Health Care

Physicians transform care for chest-pain patients, dramatically reducing admissions and costs

A nurse checks a patient's heart beat as they are both sitting down.

Fla., ORLANDO, Fla., June 27, 2019 — The clinical transformation and emergency room teams at AdventHealth have transformed the way chest-pain patients are treated in the emergency room, leading to dramatic reductions in admissions and overall costs.

Physicians and the clinical transformation team collaborated to create a written algorithm that was used to categorize patients into high-, medium- and low-risk populations. The results have been published and recognized in EClinicalMedicine, the online publication of The Lancet, the world’s leading independent international medical journal.

The project was spearheaded by Dr. Jeffrey Kuhlman, chief of quality and safety at AdventHealth. Prior to joining AdventHealth, Kuhlman served as a Navy physician for three decades, including as personal physician to President Barack Obama.

“All of us as Americans agree health care is too expensive,” Kuhlman said. “One way to change that is to remove direct cost while ensuring the highest quality of care.”

Chest-pain patients account for 10 percent of adult visits to the ER. But of those patients, only one percent are actually having a heart attack.

Despite the statistics, many chest-pain patients were historically admitted to the hospital, leading to unnecessary costs to the consumer and organization.

For the majority of chest-pain patients, physicians use the HEART score — History, EKG, Age, Risk factors and Troponin, a cardiac enzyme that rises when heart muscle is being damaged.

Kuhlman explained AdventHealth’s process: Chest pain patients at high risk for a heart attack are admitted for further evaluation and care. Patients at intermediate risk are functionally or anatomically evaluated with stress test or heart scan in observation status. Patients who are low risk are watched for three hours, connected to follow-up, and discharged safely after another troponin test.

All 200,691 patients in the study were tracked for 30 days after discharge, and none suffered major adverse cardiac events during the tracking period.

Connecting patients with appropriate follow-up care is also a key component of the initiative. Depending on their diagnosis, the care team arranges an appointment within 72 hours, either with a cardiologist or a primary-care physician.

The study concluded the algorithm resulted in avoided health care costs of over $31 million. The initiative also led to a:

  • 99 percent increase in patient discharges
  • 63 percent drop in admissions
  • 20 percent decrease in patients being put on “observation” status

“Transforming health care is going to take dramatic change,” Kuhlman said. “We have the doctors coming together, saying this is the best way, and we have the hospital supporting that approach. This consensus-driven algorithm is unique to our method.”

The clinical transformation team and physicians are piloting similar algorithms for patients with abdominal pain and fainting, which also account for substantial numbers of ER visits.

AdventHealth Orlando Newsroom