The Impact of Accelerated Diagnostic Protocol Implementation on Chest Pain Observation Unit Utilization.

BACKGROUND Data evaluating the impact of the History, ECG, Age, Risk factors, and Troponin (HEART) Pathway on Observation Unit (OU) use is limited. The objective of this study is to determine how HEART Pathway implementation affects OU use. METHODS An analysis of OU registry data from 10/2012-10/2016, 2 years before and after HEART Pathway implementation at an academic medical center, was conducted. Adult patients placed in the OU for chest pain were included. The proportion of patients placed in the OU chest pain protocol per total OU volume and hospitalization and myocardial infarction (MI) rates were determined. Proportions before vs after implementation were compared using Chi-Squared Tests and age was compared using a Mann-Whitney U Test. RESULTS During the study period, 1,688 patients with chest pain before HEART Pathway implementation and 1,692 after were included. The proportion of chest pain patients in the OU per total OU volume decreased following implementation from (57% [1,688/2968] to 43.6% [1,692/3,882]; p<0. 001). Before HEART Pathway implementation the hospitalization rate was 10.4% (175/1688) versus 12.4% (210/1692) after (p=0.07). More patients were diagnosed with MI following implementation (0.8% [14/1,665] vs. 2.0% [33/1686]; p=0. 008). Median age was older post-implementation (52 years [IQR: 45-59 years] vs 54 years [IQR: 48-64 years]; p<0. 001). CONCLUSION HEART Pathway implementation resulted in management of higher risk patients in the OU. Following implementation, OU chest pain patients were older and were more likely to be hospitalized or diagnosed with MI.