Author + information
- Archie A. Tyson,
- Herman Cheek,
- Thomas Folk,
- Steven Rohrbeck,
- Darryl Kalil,
- Jenyung Chiu,
- Sharon Mitchell,
- Lee Penry and
- Kurt Daniel
Chest pain is a leading cause of hospital admission and contributes greatly to healthcare expenditures. A standardized inpatient chest pain management protocol could safely reduce costs associated with inpatient cardiovascular diagnostic testing.
A chest pain management protocol was developed to categorize and track patients admitted to hospital according to clinical risk, and to direct testing and treatment accordingly. However, final management decisions were made by the attending physician. Patients managed conventionally from the fiscal year before protocol implementation (Control) were compared to patients managed by the protocol (Protocol) for 21 months. Hospital inpatient direct costs, readmission, and adverse events were compared before and after protocol implementation.
We compared 2346 Protocol patients to 1188 Control patients. There was no significant difference in patient demographics or payer mix between groups. Inpatient stress testing decreased from 60.8% in the Control group to 40.2% in the Protocol group (p<0.001). There was a decrease in inpatient direct costs per patient from $1601 in the Control group to $1178 in the Protocol group (p<0.001), an average savings of $423 per patient. Total savings in direct costs during the protocol period was $992,006. The 30-day readmission rate in Protocol patients was 5.0% (n=118) and did not differ in comparison to the Control patients (4.3%, p=0.3). Of the 118 Protocol patients readmitted, the attending physician did not follow the protocol in 48 cases, 13 patients were readmitted electively for cardiac catheterization after abnormal outpatient stress testing, 12 were readmitted for non-cardiac causes, 44 were noncompliant with outpatient testing and were readmitted within 30 days for chest pain. However, only 1 patient from the Protocol group was readmitted with a non-ST elevation myocardial infarction. No deaths within 30 days of discharge were identified.
Use of the Carolina Chest Pain Protocol safely reduced inpatient cardiovascular testing and significantly decreased the direct costs associated with inpatient chest pain management.
West, Room 3006
Sunday, March 10, 2013, 11:30 a.m.-11:45 a.m.
Session Title: How Outcomes Research Impacts Care
Abstract Category: 28. Quality of Care and Outcomes Assessment
Presentation Number: 929-6
- 2013 American College of Cardiology Foundation