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Statewide Chest Pain Pathway

A Chest Pain Patient Journey working party was formed and has developed the NSW Chest Pain Pathway that represents the minimum standard of care for chest pain patients presenting to emergency departments.

This pathway is part of the Cardiology Model of Care.

Current Status

Two pathways have been developed and will be implemented according to the ability of the facility to provide primary angioplasty (PCI):

  • Chest Pain Pathway - Primary PCI site
  • Chest Pain Pathway - Non-primary PCI site

The policy mandates the implementation of a standardised Chest Pain Pathway, by all hospitals in the NSW Health system. Compliance in implementation of the standardised Chest Pain Pathway will improve the management of patients by guiding clinicians through the risk stratification and outlining the best practice management, aligning with the National Heart Foundation/Cardiac Society of Australia and New Zealand Guidelines for the management of acute coronary syndromes.

Compliance with this policy will improve patient outcomes and experience.

Key elements of the policy

  1. All facilities with Emergency Departments must have and use a Chest Pain Pathway
  2. All facilities who currently do not have and use a Chest Pain Pathway must implement the standard NSW Health Chest Pain Pathway
    • Assigns triage category 2
    • Includes risk stratification
    • ECG taken and reviewed
    • Troponin taken and reviewed
    • Vital signs taken and documented
    • Times must be documented (symptom onset, presentation)
    • Aspirin given unless contraindicated
    • A Senior Medical Officer is assigned to provide advice and support on chest pain assessment and management 24/7
    • Provides information and advice regarding atypical chest pain
    • High risk alternate diagnosis listed for consideration e.g. Aortic Dissection, Pulmonary Embolism & Pericarditis
  3. Facilities that have an existing Chest Pain Pathway must ensure that it meets the following minimum standards:
  4. Sites may continue to use their current pathway provided it meets the criteria above. A local version that complies with the above minimum standards, may be developed to suit local needs
  5. The Generic Chest Pain Pathway was developed by the Chest Pain Patient Journey Working Group using available evidence to assist clinicians to provide best practice in the management of cardiac patients who present to an Emergency Department.

The Chest Pain Pathway was developed in consultation with cardiac nurses and cardiologists in both rural and metropolitan areas, the Emergency Care Taskforce, the Agency for Clinical Innovation Cardiac Network, Rural Critical Care, the NSW Health Statewide Cardiology Project team and NSW Ambulance.


The Clinical Excellence Commission (CEC) patient safety team has prepared two clinical focus reports to the Reportable Incidents Review Committee (RIRC) focusing on Acute Coronary Syndrome (ACS).

As a result of the CEC review of the Incident Information Management System data on ACS, the RIRC requested that the Health Services Performance Improvement Branch address the issues in the clinical focus reports.


Network Manager, Cardiac
NSW Agency for Clinical Innovation
Phone: 02 9464 4620

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