Implementation of a Clinical Pathway for Chest Pain in a Pediatric Emergency Department.

TitleImplementation of a Clinical Pathway for Chest Pain in a Pediatric Emergency Department.
Publication TypeJournal Article
Year of Publication2018
AuthorsMohan S, Nandi D, Stephens P, MʼFarrej M, R Vogel L, Bonafide CP
JournalPediatr Emerg Care
Volume34
Start Page778
Issue11
Pagination778-782
Date Published2018 Nov
ISSN1535-1815
Abstract

OBJECTIVE: To evaluate the impact of a pediatric emergency department (ED) chest pain clinical pathway on resource utilization.

METHODS: Motivated by perceived overuse of cardiology consultation for non-cardiac chest pain in the ED, clinicians from the Divisions of Cardiology and Emergency Medicine collaboratively developed a chest pain clinical pathway, educated staff, and implemented the pathway on March 1, 2014. We reviewed records of children aged 3 to 18 years without prior diagnoses of heart disease who presented to the ED with chest pain between March 1, 2013, and April 22, 2015. We compared diagnostic testing rates, ED length of stay, and cardiology consults before and after implementation of the pathway.

RESULTS: A total of 1687 patients were pathway eligible (675 patients preimplementation and 1012 postimplementation). Resource utilization was lower than expected before pathway implementation and remained low after implementation. There was a statistically significant reduction in rates of chest x-ray ordering after pathway implementation and ED length of stay but no change in other diagnostic testing or cardiology consultation. Follow-up in our health care system for pediatric chest pain increased from 15% to 29% with implementation, but none of these visits resulted in the diagnosis of a new cardiac condition. There were no instances identified where use of the pathway resulted in missed cardiac disease.

CONCLUSIONS: Implementation of a clinical pathway for pediatric chest pain did lead to a reduction in chest x-ray ordering in the ED and was associated with a higher rate of outpatient follow up for non-pathologic chest pain. Preimplementation utilization was lower than the prepathway perceptions of overuse suggested.

DOI10.1097/PEC.0000000000000861
Alternate JournalPediatr Emerg Care
PubMed ID27649041