Utilizing PDSA Cycle in Implementing a Chest Pain Accelerated Diagnostic Protocol.

Area of Science:

• Emergency Medicine
• Cardiology
• Healthcare Quality Improvement

Background:

• The Emergency Department (ED) implemented a Chest Pain Accelerated Diagnostic Protocol (CPADP) using the History, EKG, Age, Risk Factors, Troponin (HEART) Score.
• The Plan-Do-Study-Act (PDSA) model guided the protocol's implementation, evaluation, and modification.

Purpose of the Study:

• To assess the adequacy of outpatient follow-up for chest pain patients identified as low-risk by the HEART Score.
• To evaluate the effectiveness of the CPADP in ensuring timely and appropriate post-discharge care.

Main Methods:

• The CPADP risk-stratified patients into low, moderate, and high risk for Major Adverse Cardiac Events (MACE).
• Low-risk patients were offered discharge with outpatient follow-up within seven days.
• Protocol adherence and patient follow-up within thirty days were evaluated.

Main Results:

• Of 50 low-risk patients discharged, 18 were lost to follow-up.
• Only 47% of contacted patients followed up with a primary care provider or cardiologist.
• A mere 13% received recommended cardiac testing post-discharge.

Conclusions:

• The study revealed significant gaps in outpatient follow-up and cardiac testing for low-risk chest pain patients.
• Modifications to the CPADP are necessary to enhance the clinical appropriateness of post-discharge care.
• The Chest Pain Committee is advancing the PDSA cycle to refine the protocol.