Key result
Implementation of a clinical pathway for suspected ACS increased the mean 6-hour discharge rate compared to usual care (18.4% vs 8.3%; OR 2.4; 95% CI 2.3-2.6).
Why the study?
Does the implementation of a standardized clinical pathway for suspected ACS increase the odds of safe discharge within 6 hours in emergency department patients?
RCT (n=31,332)
stepped-wedge
Yes
Does the implementation of a standardized clinical pathway for suspected ACS increase the odds of safe discharge within 6 hours in emergency department patients?
Odds Ratio: 2.4 (95% CI 2.3–2.6)
Absolute Event Rate: 18.4% vs 8.3%
Implementation of a standardized clinical pathway for suspected ACS significantly increased the proportion of patients safely discharged within 6 hours without increasing 30-day adverse cardiac events.
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Supports accelerated ED discharge for suspected ACS; leaves open need for randomized confirmation of safety and generalizability.
Than et al. (2017) conducted an RCT in suspected acute coronary syndrome (n=31,332). Clinical pathway for suspected ACS vs. Usual care was evaluated on odds of discharge within 6 hours of presentation (OR 2.4, 95% CI 2.3-2.6). Implementation of a clinical pathway for suspected ACS increased the mean 6-hour discharge rate compared to usual care (18.4% vs 8.3%; OR 2.4; 95% CI 2.3-2.6).
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