Implementation of a clinical pathway for the assessment of patients with suspected acute coronary syndrome (ACS) may reduce the length of stay in hospital emergency departments, according to results from the ICare-ACS trial presented November 14, at American Heart Association (AHA) Scientific Sessions 2017 and simultaneously published in the journal Circulation.

Martin P. Than, MBBS, et al., looked at 31,332 patients with suspected ACS in seven hospitals in New Zealand. Clinical pathway implementation included a clinical pathway document, structured risk stratification, specified time points for electrocardiographic and serial troponin testing within three hours after arrival, and directions for combining risk stratification and electrocardiographic and troponin testing in an accelerated diagnostic protocol.

Results showed that overall, the mean six-hour discharge rate increased from 8.3% to 18.4% in patients who underwent clinical pathway implementation. Further, in patients discharged within six hours, there was no change in 30-day major adverse cardiac event rates, and no adverse events occurred when clinical pathways were correctly followed.

The authors conclude that the implementation of hospital clinical pathways to assess patients with suspected ACS safely reduced length of stay while increasing the rate of safe discharge within six hours. They add that moving forward, this has the potential to reduce the use of hospital resources and provides rapid reassurance to many patients who presented to emergency departments with symptoms consistent with ACS.