Project Description
HSR Case Study: The Accelerated Chest pain Risk Evaluation (ACRE) Project
The Project
The Accelerated Chest Pain Risk Evaluation (ACRE) project is a Queensland wide project that aims to facilitate implementation of the best evidence for the safe and efficient evaluation of patients presenting to emergency department (EDs) with possible cardiac chest pain. The project utilises clinical redesign methodology to support adoption of accelerated diagnostic protocols (ADPs) that are evidence-based, safe, and patient focused.
Since 2012, the ACRE project has worked with EDs across Queensland to implement the most current, evidence-based ADPs, thereby improving the evaluation of patients with possible cardiac chest pain.
The Problem
Chest pain is among the most common primary problems with which patients present to emergency departmants.
Excluding acute coronary syndrome in most patients without missing cases requires a conservative approach, but places a considerable burden on service delivery.
The Impact
The Project has resulted in reduced length of stay (both ED and total hospital stay) and hospital admissions through implementation of protocols able to safely and rapidly assess patients at low and intermediate risk of Acute Coronary Syndrome (ACS).
From 2012 to 2015, the ACRE project initiated implementation of the ADAPT protocol in 19 hospitals. From 2016-2018, the Improved Assessment of Chest pain Trial (ImpACT) protocol was implemented in 9 hospitals.
Pooled data has demonstrated significantly decreased ED length of stay, hospital admission rates to inpatient units and total hospital length of stay.
This has resulted in substantial released capacity with economic impact evaluation suggesting savings of more than $7.5 million per year across the state.
