How Kaiser Permanente used new assessment criteria to reduce admissions

Emergency physicians at Oakland, Calif.-based Kaiser Permanente hospitals reduced admissions and cardiac stress testing by using new criteria to assess chest pain patients' risk for subsequent cardiac events, according to an article published in Annals of Emergency Medicine.

"By assessing patients who come into the emergency department using HEART — a measure of history, electrocardiogram, age, risk factors and troponin, a blood test that measures heart injury — we were able to avoid unnecessary hospitalizations and cardiac testing for many patients without increasing their risk of heart damage," said Adam Sharp, MD, an emergency physician at the Kaiser Permanente Los Angeles Medical Center.

The researchers looked to evaluate whether the HEART tool could successfully identify patients who needed observation and further testing and which patients could go home safely.

The team used information in the EHRs of over 65,000 adult patients evaluated for suspected acute coronary syndrome at 13 Kaiser Permanente EDs in Southern California from May 2015 to June 2017.

The outcomes they studied were hospital admissions, noninvasive cardiac stress testing and whether patients died or had heart attacks within 30 days of the ED visit.

Among patients who went to the ED with chest pain, the researchers found there was a 4.4 percent decrease in hospital admissions and cardiac stress testing after implementing HEART; no increase in missed heart attacks in patients after HEART was implemented; and no increase in the rate of death in patients after HEART was implemented.

"Our program to decrease hospitalization of patients with low-risk chest pain builds upon previous efforts to improve care by avoiding unwarranted, potentially harmful treatments, such as reducing the prescriptions of antibiotics for acute sinusitis and reducing diagnostic tests such as CT imaging after head trauma," Dr. Sharp said.

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