Initial Single Centre Experience Implementing a Rapid Access Chest Pain Clinic

Abstract

Cardiac chest pain accounts for 8335 presentations to the Emergency Department at Royal North Shore Hospital (RNSH) annually and of these more than 700 are hospitalised because of intermediate risk and discharged within 1.2 days without a need for invasive investigation–a cost burden exceeding $1.5 million. A Rapid Access Chest Pain Clinic (RACPC) affords a potential mechanism of cost saving without compromise of patient safety. Aim: We report initial experiences in clinic processes, case selection, patient safety, cost analysis, outcome measures and research potential. Methods: Staff costs included 0.5 FTE advanced trainee and 0.5 FTE senior medical staff for a daily morning clinic. The Heart Score and standard NSW Chest Pain pathway were utilised to risk stratify patients. Results: 15 patients were seen in the first 4 weeks. All patients had clinical assessment. Functional tests were performed in 14 and CT coronary angiogram in 6. Four proceeded to elective angiography and 2 had culprit vessel stenting. No patient had acute myocardial infarction or urgent re-admission. 1 stented patient stayed overnight in RNSH, therefore admission was avoided in 14 patients with a potential annual saving of $68,996. Conclusion: Initial experience of managing intermediate risk patients in a RACPC shows a reduction in admitted patients, without undermining patient safety and quality of care, plus potential cost-benefit to the healthcare system with this model of care. Exploring robust methods of identifying the appropriate cohort of patients and evaluating the impact of the clinic are potential research opportunities aiming to improve on current evidence.