Development and implementation of a critical pathway for patients with chest pain through action research

Abstract

We report on the development and implementation of a critical pathway for patients with chest pain making use of action research. Firstly the population to be included in the pathway was defined and a coordinator was assigned. Secondly a multidisciplinary workgroup for the development of the pathway was instated. The actual development of the pathway consisted of four major steps: (1) evaluation of the current process of care for the chest pain unit (CPU) patients, (2) evaluation of medical evidence and practice in other hospitals, (3) optimization of the process and (4) actual drafting of the pathway. Finally the pathway development was followed by the implementation of the pathway. A chest pain critical pathway could be successfully developed, leading to (1) a triage flowchart based on the European Society of Cardiology guidelines categorizing patients in different risk groups; (2) CPU and hospital standing orders and protocols for the management of the different risk groups; (3) revision of physician and nursing medical records; and (4) development of admission and discharge brochures for patients and family admitted to the CPU. To our best knowledge this paper is the first to report on the use of action research to develop a critical pathway for patients with symptoms suggestive of an acute coronary syndrome admitted to a chest pain unit. Our experience suggests that it can serve as a means to reach the objective of conceiving and implementing an evidence-based pathway into everyday clinical practice.