Chest pain diagnosis in emergency departments

Streamlining diagnosis for patients who present to emergency departments with chest pain

Chest pain is one of the most common complaints from patients presenting to hospital emergency departments. Cardiac investigations are often conducted to determine patients’ levels of risk. This process can be time consuming for patients and expend valuable hospital resources.

This project looks at implementing a novel clinical pathway, the Legend Pathway, based on new evidence to better assess and manage patients who present to the emergency department with chest pain. The project will investigate the implementation of a single blood test in conjunction with shared decision making between patient and clinician concerned with timing of discharge.

The project aims to reduce length of stay and hospital admissions for patients presenting to emergency with chest pain and fewer cardiac investigations for patients deemed low risk, with potential to reduce over-diagnosis. The project will also collect data regarding the safety of this approach for Aboriginal and Torres Strait Islander people.

Outcomes

• Data from over 7000 patients was collected at four sites: The Prince Charles Hospital, Logan Hospital, Royal Brisbane and Women’s Hospital, and Cairns Hospital.
• Approximately 20–30 per cent of all patients have been eligible for accelerated discharge utilising the Legend Pathway.
• National Health and Medical Research Council (NHMRC) funding has been granted, three additional sites have been identified and engagement has commenced.
• Future work could include determining if the algorithm used is relevant in other settings such as regional or community settings.

Project investigators

Project investigators engage with and draw on the expertise of partners within universities, research institutes, and hospital and health services around Queensland.

• Associate Professor Jaimi Greenslade, Research Fellow, Royal Brisbane and Women’s Hospital, Metro North Hospital and Health Service, Queensland University of Technology (Lead)
• Professor Louise Cullen, Emergency Physician, Royal Brisbane and Women’s Hospital
• Laura Foran, Research Clinical Nurse, Royal Brisbane and Women’s Hospital (project management, implementation and data collection)
• Professor William Parsonage, Senior Cardiologist, Royal Brisbane and Women’s Hospital and AusHSI, Queensland University of Technology
• Dr David Brain, Health Economist, The Australian Centre for Health Services Innovation, Queensland University of Technology
• Dr Siegfried Perez, Director of Emergency Research, Logan Hospital

Additional investigators have been included with the NHMRC grant, including investigators from Cairns Hospital, The Townsville Hospital, The Prince Charles Hospital, Mackay Hospital and Bundaberg Hospital.