Cost and outcomes of assessing patients with chest pain in an Australian emergency department

Cullen, Louise; Greenslade, Jaimi; Merollini, Katharina; Graves, Nicholas; Hammett, C.; Hawkins, Tracey; Than, Martin; Brown, Anthony; Huang, Christopher B; Panahi, Seyed E; Dalton, Emily; Parsonage, William

doi:10.5694/mja14.00472

Cited by 90 publications

(91 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This thesis shows that patients with NCCP incurred more than double the societal costs annually as patients with AMI and patients with AP, as patients with NCCP are more than three times as many. Similar findings have been reported, although only regarding direct costs (142). Based on these findings, it is important that the care of these patients is structured differently and that actions are taken to reduce healthcare utilization and costs.…”

Section: Psychological Distress Healthcare Utilization and Societal supporting

confidence: 68%

“…However, patients are involved in timeconsuming and expensive assessments at the emergency departments or hospitalized and treated within cardiac units, even though the pain is not caused by a cardiac disease. This is not cost-effective (2,3,141,142), but can partly be explained by the fact that many physicians are afraid of missing a cardiac diagnosis and therefore tend to overestimate the risk (10), in addition to the fact that even cardiac patients can have NCCP (4,8,9). By comparing the costs associated with patients with NCCP, who have a less severe condition, to patients with a more severe cardiac disease, the intention was to highlight the extent of the costs these patients incur, despite the good prognosis they are assigned in different research (7,33,40).…”

Section: Psychological Distress Healthcare Utilization and Societal mentioning

confidence: 99%

See 1 more Smart Citation

Improving care for patients with non-cardiac chest pain : Description of psychological distress and costs, and evaluation of an Internet-delivered intervention

Mourad¹

2015

Linköping University Medical Dissertations

View full text Add to dashboard Cite

Introduction: More than half of all patients seeking care for chest pain do not have a cardiac cause for this pain. Despite recurrent episodes of chest pain, many patients are discharged without a clear explanation of the cause for their pain. A lack of explanation may result in a misinterpretation of the pain as being cardiac-related, causing worry and uncertainty, which in turn leads to substantial use of healthcare resources. Psychological distress has been associated with non-cardiac chest pain (NCCP), but there is limited research regarding the relationship between different psychological factors and their association with healthcare utilization. There is a need for interventions to support patients to manage their chest pain, decrease psychological distress, and reduce healthcare utilization and costs. Aim: The overall aim of this thesis was to improve care for patients with non-cardiac chest pain by describing related psychological distress, healthcare utilization and societal costs, and by evaluating an Internet-delivered cognitive behavioural intervention. Designs and methods: This thesis presents results from four quantitative studies. Studies I and II had a longitudinal descriptive and comparative design. The studies used the same initial cohort. Patients were consecutively approached within 2 weeks from the day of discharge from a general hospital in southeast Sweden. In study I, 267 patients participated (131 with NCCP, 66 with acute myocardial infarction (AMI), and 70 with angina pectoris (AP)). Out of these, 199 patients (99 with NCCP, 51 with AMI, 49 with AP) participated in study II. Participants were predominantly male (about 60 %) with a mean age of 67 years. Data was collected on depressive symptoms (Study I), healthcare utilization (Study I, II), and societal costs (Study II). Study III had a cross-sectional explorative and descriptive design. Data was collected consecutively on depressive symptoms, cardiac anxiety and fear of body sensations in 552 patients discharged with diagnoses of NCCP (51 % women, mean age 64 years) from four hospitals in southeast Sweden. Patients were approached within one month from the day of discharge. Study IV was a pilot randomized controlled study including nine men and six women with a median age of 66 years, who were randomly assigned to an intervention (n=7) or control group (n=8). The intervention consisted of a four-session guided Internet-delivered cognitive behavioural therapy (CBT) program containing psychoeducation, exposure to physical activity, and relaxation. The control group received usual care. Data was collected on chest pain frequency, cardiac anxiety, fear of body sensations, and depressive symptoms. Results: Depressive symptoms were prevalent in 20 % (Study IV) and 25 % (Study I, III) of the patients, and more than half of the patients still experienced depressive symptoms one year later (Study I). There were no significant differences in prevalence and severity of depressive symptoms between patients diagnosed with NCCP, AMI or AP. Living a...

show abstract

Section: Psychological Distress Healthcare Utilization and Societal supporting

confidence: 68%

Section: Psychological Distress Healthcare Utilization and Societal mentioning

confidence: 99%

Improving care for patients with non-cardiac chest pain : Description of psychological distress and costs, and evaluation of an Internet-delivered intervention

Mourad¹

2015

Linköping University Medical Dissertations

View full text Add to dashboard Cite

show abstract

“…The hsTnI assay has a 99th percentile concentration of 26.2 ng/L with a corresponding co-efficient of variation of <5% and a limit of detection (LoD) of 1.2 ng/L. 16 cost prediction model As described previously, 17 individual cost data were extracted from hospital administration records and adjusted for inflation to 2011 A$. To use a consistent cost matrix across all strategies, a prediction model was developed in four steps.…”

Section: Methods Study Design and Settingmentioning

confidence: 99%

The organisational value of diagnostic strategies using high-sensitivity troponin for patients with possible acute coronary syndromes: a trial-based cost-effectiveness analysis

et al. 2017

Self Cite

View full text Add to dashboard Cite

ObjectivesTo evaluate hospital-specific health economic implications of different protocols using high-sensitivity troponin I for the assessment of patients with chest pain.DesignA cost prediction model and an economic microsimulation were developed using a cohort from a single centre recruited as part of the (ADAPT) trial, a prospective observational trial conducted from 2008 to 2011. The model was populated with 40 000 bootstrapped samples in five high-sensitivity troponin I-enabled algorithms versus standard care.SettingAdult emergency department (ED) of a tertiary referral hospital.ParticipantsData were available for 938 patients who presented to the ED with at least 5 min of symptoms suggestive of acute coronary syndrome. The analyses included 719 patients with complete data.Main outcome(s)/measure(s)This study examined direct hospital costs, number of false-negative and false-positive cases in the assessment of acute coronary syndrome.ResultsHigh-sensitivity troponin I-supported algorithms increased diagnostic accuracy from 90.0% to 94.0% with an average cost reduction per patient compared with standard care of $490. The inclusion of additional criteria for accelerated rule-out (limit of detection and the modified 2-hour ADAPT trial rules) avoided 7.5% of short-stay unit admissions or 25% of admissions to a cardiac ward. Protocols using high-sensitivity troponin I alone or high-sensitivity troponin I within accelerated diagnostic algorithms reduced length of stay by 6.2 and 13.6 hours, respectively. Overnight stays decreased up to 43%. Results were seen for patients with non-acute coronary syndrome; no difference was found for patients with acute coronary syndrome.ConclusionsHigh-sensitivity troponin I algorithms are likely to be cost-effective on a hospital level compared with sensitive troponin protocols. The positive effect is conferred by patients not diagnosed with acute coronary syndrome. Implementation could improve referral accuracy or facilitate safe discharge. It would decrease costs and provide significant hospital benefits.Trial registrationThe original ADAPT trial was registered with the Australia-New Zealand Clinical trials Registry, ACTRN12611001069943.

show abstract

“…The observation and investigation of such patients are major health-system burdens. [1][2][3] Clinical guidelines and clinical pathways are increasingly being used in these situations in which clinical uncertainty may lead to inappropriate or unnecessary investigation.…”

mentioning

confidence: 99%

ICare-ACS (Improving Care Processes for Patients With Suspected Acute Coronary Syndrome)

Than¹,

Pickering

Dryden³

et al. 2018

Circulation

Self Cite

View full text Add to dashboard Cite

Background: Efforts to safely reduce length of stay for emergency department patients with symptoms suggestive of acute coronary syndrome (ACS) have had mixed success. Few system-wide efforts affecting multiple hospital emergency departments have ever been evaluated. We evaluated the effectiveness of a nationwide implementation of clinical pathways for potential ACS in disparate hospitals. Methods: This was a multicenter pragmatic stepped-wedge before-and-after trial in 7 New Zealand acute care hospitals with 31 332 patients investigated for suspected ACS with serial troponin measurements. The implementation was a clinical pathway for the assessment of patients with suspected ACS that included a clinical pathway document in paper or electronic format, structured risk stratification, specified time points for electrocardiographic and serial troponin testing within 3 hours of arrival, and directions for combining risk stratification and electrocardiographic and troponin testing in an accelerated diagnostic protocol. Implementation was monitored for >4 months and compared with usual care over the preceding 6 months. The main outcome measure was the odds of discharge within 6 hours of presentation Results: There were 11 529 participants in the preimplementation phase (range, 284–3465) and 19 803 in the postimplementation phase (range, 395–5039). Overall, the mean 6-hour discharge rate increased from 8.3% (range, 2.7%–37.7%) to 18.4% (6.8%–43.8%). The odds of being discharged within 6 hours increased after clinical pathway implementation. The odds ratio was 2.4 (95% confidence interval, 2.3–2.6). In patients without ACS, the median length of hospital stays decreased by 2.9 hours (95% confidence interval, 2.4–3.4). For patients discharged within 6 hours, there was no change in 30-day major adverse cardiac event rates (0.52% versus 0.44%; P =0.96). In these patients, no adverse event occurred when clinical pathways were correctly followed. Conclusions: Implementation of clinical pathways for suspected ACS reduced the length of stay and increased the proportions of patients safely discharged within 6 hours. Clinical Trial Registration: URL: https://www.anzctr.org.au/ (Australian and New Zealand Clinical Trials Registry). Unique identifier: ACTRN12617000381381.

show abstract

Cost and outcomes of assessing patients with chest pain in an Australian emergency department

Cited by 90 publications

References 19 publications

Improving care for patients with non-cardiac chest pain : Description of psychological distress and costs, and evaluation of an Internet-delivered intervention

Improving care for patients with non-cardiac chest pain : Description of psychological distress and costs, and evaluation of an Internet-delivered intervention

The organisational value of diagnostic strategies using high-sensitivity troponin for patients with possible acute coronary syndromes: a trial-based cost-effectiveness analysis

ICare-ACS (Improving Care Processes for Patients With Suspected Acute Coronary Syndrome)

Contact Info

Product

Resources

About