Emergency Department Quality Improvement Efforts for Safe Discharge of Low-Risk Chest Pain

Problem: Through participation in the Michigan Emergency Department Improvement Collaborative (MEDIC), an interdisciplinary team aimed to increase the safe discharge rate of low-risk chest pain patients by expanding the use of the HEART Scoring tool among an independent emergency medicine provider group. MEDIC is a unique physician-led quality improvement partnership.

Measurement: The population measured included ED visits collected from eight emergency departments (ED) for select, low-risk chest pain-related visits. Cases were abstracted utilizing the MEDIC database by nurses specifically trained to abstract data according to a data dictionary between January 2021 and February 2022.

Analysis: Data were collected utilizing Tableau to monitor monthly performance trends for the pre-and post-intervention period. These data were then analyzed within Excel to understand the statistical significance of changes and linear correlation patterns to understand the impact of the quality improvement methods implemented by the interdisciplinary team.

Implementation: The project utilized Donabedian’s methodology to design a bundle of organization-specific interventions including quality guidelines, clinician education, optimization of the Electronic Health Record, and individualized provider feedback to improve a) provider utilization of the HEART Score for ED patients presenting with chest pain and b) group performance within MEDIC.

Results/Discussion: Adopting a risk-stratification tool for emergency patients with chest pain is feasible within a large, multi-center physician group.  Implementation of a QI bundle with support from a large quality collaborative resulted in a statistically significant increase in the number of low-risk chest pain patients who had a documented Heart Score.

Speakers
Program Evaluation Specialist
Program Evaluation Specialist – Emergency Care Specialist

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Chief Medical Officer
Chief Medical Officer – Emergency Care Specialist

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Clinical Data Abstractor
Clinical Data Abstractor – Emergency Care Specialist

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Quality Program Clinical Manager
Quality Program Clinical Manager – Emergency Care Specialist

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Director of Quality, Practice and Integration
Director of Quality, Practice and Integration – Emergency Care Specialist 

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Physician, Director of Informatics
Physician, Director of Informatics – Emergency Care Specialist

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