SHM Converge Scientific Abstract ePoster Gallery-A Value-Based, Patient-Centric Model to Manage Low Risk Chest Pain in the Setting of High Sensitivity Troponin

Pdf Summary

This project aimed to reduce variation in emergency department care for adult patients presenting with chest pain, especially low-risk cases. Before the intervention, provider practices differed widely: some patients were discharged home while others were admitted to observation or inpatient care, and stress testing was used inconsistently. The team identified several barriers, including unclear disposition planning, inconsistent use of risk stratification, and variation in consult and imaging decisions.<br /><br />A multidisciplinary group from Cardiology, Emergency Medicine, Internal Medicine, Family Medicine, Anesthesia, and Laboratory Medicine developed a standardized chest pain pathway. Key interventions included switching to high-sensitivity troponin testing, applying the HEART score consistently, creating a risk stratification algorithm, and establishing an outpatient “fast track” cardiology consultation option.<br /><br />The pathway was tracked closely using monthly review of adherence, outcomes, and major adverse cardiac events (MACE). In the study period, 5,941 chest pain encounters were reviewed. After implementation, discharge home increased from 80.7% to 94.8%, while cardiac observation admissions fell from 16.9% to 3.9% and inpatient admissions from 2.4% to 1.4%. Stress testing in observation patients also dropped substantially, from 78.4% before the intervention to 49.7% afterward.<br /><br />The program saved 525.7 observation bed days and 73.7 inpatient bed days, avoided 1,050 stress tests, and generated an estimated $1,175,875 in savings over 11 months. Importantly, MACE rates remained very low and slightly improved, from 0.26% pre-intervention to 0.23% post-intervention.<br /><br />Overall, the new chest pain pathway reduced unnecessary testing and hospital utilization, improved consistency in care, and maintained patient safety while delivering more cost-effective, patient-centered management.

Asset Subtitle

Charmaine A. Lewis

Meta Tag

Author List Abby E. Roetger, Adam W. Saucerman, Charmaine A. Lewis, Christopher McKinney, De Winter III, Kristopher Swiger

Category Innovations

Concept Chest Pain Pathway

Concept High-Sensitivity Troponin I

Concept HEART Pathway

Concept Emergency Department Disposition

Concept Risk Stratification Algorithm

Distinguished Non-Finalist

Presenter Organization New Hanover Regional Medical Center

Presenting Author Charmaine A. Lewis

Track Value in Hospital Medicine

Keywords

chest pain pathway

emergency department

risk stratification

HEART score

high-sensitivity troponin

cardiology consultation

stress testing reduction

observation admissions

major adverse cardiac events

care standardization

Chest Pain Pathway

High-Sensitivity Troponin I

HEART Pathway

Emergency Department Disposition

Risk Stratification Algorithm