Heart Score in the Emergency Department

The evaluation of chest pain can be very costly. Ruling out low-suspicion chest pain early can lead to decreased costs to patients and hospitals. Currently, all patients who present to the ED with the chief complaint of chest pain receive an extensive work-up, including serial labs, electrocardiograms and often a cardiology consultation. This approach utilizes time, money and hospital resources when some of these patients could likely have a cardiac cause ruled-out and discharged home much sooner. The purpose of this scholarly project was to select and implement a pop-up tool for use in the emergency department (ED) at a large urban teaching hospital using a risk stratification tool called the HEART score. This tool was used to risk stratify patients presenting to the emergency department with the chief complaint of chest pain. The objectives of this scholarly project included: 1) Implementation of the HEART score tool in the ED at a large urban teaching hospital in order to earlier identify low-risk acute coronary syndrome (ACS) chest pain patients and improve quality of care for these patients; 2) assessment of patient outcomes in those who present to the ED with the chief complaint of chest pain; and 3) to evaluate the usefulness of the HEART score tool. The HEART score was developed in 2008 for patients who present to the ED with chest pain. It is a validated, clinical decision-making tool comprised of five parameters: history, ECG, age, troponin and risk factors. Each parameter is scored either 0, 1 or 2 and patients receive a score from 0-10. Patients are then divided into low (0-3), intermediate (4-6) or high risk (7-10) groups. The purpose of this is to determine whether a patient can be discharged home or should be admitted to the hospital. Implementation and evaluation included a one-month trial period at a large urban teaching hospital. Assessment of patient outcomes were obtained. The data collection was performed using a retrospective chart review two weeks prior to and after initiation of the HEART Score pop-up tool. Additionally, 10 medical providers were asked to complete a questionnaire regarding the HEART score tool to evaluate whether or not they felt it was something they would like to continue using in the ED. Once the results were compiled, a presentation of the results was presented to the ED director. The results of the project did not show a significant change in patient outcome pre and post implementation of the HEART score tool. However, all of the providers surveyed said they liked the tool and would like to continue using it. Lack of significant change may be attributed to several different factors, such as the variability in comfort level with chest pain patients amongst providers, the short trial period, small sample size and the variability of test ordering amongst providers. This project has the potential, with time and continued education to greatly positively impact patient care and should be continued and reassessed in the future. The plan is to continue to use this tool in the ED and assess outcomes in the future.