Implementation of a clinical pathway for the assessment of patients with suspected acute coronary syndrome (ACS) may reduce the length of stay in hospital emergency departments, according to results from the ICare-ACS trial presented Nov. 14 at AHA 2017 in Anaheim, CA, and simultaneously published in Circulation.

Martin P. Than, MBBS, et al., looked at 31,332 patients with suspected ACS in seven hospitals in New Zealand. Clinical pathway implementation included a clinical pathway document, structured risk stratification, specified time points for electrocardiographic and serial troponin testing within three hours after arrival, and directions for combining risk stratification and electrocardiographic and troponin testing in an accelerated diagnostic protocol.

Results showed that overall, the mean six-hour discharge rate increased from 8.3 percent to 18.4 percent in patients who underwent clinical pathway implementation. Further, in patients discharged within six hours, there was no change in 30-day major adverse cardiac event rates, and no adverse events occurred when clinical pathways were correctly followed.

The authors conclude that "the implementation of hospital clinical pathways to assess patients with suspected ACS safely reduced length of stay while increasing the rate of safe discharge within six hours." They add that moving forward, "this has the potential to reduce the use of hospital resources and provides rapid reassurance to many patients who presented to [emergency departments] with symptoms consistent with ACS."

Abe Joseph, vice president of ACC Accreditation Services, commented that "Building on our criteria for Chest Pain Center accreditation, these facilities were able to suggest best practices and process improvement protocols that show their commitment to raising the standards of cardiovascular patient care and shines a light on the critical importance of early assessment, diagnosis and treatment of ACS."

Phillip Levy, MD, chair of ACC Accreditation Management Board, emphasized how the adoption and use of standardized processes can effectively drive safe and efficient cardiovascular patient care. "Insights gained through accreditation demonstrate how processes of care can affect things that actually matter to patients, payers and governmental agencies."

Keywords: AHA17, AHA Annual Scientific Sessions, Acute Coronary Syndrome, Emergency Service, Hospital

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