Journal
ECLINICALMEDICINE
Volume 10, Issue -, Pages 78-83Publisher
ELSEVIER
DOI: 10.1016/j.eclinm.2019.04.010
Keywords
ED; SCAMPs; Chest pain; Heart score; Clinical transformation; Change management; Physician behavior and practice; Reduction in cost and resource utilization
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Introduction/background: Adults with chest pain presenting to an emergency department are high-risk and high-volume. A methodology which gathers practicing physicians together to review evidence and share practice experience to formulate a written algorithm with key decision points and measures is discussed with implementation, based on change management principles, and results. Methods: A methodology was followed to establish the standard-of-care. Literature and data were reviewed, a written consensus algorithm was designed with ability to track adherence and deviations. We performed a before and after analysis of a performance improvement intervention in adult patients with undifferentiated chest pain in our nine-campus hospital system in Florida between January 1st, 2014 and December 31st, 2018. Results: A total of 200,691 patients were identified as adults with chest pain and the algorithm was used. A dramatic change in the disposition decision rate was noted. When the 'Baseline-Year' was compared with the 'Performance-Year', chest pain patients discharged from the ED increased by 99%, those going to the 'Observation' status decreased by 20%, and inpatient admissions decreased by 63% (p < 0.0001) All patients were tracked for 30-days for major adverse cardiac event (MACE) or return to the ED within the same system. If the s emergency physicians had not changed their practice/behavior and the Baseline-Year decision rate during the entire Performance-Year was unchanged, then 4563 more patients would have gone to Observation and 7986 patients to Inpatient. The opportunity costs avoided would be approximately $31million (US$. Conclusions: For successful clinical transformation through change management, we learned: select strategic topics, get active physicians together, write a consensus algorithm with freedom to deviate, identify and remove barriers, communicate vision, pilot with feedback, implement, sustain by hard wiring into the electronic medical record and measure outputs. (C) 2019 Published by Elsevier Ltd.
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