Feedback, Education, and Protocols to Safely Reduce Emergency Department Admissions for Chest Pain

We evaluate a program designed to safely reduce avoidable emergency department (ED) admissions for chest pain using peer feedback.

We analyzed data from August 1, 2020, to December 31, 2022, comparing clinical protocols, education, and feedback starting in July 2021 at 16 EDs in a Mountain-region state (state A) and 22 in a Southwestern state (state B), compared with 70 controls with protocols and education alone. Difference-in-difference analyses compared temporal changes in admission rates in intervention versus control EDs.

The study included 368,730 visits for chest pain. After implementation, feedback was not associated with a significant overall relative improvement in ED admission rates for chest pain. However, among baseline high-admitting clinicians, chest pain admissions declined in state A by 14.3% (95% confidence interval -21.7% to -6.9%) and in state B by 5.6% (95% confidence interval -10.5% to -0.8%), relative to high-admitting clinicians in control states. We estimate that 4 admissions in every 100 chest pain visits could have been avoided if feedback had the same effect in control EDs as it did in state A.

Adding peer feedback to clinical protocols and education was associated with reduced admissions for chest pain among baseline high-admitting clinicians.