Safe Discharge for Adults with Low Risk Chest Pain

Safe Discharge for Adults with Low Risk Chest Pain

Patients with chest pain commonly seek care in the emergency department. Chest pain can be tied to numerous diagnoses, ranging widely in severity, type, and urgency of treatment. The most severe cases may require an immediate intervention and admission to the hospital. Many cases, however, can be identified using evidence-based guidelines to be of low risk and therefore can be managed within the emergency department before being safely discharged home. Within MEDIC, we measure clinical performance on this quality initiative using the HEAR+T pathway, which has been rigorously tested and shown to appropriately identify chest pain patients who can safely be discharged home. This clinical decision tool takes into account the patient’s history, EKG, age, risk factors, and troponin interpretation to evaluate level of risk, and has consistently been shown to accurately predict very low incidence of any subsequent adverse events.

MEDIC Safe Discharge for Adults with Low Risk Chest Pain Toolkit

Key References

  • Backus BE, et al. Chest pain in the emergency room: a multicenter validation of the HEART score. Critical Pathways in Cardiology. 2010;9(3):164-169.
  • Gershon CA, et al. Inter-rater Reliability of the HEART Score. Academic Emergency Medicine. 2018;26(5):552-555.
  • Laureano-Phillips J, et al. HEART Score Risk Stratification of Low-Risk Chest Pain Patients in the Emergency Department: A Systematic Review and Meta-Analysis. Annals of Emergency Medicine. 2019;74(2):187-203.
  • Ljung L, et al. A Rule-Out Strategy Based on High-Sensitivity Troponin and HEART Score Reduces Hospital Admissions. Annals of Emergency Medicine. 2019;73(5):491-499.
  • Mahler SA, et al. The HEART Pathway Randomized Trial. Circulation: Cardiovascular Quality and Outcomes. 2015;8(2):195-203.
  • Mahler SA, et al. Safely Identifying Emergency Department Patients With Acute Chest Pain for Early Discharge: HEART Pathway Accelerated Diagnostic Protocol. Circulation. 2018;138(22):2456-2468.
  • Sharp AL, et al. Effect of a HEART Care Pathway on Chest Pain Management Within an Integrated Health System. Annals of Emergency Medicine. 2019;74(2):171-180.
  • Stopyra JP, et al. The HEART Pathway Randomized Controlled Trial One‐year Outcomes. Academic Emergency Medicine. 2018.
  • Tomaszewski CA, et al. Clinical Policy: Critical Issues in the Evaluation and Management of Emergency Department Patients With Suspected Non–ST-Elevation Acute Coronary Syndromes. Annals of Emergency Medicine. 2018;72(5):556-557.