Utilization of Chest Pain Decision Aids in a Community Hospital Emergency Department: A Mixed-methods Implementation...

Area of Science:

• Emergency Medicine
• Clinical Decision Support
• Implementation Science

Background:

• Chest pain is a frequent reason for emergency department (ED) visits.
• Evidence-based risk assessment tools for adverse cardiac events are underutilized in community hospitals.
• This study addresses the gap in implementing decision aids for chest pain management.

Purpose of the Study:

• To explore the implementation of the HEART Score, accelerated diagnostic pathway, and shared decision-making visual aid in a community hospital ED.
• To identify barriers and facilitators to adopting these tools among physicians and patients.
• To assess the acceptability and feasibility of these evidence-based interventions.

Main Methods:

• A single-center, mixed-methods study involving physician interviews and patient/physician surveys.
• Utilized The Consolidated Framework for Implementation Research for qualitative analysis.
• Included a 16-week intervention with physician training and pilot testing of decision aids.

Main Results:

• Physicians identified EMR decision support and ease of use as facilitators, but cited time constraints and workflow changes as barriers.
• Most patients (85%) were satisfied with the shared decision-making visual aid.
• Physician support for the HEART Score was high (95%), but acceptance of the visual aid was lower (57%).

Conclusions:

• The implementation of evidence-based chest pain decision aids in community hospital EDs is feasible and acceptable.
• Key barriers and facilitators were identified, informing future implementation strategies.
• Further research is needed to confirm findings and test generalizability in community settings.