Abstract 15713: A Novel Chest Pain Pathway Triaging Low-Risk Emergency Department Patients via Ambulatory Care Reduces Hospital Admissions Without Increased 30-Day Readmissions or All-Cause Mortality

Abstract

Introduction: Chest pain is a common presentation to the Emergency Department (ED). Current international guidelines emphasise the importance of triage pathways involving patient-centric algorithms. In 2019, a front-door ED pathway (Figure 1) was created to direct low-risk chest pain towards ambulatory care. We aimed to characterise clinical outcomes with this pathway in a real-world UK ED cohort presenting with cardiac chest pain. Methods: The chest pain pathway stratified patients as low-, intermediate- and high-risk at presentation. Patients presenting to the ED at our institution in London, UK, were consecutively included in two groups: a pre-pathway group prior to implementation of the chest pain pathway and a post-pathway group following implementation. Baseline demographics were compared using Pearson’s χ 2 test for categorical variables and unpaired t-tests for continuous variables. Primary endpoints were 30-day readmissions, and all-cause mortality. Multiple logistic regression models were constructed to assess the impact of the pathway on the primary outcomes, adjusting for age, sex, risk category and HEART score. Results: Baseline demographics were similar between pre-pathway and post-pathway groups, except for presence of a smoking history ( p = 0.04). Smoking was therefore adjusted for in multivariable analyses. Approximately 10% (13/136) of post-pathway patients avoided hospital admission and were triaged towards ambulatory care. There was no significant difference in 30-day readmissions: 18/139 post-pathway vs 12/167 pre-pathway (OR 1.79, 95% CI 0.79 - 4.22, p = 0.17); or all-cause mortality: 2/167 pre-pathway vs 5/139 post-pathway (OR 2.96, 95% CI 0.49 - 25.68, p = 0.26). Conclusions: This novel chest pain pathway demonstrated a 10% reduction in hospital admissions without concurrent increases in 30-day readmissions or all-cause mortality. This is likely to reduce burdens on hospital resources and patient flow whilst maintaining safety.