An Updated Healthcare System-Wide Clinical Pathway for Managing Patients With Chest Pain and Acute Coronary Syndromes

Abstract

Clinical pathways reinforce best practices and help healthcare institutions standardize care delivery. The NewYork-Presbyterian/Columbia University Irving Medical Center has used such a pathway for the management of patients with chest pain and acute coronary syndromes for almost 2 decades. A multidisciplinary panel of stakeholders serially updates the algorithm according to new data and recently published guidelines. Herein, we present the 2019 version of the clinical pathway. We explain the rationale for changes to the algorithm and describe our experience expanding the pathway to all the 8 affiliated institutions within the NewYork Presbyterian healthcare system.

Twenty Years of an Institutional Chest Pain Pathway: What’s Come and What’s Yet to Come

“…30 By the 2019 update of our pathway, concern that the benefit of the intravenous beta-blocker on infarct size in STEMI patients may have been exaggerated by significant selection bias, and further studies demonstrating that early oral beta blockade with metoprolol in patients with ACS benefited patients moved our institution to preferentially use oral beta-blockers as up-front therapy in patients with ACS. 31,32…”

Implementing “Chest Pain Pathway” Using Smartphone Messaging Application “WhatsApp” as a Corrective Action Plan to Improve Ischemia Time in “ST-Elevation Myocardial Infarction” in Primary PCI Capable Center “WhatsApp-STEMI Trial”

“…Additionally, it can improve resources utilization like reduction of length of stay and unnecessary hospital admissions. [14][15][16][17][18][19][20] Constant feedback with a closed-loop debriefing for each case using different means of communication is known to improve outcomes. [21][22][23][24][25][26][27][28] The use of WhatsApp (a smartphone messaging application) was already reported in the literature for quality improvement in multiple studies for telemedicine, emergency room disposition, and guidelines compliance.…”

“…Additionally, it can improve resources utilization like reduction of length of stay and unnecessary hospital admissions. 14–20…”

Updating a Healthcare System-wide Clinical Pathway for Managing Chest Pain and Acute Coronary Syndromes

“…The last update of this pathway, published in 2019, described the implementation of a healthcare system-wide chest pain algorithm adopted by all 8 hospitals within the NewYork-Presbyterian Healthcare System, and the key changes and dynamics necessary to ensure streamlined care for patients presenting with chest pain. 3…”