Efficacy of Implementation of a Chest Pain Center at a Community Hospital

Davis, Alexandra; Chiu, Jen-Fu; Lau, Stanley K.; Kok, Yih Jen; Wu, Jonathan Y. H.

doi:10.1097/hpc.0000000000000133

Cited by 4 publications

(2 citation statements)

References 20 publications

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“…To provide a rapid and accurate diagnosis of patients with acute chest pain and regularize their treatment according to guidelines, chest pain centers (CPCs) have been established in hospitals(6-8).The CPC is an organized, multidisciplinary medical treatment system that extends from an in-hospital green channel to prehospital emergency care, regional cooperative rescue, and community outreach, integrating various resources according to actual situations (9)(10)(11)(12).The accreditation process is an intrinsic part of the CPC, which focuses on the evaluationby a professional committee of applications submitted by institutions to determine whether the applicant institutions meet the accreditation criteria. After the 1990s, many countries around the world began to set up CPCs.…”

Section: Introductionmentioning

confidence: 99%

Trends in the quality of care for acute chest pain after chest pain center accreditation

Hou

Liu

2022

Preprint

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Background:Chest pain centers (CPCs) have become important for improving the quality of care for acute chest pain. However, no study has shown whether adherence to guidelines continuously improvesin CPCs after certification. Objectives:We aimed to analyze trends in quality indicator (QI) compliance rates of Chinese CPCs between January 1, 2016 and December 31, 2018. Methods: We drew a time series stacked area plot of compliance rates forQIs to describe the change in their cumulative value over time. Next, we selected the time points with the most remarkable change in the stacked area plot as the breakpoints and constructed an interrupted time series (ITS) design for analysis. Significant ITS results indicated that the breakpoints had effects on the trend. We then estimated the average monthly percent change (AMPC) using joinpoint regression analysis. Results: We found an unexpected downward trend in the cumulative compliance rates for the nine QIs assessed between the 12thand 13th months and between the 24thand 25th months. The trends of QI1‒5 showed a continuously increasing change. QI6‒8 showed an increasing trend in the middle and late periods of the study; QI9 showed an increasing trend in the early period. Conclusions:This study demonstrated a trend toward continued improvement in quality of care in CPCs after certification. Accreditation should focus on the coordination and management of cross-cutting clinical issues, while not neglecting the accuracy of timely diagnosis.

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Section: Introductionmentioning

confidence: 99%

Trends in the quality of care for acute chest pain after chest pain center accreditation

Hou

Liu

2022

Preprint

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“…13–16 However, it is standard of care in many countries that patients with suspected MI are directly transferred to chest pain units or other specialised centres. The use of such units has shown to improve outcome and to be cost-effective 17–19. The prevalence of MI of these selected patients is usually much higher than that of patients in general emergency departments.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of a 1-hour troponin algorithm for diagnosing myocardial infarction in high-risk patients admitted to a chest pain unit: the prospective FAST-MI cohort study

et al. 2019

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ObjectiveThis study sought to evaluate the diagnostic performance of the 1-hour troponin algorithm for diagnosis of myocardial infarction (MI) without persistent ST-segment elevations (non-ST-segment MI (NSTEMI)) in a cohort with a high prevalence of MI. This algorithm recommend by current guidelines was previously developed in cohorts with a prevalence of MI of less than 20%.DesignProspective cohort study from November 2015 until December 2016.SettingDedicated chest pain unit of a single referral centre.ParticipantsConsecutive patients with suspected MI were screened. Patients with subacute symptoms lasting more than 24 hours, new ST-segment elevations at presentation, or an already diagnosed or ruled-out acute MI were excluded. All enrolled patients (n=1317) underwent a full clinical assessment and measurements of high-sensitivity troponin, and were scheduled for an early invasive strategy if clinically indicated.Main outcome measuresFinal diagnosis of MI according to the Fourth Universal Definition of MI.ResultsThe prevalence of NSTEMI in the present cohort was 36.9%. The sensitivity for rule-out of MI was 99.8%. The specificity for rule-in of MI was found to be 94.3%. However, in 35.7% of patients neither rule-in nor rule-out was possible. In 51.4% of patients diagnosed with MI, a primary non-coronary reason for MI was found (type 2 MI). Different receiver operating characteristic-curve derived cut-offs for troponin and its dynamics did not provide a sufficient differentiation between type 1 and 2 MI for clinical decision making (negative predictive value for rule-out of type 1 MI <70%).ConclusionsThe 1-hour diagnosis algorithm for patients with suspected NSTEMI can accurately diagnose acute MI in high-risk cohorts. However, discrimination between patients needing an early invasive strategy or not is limited.Trial registration numberDRKS00009713.

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Incorporation of the HEART Score Into a Low-risk Chest Pain Pathway to Safely Decrease Admissions

Allen

Simpson

Zeinali

et al. 2018

Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine

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Chest pain can be a challenging complaint to manage in the emergency department. A missed diagnosis can result in significant morbidity or mortality, whereas avoidable testing and hospitalizations can lead to increased health care costs, contribute to hospital crowding, and increase risks to patients. The HEART score is a validated decision aid to identify patients at low risk for acute coronary syndrome who can be safely discharged without admission or objective cardiac testing. In the largest and one of the longest studies to date (N = 31,060; 30 months), we included the HEART score into a larger, newly developed low-risk chest pain decision pathway, using a retrospective observational pre/post study design with the objective of safely lowering admissions. The modified HEART score calculation tool was incorporated in our electronic medical record. A significant increase in discharges of low-risk chest pain patients (relative increase of 21%; p < 0.0001) in the postimplementation period was observed with no significant difference in the rates of major adverse cardiac events between the pre and post periods. There was a decrease in the amount of return admissions for 30 days (4.65% fewer; p = 0.009) and 60 days (3.78% fewer; p = 0.020). No significant difference in length of stay was observed for patients who were ultimately discharged. A 64% decrease in monthly coronary computed tomography angiograms was observed in the post period (p < 0.0001). These findings support the growing consensus in the literature that the adoption of the HEART pathway or similar protocols in emergency departments, including at large and high-volume medical institutions, can substantially benefit patient care and reduce associated health care costs.

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Efficacy of Implementation of a Chest Pain Center at a Community Hospital

Cited by 4 publications

References 20 publications

Trends in the quality of care for acute chest pain after chest pain center accreditation

Trends in the quality of care for acute chest pain after chest pain center accreditation

Evaluation of a 1-hour troponin algorithm for diagnosing myocardial infarction in high-risk patients admitted to a chest pain unit: the prospective FAST-MI cohort study

Incorporation of the HEART Score Into a Low-risk Chest Pain Pathway to Safely Decrease Admissions

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