Key result
A safe-for-self-transport tool cuts EMS transports by ~41% for low-risk chest pain in urgent care.
Why the study?
Low-risk chest pain patients often do not require continuous cardiac monitoring, yet over 70% were being transferred via EMS for ACS rule-out work-ups, prompting efforts to streamline care and reduce critical resource utilization.
Does a quality improvement initiative reduce EMS utilization for interfacility transport of low-risk chest pain patients?
Does a quality improvement initiative reduce EMS utilization for interfacility transport of low-risk chest pain patients?
A quality improvement initiative utilizing a safe-for-self-transport tool and physician education safely reduced EMS utilization by 30% for low-risk chest pain patients.
May support reduced EMS use for low-risk chest pain in urgent care; leaves open need for randomized confirmation of safety and generalizability.
Background: Acute coronary syndrome (ACS) is a “can’t miss” diagnosis. The gold-standard workup for this requires serial troponin biomarker evaluation over a period of hours. Traditionally, many of these patients required telemetry while being evaluated in this fashion; however, the high-quality literature suggests that low-risk patients do not require ongoing continuous cardiac monitoring. Locally, it was found that over 70% of patients presenting with low-risk chest pain to our high-volume urgent care were transferred to the main hospital for an ACS rule-out work-up via emergency medical services (EMS). We felt this intersection of patient care and medical services could be streamlined to reduce critical resource utilization. Objective: The aim of this study is to reduce the usage of EMS utilization for transport of low-risk chest-pain patients from the urgent care to the main hospital by 25% over a 3-month period. Methods: This study was conducted as an uncontrolled before–after interrupted time series design. A comprehensive data drilldown was performed through a chart review and structured clinical-practice evaluation. This led to a multi-factorial quality improvement initiative centered around the creation of an evidence-based safe-for-self-transport tool and physician education. The primary outcome measure was the proportion of patients transported via EMS with the main balancing measures being the proportion of self-transported patients admitted to the hospital and the time to troponin blood-draw in self-transported patients. Results: The education and the newly developed transport tool resulted in a sustained shift below the previous baseline system mean control limit, indicating a significant reduction in EMS usage for patient transport. The overall reduction in usage was 30%. No change in balancing (safety) measures was identified post-implementation. Conclusions: EMS remains a finite resource within many Canadian health regions. The results of this study show that by focusing on a cardinal emergency-department presentation like chest pain, adapting evidence-based practice through quality-improvement methodologies can result in a significant sustained reduction in EMS utilization.
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Hewitt et al. (2026) studied Adults over 18 presenting with low-risk chest pain to a high-volume urgent care center requiring serial troponin testing and ECG for ACS rule-out. Safe-for-self-transport Clinical Decision Tool (CDT) plus physician education vs. Usual care without the decision tool and standard EMS transfer was evaluated on Proportion of patients with chest pain transported by EMS from urgent care center to main hospital (30% absolute reduction). Implementation of a safe-for-self-transport clinical decision tool with physician education reduced EMS transport usage by 30% from baseline 73% to 43% among low-risk chest pain patients in an urgent care setting.
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