Ambulatory Emergency Care Pathways

(Low Risk Cardiac) Chest Pain

Content Summary

Ref Title Description

1 Condition Details Identifies pathway details and clinical sign-off

2 Pathway Algorithm Identifies the pathway to follow to identify patients suitable for Ambulatory
Care

3 Patient Criteria Criteria for patients appropriate for the pathway

4 Patient Information Identifies Patient Information leaflets for issue to patients regarding their
pathway

5 KPIs Identifies how the pathways are measured

1. Condition Details

Data 1: P
Condition Details Summary
(Baseline using 2010/11 outturn) 1:
EB10Z, EB01Z / J100, J110, J120, J121, J122, Pat
HRG/ICD-10 Codes J128, J129, J13X, J14X, J153, J154, J157, J158, hw
J159, J160, J168, J181, J188, J189
ay
Total Patients per Month (Avg) 66.58 Det
ails
Bed Days Utilised per Month (Avg) 53.33

Number of Beds Utilised per Month (Avg) 0.15

Average Length of Stay 0.80 1:

Pat
Potential Percentage suitable for ambulatory care 30-60% hw
ay
Details

Sign Off:

Pathway Designed by Clinical Subject Matter Expert Signed

Dr Adam Jacques Print

Pathway Approved by Specialty Lead Signed

Dr Adam Jacques Print

Pathway Approved by Emergency Department Lead Signed

Dr Jacob Addo Print

Additional Sign-off

Dr David Cartwright

Pathway Authorised by Divisional Director Signed

Dr Peter Wilkinson Print

2. Pathway Algorithm
Patient Presents with:
Suspected (Low Risk) Suspected (Low Risk) Cardiac Chest Pain

Chest Pain
History & Examination
(Including basic observations)

Investigations
12 Lead ECG, Bloods, Chest X-Ray

Red Flags: Follow STEMI

Yes
12 Lead ECG Indicates STEMI Pathway

No

Suspected Consider Alternative Diagnosis:

Yes NSTEMI or Angina
No Refer to appropriate Physician for
(If suspected NSTEMI or Angina,
Non-Cardiac Chest pain
Consider ACS protocol)

st
1 Troponin Levels
Yes = Positive >0.04 µg/L

Admit No Has a Consultant Cardiologist, ED consultant or

Medical registrar reviewed patient and approved
Repeat Troponin Levels after 3 hrs Discharge?
Yes and 6 hours = Positive >0.04 µg/L No st
(This may have been post 1 Troponin review with
guidance that patient may be discharged
if 6 hr Troponin levels were negative)
Discharge Patient
- Arrange F/Up (if Required)
- Prescribe and Supply Medication (if required)
Refer to Consultant Cardiologist No Yes - Letter to GP
- “Tick” APD box on CAS form
Does Consultant Cardiologist Approve
No Patient Discharge Yes
3. Patient Criteria

Red Flags - Exclude the following Patients and Admit:

12 Lead ECG Indicates STEMI

Clinical Criteria that requires addressing same day for AECP, else Admit / Reconsider Diagnosis:

Refer to appropriate Physician for Non-Cardiac Chest Pain

As a Cardiac Chest Pain will have been excluded as a diagnosis, Patient Information (if
required) would relate to other Clinical Conditions causing the Non-Cardiac Chest Pain.

The issue of Cardiac Chest Pain related information may only cause unnecessary concern
and is not advised.
4. KPIs

How it will be Baseline

KPIs Description At Min % At Max %
measured (2010/11)
Reduction in the number of patients
Core KPIs requiring a stay of more than 24 hours (i.e. PAS 799 120 240
a 0-Day LoS)
Reduction in the Avg number of Bed Days
PAS 640 96 192
utilised for the condition
Reduction in Bed Numbers PAS 1.75 0.26 0.52
Other KPIs

Scope Scope: Patients entering the AECP Pathway at St. Peter’s Hospital
Governance Governance: Reports to the Unscheduled Care Programme Board and Divisional Performance Review Meetings

• Above Min and Max figures are part year effects for 2011/12 based on month of implementation