One minute can help patients avoid unnecessary hospitalization

One minute is not a long stretch of time. But according to a new study from the Mayo Clinic, it could be just enough time to save a life and avoid unnecessary hospitalizations.

A shared decision-making tool—the Chest Pain Choice—can provide an estimated risk for acute coronary syndrome within 45 days. Based on that assessment, physicians and patients can discuss whether hospital admission and advanced cardiac testing is necessary.

Chest pain can be caused by a variety of problems—and all patients are encouraged to take its onset seriously. Resultantly, physicians often admit very low risk patients for prolonged observation and urgent cardiac testing in order to avoid a missed diagnoses. Unfortunately, the costs of these lengthy hospital stays adds up.

“Despite little possibility that these low-risk patients are experiencing acute coronary syndrome, emergency physicians are more likely to default to admission for observation and additional testing.” said Erik Hess, MD, the study's lead author and emergency medicine physician at Rochester, Minnesota's Mayo Clinic. “This presents a substantial unnecessary burden and cost to the patient and the healthcare system.”

In a randomized clinical trial across six emergency departments in five states, researchers compared usual care for 447 patients to 451 patients receiving the Chest Pain Choice decision aid intervention. The primary outcome, selected by patient and caregiver representatives, was patient knowledge. Secondary outcomes were involvement in the decision to be admitted, proportion of patients admitted for cardiac testing, and the 30-day rate of major adverse cardiac events.

Results showed that the decision aid improved patient knowledge of chest pain symptoms, more fully engaged patients in the decision-making process and helped patients better assess their own 45-day risk of acute coronary syndrome.

This lead to a decrease in admissions from 52 percent to 37 percent.

“When patients are involved with their care decisions, it is more likely they will get the right care for their concerns,” Hess said. “We believe that the Chest Pain Choice decision aid will make it easier for patients and physicians to have a thoughtful discussion and make an individualized care plan that is less likely to overuse unnecessary services.”

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