Implementation of the Guidelines for the Management of Patients With Chest Pain Through a Critical Pathway Approach Improves Length of Stay and Patient Satisfaction But Not Anxiety

Abstract

OBJECTIVE: To compare length of stay (LOS), clinical and psychological outcomes, and patient satisfaction before and after implementation of a chest pain critical pathway. DESIGN: A pre- and post-test quasi-experimental design. SETTING: The Chest Pain Unit (CPU) of the Antwerp University Hospital. PATIENTS: Patients admitted to the CPU with symptoms suggestive of an acute coronary syndrome older than 18 years. INTERVENTIONS: Implementation of a critical pathway focusing on implementation of the guidelines for the management of chest pain. MAIN OUTCOME MEASURES: Patient satisfaction, length of stay and anxiety were evaluated. RESULTS: The median LOS of intervention subjects was almost 4 hours shorter than that of control subjects (without, P = 0.04, or with propensity correction, P = 0.019). The overall patient satisfaction with CPU care of the intervention group was significantly higher than that of the control group (without, P < 0.001, or with propensity correction, P < 0.001). Differences in anxiety and occurrences of major adverse cardiac events between the groups were not statistically significant. CONCLUSION: A critical pathway can effectively and safely reduce LOS, increase patient satisfaction, and improve adherence to the guidelines for managing patients with chest pain. Anxiety is not statistically significantly reduced by this intervention.