Chest pain is the second leading reason for emergency department (ED) visits in the United States. Resource utilization for this ED subpopulation is particularly high, in part due to a dearth of accepted standardized clinical approaches and general overestimation of risk on the part of both providers and patients. This prospective observational cohort study seeks to address this issue by providing externally validated risk scores for major adverse cardiac events using a web-based clinical decision support platform (RISTRA) embedded within the electronic health record at 13 Kaiser Permanente Northern California (KPNC) EDs over a 12-month period. The decision support will provide risk estimates specific to the KPNC patient population. This studies hypothesis is that the provision of more accurate risk estimation for major adverse cardiac events will improve informed decision making by both providers and patients, resulting in less provocative testing and lower ED lengths of stay amongst low risk patients, as well as improving medical management among non-low risk patients and decreasing future rates of major adverse cardiac events.
Study Type
OBSERVATIONAL
Enrollment
13,419
Provision of estimated risk for major cardiac events at 60 days based on the modified HEART and/or EDACS, using KPNC specific estimates derived from an internal validation study
Kaiser Permanente Antioch Emergency Department
Antioch, California, United States
Kaiser Permanente Fremont Emergency Department
Fremont, California, United States
Kaiser Permanente Oakland Emergency Department
Oakland, California, United States
Kaiser Permanente Richmond Emergency Department
Richmond, California, United States
Kaiser Permanente Roseville Emergency Department
Roseville, California, United States
Kaiser Permanente South Sacramento Emergency Department
Sacramento, California, United States
Kaiser Permanente Sacramento Emergency Department
Sacramento, California, United States
Kaiser Permanente San Francisco Emergency Department
San Francisco, California, United States
Kaiser Permanente San Leandro Emergency Department
San Leandro, California, United States
Kaiser Permanente San Rafael Emergency Department
San Rafael, California, United States
...and 2 more locations
Major adverse cardiac event (MACE)
A composite outcome of either acute myocardial infarction, cardiac arrest, malignant arrhythmia, cardiac-related mortality
Time frame: 12 months
Provocative and anatomic cardiac testing rates
Treadmill stress test, myocardial perfusion imaging, stress echocardiography, CT coronary angiography, catheter-based coronary angiography
Time frame: 12 months
Emergency department length of stay
Total hours spent in the emergency department among study eligible patients
Time frame: 12 months
Hospital admission rate
Percentage of hospital admissions among study eligible patients
Time frame: 12 months
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