Reducing avoidable chest pain admissions and implementing high sensitivity troponin testing

NHS Accident and Emergency (A&E) departments see 0.5 million patients presenting witha cardiac conditioneach year. The accurate assessment of chest pain and subsequent diagnosisor exclusion of myocardial infarction (MI) represents a significant challenge; with important consequences on patient outcome and healthcare resources.We conducted a cross-sectional analysis of patients admitted with cardiac chest pain to a busy district general hospitalin London.The criteria used by physicians to admit patients for furthercardiac investigations,were measured against national guidance on chest pain assessment and diagnosis of MI. We found that poor adherence to guidance, unsuitable patient pathways and inappropriate diagnostic tools at thepoint of presentation led to unnecessary inpatient admissions to hospital. Quality improvement methods were usedwith the aimto reduce avoidableadmissions to hospitalin patients presenting withchest pain.We describe asystemto implement new high sensitivity troponin testing into legacy chest pain pathways.This was achieved through localeducationof national institute for health and care excellence (NICE)guidance, the use of patient proformas and the creationof twonew chest pain pathway arms to enable physicians to streamline patients for appropriate inpatient or outpatient care. As result of these changes,we reduced non-compliance with NICE guidance by 83% and achieved a 42% reduction in avoidable chest pain admissions. Overall the improvements made by this project were sustained over 2 years and saved£21,000 per monthin avoidable admissions