Improving the outcomes of chest pain patients in the ED at MemorialCare

Emergency physicians across the country struggle to get comfortable sending low-risk chest pain patients home without a stress test, cardiologist consult and, in some cases, inpatient admission. Missed heart attacks are associated with a significant number of deaths and are common grounds for legal action, so ED physicians understandably maintain a high level of suspicion of heart attack or unstable angina.

When MemorialCare administrative and physician leadership attended an Advisory Board national research meeting and learned about the HEART score, they recognized an opportunity to employ an evidence-based protocol to improve care choices and resource utilization for chest pain patients in the emergency department.

MemorialCare’s cardiovascular leaders took the HEART score concept back to its Los Angeles County hospital, Long Beach Medical Center, conducted additional due diligence, and implemented the pathway in the emergency room. Within six months, they saw a significant improvement in quality outcomes, resource utilization and patient experience for those patients who received the HEART score.

Each year, 20 MemorialCare administrative and physician leaders attend the Advisory Board’s national meeting in California to hear experts present original research on the most top-of-mind issues facing cardiovascular leaders. The MemorialCare team uses the 2-day forum to review the latest research, discuss implications for MemorialCare, and engage with Advisory Board experts and peers from across the country.

At the request of cardiovascular leaders across the country, Advisory Board researchers spent six months researching strategies and tactics for perfecting cardiovascular short-stay patient management in late 2015 through early 2016.

One of the nine tactics surfaced—through a comprehensive review of industry and clinical research, interviews with 60 cardiovascular administrative and physician leaders, and conversations with dozens of emergency department medical directors—was the HEART score, a new risk stratification tool for chest pain patients in the ED that was beginning to accumulate evidence as a means of improving quality and cost outcomes. MemorialCare leaders immediately recognized its potential to improve care choices and resource utilization for chest pain patients in its emergency departments.

MemorialCare's cardiovascular leaders presented the HEART score concept to Long Beach Medical Center's chest pain committee and department of cardiology in February 2016. The chest pain committee reviewed HEART score literature, contacted colleagues across the country using the HEART score, adapted the pathway to suit the Long Beach Medical Center medical community and patient population, and implemented the pathway in May.

The MemorialCare research staff measured the impact of the HEART score through EPIC chart review, and demonstrated a marked impact on patient experience, quality of care and cost. Patients were 70% less likely to have to return to the ED within 30 days and also experienced shorter lengths of stay in the ED and in observation. Use of the HEART score also reduced variability in treatment of chest pain patients and aligned resource utilization with patient risk—cardiac consultations were performed on 45% of the non-low risk patients (defined as patients with a HEART score of 4 or higher) versus just 2.4% of low risk patients (defined as patients with a HEART score of 3 or lower), and stress tests were performed on 44% of the non-low risk patients versus 0% of low risk patients.

The MemorialCare team presented these results at the American College of Cardiology (ACC) chapter conference in November 2016.

Hundreds of CV leaders asked us to discover ways to achieve performance excellence in the outpatient setting, a foundational building block of establishing the value of a CV program and positioning it for future growth.

Download an excerpt of the study that featured a set of benchmarks, tactics and supporting tools (including the HEART score) to assist CV programs with three key areas of short-stay patient care.

Twenty MemorialCare leaders attend the Advisory Board’s national meeting in California every year to hear original research on top-of-mind issues facing cardiovascular leaders. The MemorialCare team uses the 2-day forum to not just review the research, but also discuss implications for MemorialCare.

The MemorialCare team taps into additional Advisory Board resources throughout the year as they chart the course for their organization, implement new programs and tackle operational challenges. Hear directly from MemorialCare leaders on why they have utilized Advisory Board research for decades.