None listed
Conditions
Brief summary
The aim of this project is to collect reliable and consistent data relating to a NZ Ministry of Health initiative implementing an accelerated chest pain pathway for suspected Ischaemic Heart Disease into New Zealand hospitals. The Ministry of Health has now introduced their requirement for district health boards to introduce accelerated assessment pathways and frameworks as a standard of care for service delivery in New Zealand hospitals. This requirement has been introduced into district health board annual plans and national regional service frameworks. It is planned that all hospitals within New Zealand will be using or near to using such pathways by June 2015. As part of this service implementation a small minimum dataset is planned using health information which is already collected in order to monitor the effectiveness of this service rollout. The purpose of this project is to focus on producing a very robust dataset in the early adopting sites which will introduce the pathway in a preplanned sequence in order to demonstrate incremental benefits at each site that becomes active. There will also be careful collection of lessons learned regarding the implementation of pathways in each site which will be deliberately passed on to successive sites and hospitals which are not part of the study and which will be introduced in the procedures later. The purpose of this project therefore is to produce high quality information on the effectiveness and lessons learned from this service improvement with which it will be possible to inform the Ministry of Health and other New Zealand hospital sites. Context: Of the thousands of patients who present to NZ emergency departments every year with suspected cardiac chest pain, approximately 20% could be discharged early which could reduce patient worry, increase clinician availability to acutely ill patients, reduce ED overcrowding and admissions, and thereby reduce unnecessary healthcare costs.
Interventions
This is an audit of a change of practice mandated by the Ministry of Health to implement an accelerated chest pain pathway for suspected Ischaemic Heart Disease into New Zealand hospitals, requiring reliable and consistent retrospective collection of chest pain data. Each of the eight hospitals will have control period of 6 months prior to the implementation of the accelerated pathway and a minimum of 4 months of cases following the implementation. Implementation will begin in each of the eigh
This is an audit of a change of practice mandated by the Ministry of Health to implement an accelerated chest pain pathway for suspected Ischaemic Heart Disease into New Zealand hospitals, requiring reliable and consistent retrospective collection of chest pain data. Each of the eight hospitals will have control period of 6 months prior to the implementation of the accelerated pathway and a minimum of 4 months of cases following the implementation. Implementation will begin in each of the eight sites in a staggered fashion (1 month apart). The total data collection time, including a 30 day follow up, will be 18 months. Each site will determine its own accelerated pathway based on current evidence and local conditions. This will comprise biochemistry (a 0h high sensitive troponin I or T, and a 2 or 3 hour second high sensitive troponin, ECG, and a risk evaluation with an appropriate scoring system with a decision point for assigning to low risk and therefore eligible for early discharge). Sites vary in practice at the moment. For most sites this will mean measuring an earlier time point second troponin, and implementation of a scoring system not currently implemented.
Sponsors
Dr Martin Than
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Adults (greater than or equal to 18 years of age), Serial troponin testing for possible cardiac disease as indicated by a cardiac troponin test performed during initial assessment in the ED with a 2nd test performed within 24 hours of attendance.
Exclusion criteria
A clear non-coronary cause of chest pain, Domiciled overseas.
Outcome results
None listed