The HAS-Choice study: Utilizing the HEART score, an ADP, and shared decision-making to decrease admissions in chest pain patients
The HAS-Choice pathway utilizes the HEART Score, an accelerated diagnostic protocol (ADP), and shared decision-making using a visual aid in the evaluation of chest pain patients. We seek to determine if our intervention can improve resource utilization in a community emergency department (ED) settin...
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| Veröffentlicht in: | The American journal of emergency medicine 2018-10, Vol.36 (10), p.1825-1831 |
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| container_title | The American journal of emergency medicine |
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| creator | Gafni-Pappas, Gregory DeMeester, Susanne D. Boyd, Michael A. Ganti, Arun Nicholson, Adam M. Albright, Jeremy Wu, Juan |
| description | The HAS-Choice pathway utilizes the HEART Score, an accelerated diagnostic protocol (ADP), and shared decision-making using a visual aid in the evaluation of chest pain patients. We seek to determine if our intervention can improve resource utilization in a community emergency department (ED) setting while maintaining safe patient care.
This was a single-center prospective cohort study with historical that included ED patients ≥21years old presenting with a primary complaint of chest pain in two time periods. The primary outcome was patient disposition. Secondary outcomes focused on 30-day ED bounce back and major adverse cardiac events (MACE). We used multivariate logistic regression to estimate the odds ratio (OR) and its 95% confidence interval (CI).
In the pre-implementation period, the unadjusted disposition to inpatient, observation and discharge was 6.5%, 49.1% and 44.4%, respectively, whereas in the post period, the disposition was 4.8%, 41.5% and 53.7%, respectively (chi-square p |
| doi_str_mv | 10.1016/j.ajem.2018.02.005 |
| format | Article |
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This was a single-center prospective cohort study with historical that included ED patients ≥21years old presenting with a primary complaint of chest pain in two time periods. The primary outcome was patient disposition. Secondary outcomes focused on 30-day ED bounce back and major adverse cardiac events (MACE). We used multivariate logistic regression to estimate the odds ratio (OR) and its 95% confidence interval (CI).
In the pre-implementation period, the unadjusted disposition to inpatient, observation and discharge was 6.5%, 49.1% and 44.4%, respectively, whereas in the post period, the disposition was 4.8%, 41.5% and 53.7%, respectively (chi-square p<0.001). The adjusted odds of a patient being discharged was 40% higher (OR=1.40; 95% CI, 1.30, 1.51; p<0.001) in the post-implementation period. The adjusted odds of patient admission was 30% lower (OR=0.70; 95% CI, 0.60, 0.82; p<0.001) in the post-implementation period. The odds of 30-day ED bounce back did not statistically differ between the two periods. MACE rates were <1% in both periods, with a significant decrease in mortality in the post-implementation period.
Our study suggests that implementation of a shared decision-making tool that integrates an ADP and the HEART score can safely decrease hospital admissions without an increase in MACE.</description><identifier>ISSN: 0735-6757</identifier><identifier>EISSN: 1532-8171</identifier><identifier>DOI: 10.1016/j.ajem.2018.02.005</identifier><identifier>PMID: 29454508</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Acute coronary syndromes ; Age ; Chest ; Chest pain ; Clinical decision making ; Decision aid ; Decision making ; Emergency medical care ; Emergency medical services ; Emergency services ; Health services utilization ; Healthcare utilization ; Heart ; Heart score ; Hospitals ; Pain ; Patient satisfaction ; Physicians ; Resource utilization ; Risk stratification tool ; Shared decision-making ; Visual aids</subject><ispartof>The American journal of emergency medicine, 2018-10, Vol.36 (10), p.1825-1831</ispartof><rights>2018 Elsevier Inc.</rights><rights>Copyright © 2018 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Oct 2018</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c384t-669a51a9fa374782b3ee319cbeaccf89ad4c0a502c1095571d0733cc6167c0d43</citedby><cites>FETCH-LOGICAL-c384t-669a51a9fa374782b3ee319cbeaccf89ad4c0a502c1095571d0733cc6167c0d43</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/2184328418?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,777,781,3537,27905,27906,45976,64364,64366,64368,72218</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29454508$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gafni-Pappas, Gregory</creatorcontrib><creatorcontrib>DeMeester, Susanne D.</creatorcontrib><creatorcontrib>Boyd, Michael A.</creatorcontrib><creatorcontrib>Ganti, Arun</creatorcontrib><creatorcontrib>Nicholson, Adam M.</creatorcontrib><creatorcontrib>Albright, Jeremy</creatorcontrib><creatorcontrib>Wu, Juan</creatorcontrib><title>The HAS-Choice study: Utilizing the HEART score, an ADP, and shared decision-making to decrease admissions in chest pain patients</title><title>The American journal of emergency medicine</title><addtitle>Am J Emerg Med</addtitle><description>The HAS-Choice pathway utilizes the HEART Score, an accelerated diagnostic protocol (ADP), and shared decision-making using a visual aid in the evaluation of chest pain patients. We seek to determine if our intervention can improve resource utilization in a community emergency department (ED) setting while maintaining safe patient care.
This was a single-center prospective cohort study with historical that included ED patients ≥21years old presenting with a primary complaint of chest pain in two time periods. The primary outcome was patient disposition. Secondary outcomes focused on 30-day ED bounce back and major adverse cardiac events (MACE). We used multivariate logistic regression to estimate the odds ratio (OR) and its 95% confidence interval (CI).
In the pre-implementation period, the unadjusted disposition to inpatient, observation and discharge was 6.5%, 49.1% and 44.4%, respectively, whereas in the post period, the disposition was 4.8%, 41.5% and 53.7%, respectively (chi-square p<0.001). The adjusted odds of a patient being discharged was 40% higher (OR=1.40; 95% CI, 1.30, 1.51; p<0.001) in the post-implementation period. The adjusted odds of patient admission was 30% lower (OR=0.70; 95% CI, 0.60, 0.82; p<0.001) in the post-implementation period. The odds of 30-day ED bounce back did not statistically differ between the two periods. MACE rates were <1% in both periods, with a significant decrease in mortality in the post-implementation period.
Our study suggests that implementation of a shared decision-making tool that integrates an ADP and the HEART score can safely decrease hospital admissions without an increase in MACE.</description><subject>Acute coronary syndromes</subject><subject>Age</subject><subject>Chest</subject><subject>Chest pain</subject><subject>Clinical decision making</subject><subject>Decision aid</subject><subject>Decision making</subject><subject>Emergency medical care</subject><subject>Emergency medical services</subject><subject>Emergency services</subject><subject>Health services utilization</subject><subject>Healthcare utilization</subject><subject>Heart</subject><subject>Heart score</subject><subject>Hospitals</subject><subject>Pain</subject><subject>Patient satisfaction</subject><subject>Physicians</subject><subject>Resource utilization</subject><subject>Risk stratification tool</subject><subject>Shared decision-making</subject><subject>Visual aids</subject><issn>0735-6757</issn><issn>1532-8171</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9UU1v1DAUtBCILoU_wAFZ4sKBhOevOEFcVttCkSqBYHu2vPZb1mGTbO2kUnvrP8dhCwcOnMbymxnNe0PISwYlA1a9a0vbYldyYHUJvARQj8iCKcGLmmn2mCxAC1VUWukT8iylFoAxqeRTcsKbjArqBblf75BeLL8Xq90QHNI0Tv72Pb0awz7chf4HHef5-fLbmiY3RHxLbU-XZ19n9DTtbERPPbqQwtAXnf35WzPMXxFtQmp9F9I8TDT01O0wjfRg8_Ngx4D9mJ6TJ1u7T_jiAU_J1cfz9eqiuPzy6fNqeVk4UcuxqKrGKmabrRVa6ppvBKJgjdugdW5bN9ZLB1YBdwwapTTzeXvhXMUq7cBLcUreHH0PcbiecgyTgznc722Pw5QMB5CigUZXmfr6H2o7TLHP6QxntRS8lqzOLH5kuTikFHFrDjF0Nt4aBmYuyLRmLsjMBRngJheURa8erKdNh_6v5E8jmfDhSMB8i5uA0SSX7-TQh4huNH4I__P_BQIRoAw</recordid><startdate>201810</startdate><enddate>201810</enddate><creator>Gafni-Pappas, Gregory</creator><creator>DeMeester, Susanne D.</creator><creator>Boyd, Michael A.</creator><creator>Ganti, Arun</creator><creator>Nicholson, Adam M.</creator><creator>Albright, Jeremy</creator><creator>Wu, Juan</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>201810</creationdate><title>The HAS-Choice study: Utilizing the HEART score, an ADP, and shared decision-making to decrease admissions in chest pain patients</title><author>Gafni-Pappas, Gregory ; 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We seek to determine if our intervention can improve resource utilization in a community emergency department (ED) setting while maintaining safe patient care.
This was a single-center prospective cohort study with historical that included ED patients ≥21years old presenting with a primary complaint of chest pain in two time periods. The primary outcome was patient disposition. Secondary outcomes focused on 30-day ED bounce back and major adverse cardiac events (MACE). We used multivariate logistic regression to estimate the odds ratio (OR) and its 95% confidence interval (CI).
In the pre-implementation period, the unadjusted disposition to inpatient, observation and discharge was 6.5%, 49.1% and 44.4%, respectively, whereas in the post period, the disposition was 4.8%, 41.5% and 53.7%, respectively (chi-square p<0.001). The adjusted odds of a patient being discharged was 40% higher (OR=1.40; 95% CI, 1.30, 1.51; p<0.001) in the post-implementation period. The adjusted odds of patient admission was 30% lower (OR=0.70; 95% CI, 0.60, 0.82; p<0.001) in the post-implementation period. The odds of 30-day ED bounce back did not statistically differ between the two periods. MACE rates were <1% in both periods, with a significant decrease in mortality in the post-implementation period.
Our study suggests that implementation of a shared decision-making tool that integrates an ADP and the HEART score can safely decrease hospital admissions without an increase in MACE.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>29454508</pmid><doi>10.1016/j.ajem.2018.02.005</doi><tpages>7</tpages></addata></record> |
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| source | Elsevier ScienceDirect Journals Complete; ProQuest Central |
| subjects | Acute coronary syndromes Age Chest Chest pain Clinical decision making Decision aid Decision making Emergency medical care Emergency medical services Emergency services Health services utilization Healthcare utilization Heart Heart score Hospitals Pain Patient satisfaction Physicians Resource utilization Risk stratification tool Shared decision-making Visual aids |
| title | The HAS-Choice study: Utilizing the HEART score, an ADP, and shared decision-making to decrease admissions in chest pain patients |
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