Auditing the implementation of the Chest Pain Pathway in the emergency department to improve quality care of patients with possible cardiac chest pain

Josephine Sau Fan Chow, Raju Asalam, Rohan Rajaratnam



In 2011, the NSW Ministry of Health in Australia introduced the Chest Pain Pathway in all Emergency Departments (EDs) to ensure a minimum standard of care for patients presenting with chest pain. The aim is to audit the records of chest pain patients in regard to compliance with elements of an overarching Chest Pain Pathway. The purpose is to determine if regular audit and feedback improves Pathway compliance.



Three quarterly quality audits were conducted, followed by annual audits in the subsequent two years on the utilisation of the Chest Pain Pathway, using a locally designed tool. Five performance standards were used to measure the essential elements of the Chest Pain Evaluation Project including Patient Presentation, History Taking, Physical Examination, Risk Stratification and Management.



Over 500 files were audited across 5 facilities.  Patient Presentation which included appropriate triages category, triage to vital signs and ECG within 10 minutes showed improved compliance by 74%. Compliance also significantly improved in risk stratification and management. These improvements continued a year after the initial audits were undertaken and processes were introduced specific to each facility.  This has resulted in significant productivity improvement over the 12-month period.  A small improvement of 0.1 average bed days (144 mins) in 2014 was achieved compared to the pre chest pain audit period which translated to a productive improvement (saving) of $136,672.00.  However, the audit results were slightly worsened in April 2015, 12 months from the previous audits.



Regular audit and feedback, using a locally developed audit tool, improved compliance with the mandated Chest Pain Evaluation Project.  There was reported improvement in associated EDs length of stay reductions which may incur cost savings.


Chest pain; pathway; audit

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