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Electronic Chest Pain Pathway (eCPP) in the eMR

Illawarra Shoalhaven Local Health District
Project Added:
21 November 2014
Last updated:
15 December 2014

Electronic Chest Pain Pathway (eCPP) in the eMR

Summary

The most common Emergency Department (ED) presentation across Australia is Chest Pain. Early identification, diagnosis and treatment is paramount to prevent adverse patient outcomes or death.

The seamless, person-centred Electronic Chest Pain Pathway (eCPP) was developed to be compatible with all other pathways. It provided continuous care for patients with deteriorating health and developed key partnerships between the project teams that co-designed the easy to use evidence based tool.  

This project was a finalist in the Integrated Health Care category of the 2014 NSW Health Awards. Download the poster from the 2014 NSW Health Awards.

Aim

To create an eCPP, reduce Acute Coronary Syndrome (ACS) morbidity/mortality, and decrease ACS patients’ ED length of stay to less than four hours and improve the compliance and documentation to 100%.

Benefits

  • Improved outcomes for patients presenting with chest pain.
  • Increased access to effective care and reduced length of stay in ED.
  • Improved compliance and documentation.

Project status

Sustained: The project has been implemented, is sustained in standard business.

Implementation

The project focussed on co-designing an evidence-based tool with clinicians that is easy to use, meets clinician needs, and encourages compliance, with the aim of improving patient outcomes and reducing adverse events.

Using the existing Chest Pain Pathway, the Project Team developed and trialled the new eCPPat a tertiary hospital (Wollongong) and a rural/base (Shoalhaven) hospital in collaboration with NSW cardiology, EDs and other NSW Health organisations.

Unlike the paper based pathway, the unique eCPP:

  • ensures access to the latest best practice guidelines, resulting in optimal health outcomes for the patient
  • promotes compliance due to its integration in the electronic medical record (eMR)
  • is intuitive, unambiguous and supports decision pathways
  • requires no printing, is inexpensive and eliminates use of obsolete versions
  • eliminates the need for manual data collection
  • reduces treatment errors and misinterpretation
  • is accessible by all health care professionals wherever they are in the Local Health District
  • reduces unwarranted clinical variation (UCV) in care by providing clear ACS treatment pathways.

Implementation sites 

  • Wollongong Hosptial
  • Shoalhaven Hospital

Results

As the first successful eCPP in Australia, it has proven an invaluable tool in the assessment and treatment of ED chest pain presentations resulting in a 400% increase in compliance, no serious (SAC 1 or 2) incidences associated with ACS, and a 30% reduction in ED length of stay.

Other results include:

  • faster completion of the eCPP - electronic documentation is two/three times faster
  • increased completion rate - The ease and usability of the eCPP resulted in a 1000% increase in total pathways completed.
  • reduction in diagnosis/treatment errors as the eCPP's refined decision matrix provides up to date treatment, yet allows divergence from the dictated path if deemed clinically appropriate.

The eCPP design can be easily adapted to other health disciplines and used as the template for all clinical pathways. It is easily transferable and can be added to any Australian eMR site within minutes.

Partnerships

  • Agency for Clinical Innovation (ACI)
  • NSW Health eMR 2 Teams

References

Chest Pain Evaluation (NSW Chest Pain Pathway). 2011. NSW Health.

Clinical pathways: effects on professional practice, patient outcomes, length of stay and hospital costs (Review) 1. 2010. The Cochrane Collaboration. Published by JohnWiley & Sons, Ltd.

Acute Coronary Syndrome. Safety Notice 009/09. 2009. NSW Health.

Guidelines for the management of acute coronary syndromesNational Heart Foundation of Australia/The Cardiac Society of Australia and New Zealand. Guidelines for the management of acute coronary syndromes. 2006. MJA 184;8: S1-S30.

Contact

Tony Tiberio
Cardiac Assessment Nurse Consultant
Illawarra Shoalhaven Local Health District (ISLHD)
Phone: 02 4222 5760
Email: TonyAntonio.Tiberio@sesiahs.health.nsw.gov.au

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