Improvement of Emergency Department Chest Pain Evaluation Using Hs-cTnT and a Risk Stratification Pathway

Area of Science:

• Emergency Medicine
• Cardiology
• Clinical Pathway Development

Background:

• Chest pain is a frequent emergency department (ED) presentation globally.
• Efficient differentiation between serious and benign causes of chest pain is crucial for effective patient management and resource allocation.

Purpose of the Study:

• To assess the effectiveness of a novel risk stratification pathway in reducing ED resource utilization for nontraumatic chest pain.
• The pathway integrates the 5th generation high-sensitivity cardiac troponin T assay (Hs-cTnT) with the HEART score.

Main Methods:

• A retrospective chart review compared outcomes before and after implementing the Hs-cTnT and HEART score pathway.
• The study analyzed 1707 patients pre-implementation and 1529 patients post-implementation.
• Key outcome measures included ED length of stay (LOS), cardiology consult rates, admission rates, and ED boarding.

Main Results:

• Median ED LOS decreased by 31 minutes post-implementation (p < 0.001).
• Cardiology consult rates fell from 26.9% to 16.0% (p < 0.0001).
• Admission rates decreased from 30.1% to 22.7% (p < 0.0001), and ED boarding proportions also reduced significantly.

Conclusions:

• The novel chest pain pathway effectively improved ED throughput metrics for nontraumatic chest pain evaluations.
• This integrated approach demonstrates significant benefits in managing chest pain presentations within the ED setting.