Abstract 13118: The Use of Automated Daily Reporting Improves Utilization of the HEART Score in Evaluation of Patients With Chest Pain in the Emergency Department

Abstract

Introduction: Despite the proven effectiveness of the HEART Score in discriminating the need for further observation versus discharge of patients presenting to the Emergency Department (ED) for evaluation of chest pain, utilization rates remain low in many institutions. One reason frequently cited for failure to use this tool is concern by the ED providers that discharged patients will not receive appropriate follow-up. Hypothesis: We hypothesized that the use of a simple daily report (DR) of treated patients would improve utilization rates of the HEART score, and allow for close follow-up of patients discharged from the ED. Methods: We created an electronically-generated report which listed all patients presenting to the ED with a complaint of chest pain in a community hospital, along with their HEART score, and their admission or discharge status. The report was provided on a daily basis to the ED medical director, who could provide counseling to providers who were not utilizing the HEART score regularly, and to case management, who could contact each discharged patient to assess their clinical status and ensure that they had appropriate follow-up plans. Results: Baseline utilization of the HEART Score in chest pain patients (n=305) over a 4 month period prior to the use of this DR was 51.8%. After instituting the DR, utilization rose to 66% (n=339 patients) over the next four months (p=0.0003). Furthermore, correlation of the numbers of ER discharges vs. patients kept for observation or admitted continued to correlate well with the calculated HEART score. Conclusions: The use of a simple DR significantly increased the utilization of the HEART score in the ED of a community hospital to identify patients who could be discharged safely, versus those who required further observation or admission.