have improved quality of life, less disability affected life years, we're going to reduce the burden on the health system as well.
The Rockhampton Hospital is a good example of where a care was implemented up in Rockhampton there are some, you know, stretched resources, there's a big community need, of course, the chest pain and the cardiac disease up there is no different to anywhere else. We were able to collaborate with Adam Scott and the clinical Telehealth Cardiac Investigation Services there to not only implement a rapid testing with blood tests, but to back that up with a definitive test, which was stress testing done remotely. So here there was the meeting of the minds, we're able to do everything together in the patient's own local hospital, without needing to move a significant number of patients to other places to get those tests done.
With patients here that we can actually capture before they had an event, their quality of life is so much higher. And it's really actually satisfying for us to pick up something that might have otherwise been missed and was often missed in the past. And I've got the good fortune of also working within the cardiac rehab unit here, I see a number of these patients come through where they've had assessment here. Sometimes I've done a stress test, or in the case where with Deane here where Jacinta has done, done the stress test and looked after him, and he's gone through his treatment journey within the hospital, and then come to cardiac rehab to look at his recovery and to return himself to his regular function. And I've actually done his cardiac rehab assessment there. So it's really satisfying, especially to close that circle. I think it really, gets me up in the morning.
I still couldn't believe it. I was really in, in a, in a case of disbelief, that this is not happening. It's not me. Very happy to be alive. It would have been a totally different story if, if, if especially Dr. Jack, I'm gonna I can't make I can't mention that man too much if he had not taken the extra time and the extra effort to check me out thoroughly and then do more about it. Yeah, would have been a totally different result. Could have been dead, out there in the paddock somewhere, the sheep and the cows nibbling on my toes.
As a clinician and a researcher, my mantra is I don't do research for research sake. What I mean by that is is that once we create the evidence, the onus is back on us to put this into clinical practice to improve the health care of all Queenslanders.
Listen to how we partner with local health services to implement care pathways to rapidly identify those patients presenting with chest pain.
Visit the Accelerated Chest Pain Risk Evaluation (ACRE) page on the improvement exchange to learn more.
EMA ACRE article
Read Introduction of an accelerated diagnostic protocol in the assessment of emergency department patients with possible acute coronary syndrome
ACRE Journal paper
Visit the Journal of the American College of Cardiology website to view the Accelerated Chest Pain Risk Evaluation (ACRE) journal