55 Evaluation of a novel outreach service for rapid assessment of inpatients with suspected cardiac chest pain

Introduction Patients admitted to hospital with suspected cardiac chest pain require prompt specialist assessment and risk stratification without significant adverse impact on length of stay (LOS) and outpatient resources. This requires the appropriate use of anatomical and functional investigations, which is facilitated by streamlined care pathways. Objectives To evaluate the impact of a novel chest pain outreach team (CPORT) comprising a senior clinical fellow and cardiac specialist nurse practitioners on the care of inpatients with suspected cardiac chest pain. Methodology We assessed the impact of the CPORT service by retrospective case notes review and analysis of key performance indicators including LOS, use of cardiac investigations, and outpatient referrals for follow-up evaluation. Patients were identified using relevant International Classification of Diseases (ICD) codes for chest pain, angina, and precordial pain from the institutional Quality Surveillance Information System (QSIS). Findings were compared with a historical control group of patients admitted to hospital before the introduction of the CPORT service. Results A total of 100 patients reviewed by the CPORT team were included. A separate group of 39 patients were selected for the control group, from a cohort of 746 inpatients with chest pain, filtered using the aforementioned ICD codes, excluding a definitive diagnosis of myocardial infarction or non-cardiac pathology. Figure 1a illustrates that 52% of patients under CPORT had a LOS <5 days compared to 70% of controls. All patients admitted under CPORT had an inpatient cardiology review compared to 72% in the control group (figure 1b). The CPORT service delivered definitive management during the index admission to 88% of patients with no need for further outpatient evaluation, compared to 41% in the control group requiring follow-up assessment after discharge (figure 2a). As summarised in figure 2b, 77% of CPORT patients underwent inpatient coronary evaluation with structural or functional tests compared to 28% of the control group. Definitive anatomical testing was completed in 73% of CPORT patients. Conclusion The chest pain outreach team approach to the evaluation of suspected cardiac chest pain has successfully improved the inpatient risk stratification and management of patients whilst also reducing the pressure on outpatient services. The current focus of the chest pain service is to reduce the inpatient waiting time for investigations aiming to complete the care pathway for the majority of patients within five days of admission. Conflict of Interest None