HEART Score-Guided Accelerated Discharge for Patients Admitted With Chest Pain: A Community-Hospital Quality Initiative.

BACKGROUND

Most patients admitted for chest pain rule-out for acute coronary syndrome yet undergo low-value inpatient testing that prolongs stay and consumes scarce community-hospital resources.

PROJECT RATIONALE: Baseline review showed utilization misaligned with HEART (History, Electrocardiogram, Age, Risk factors, Troponin)-derived risk and inconsistent, upwardly inflated score documentation, indicating the need for a standardized discharge pathway.

PROJECT SUMMARY: Among 156 emergency department chest-pain encounters (0% 6-week major adverse cardiac events), 89% received cardiology consultation and 45% echocardiography (88% normal); 44% of documented HEART scores were inflated. We adopted the HEART Score-Guided Accelerated Discharge Protocol: mandatory same-admission cardiology consult, indication-only echocardiography, no reflexive labs, target discharge under 24 hours, and guaranteed follow-up, with prespecified measures and an approximate cost avoidance of $120,000 (about $1,000 per patient) per rule-out cohort.

TAKE-HOME MESSAGE: A simple, electronic medical record-free HEART-guided pathway can safely reduce low-value testing and redirect scarce resources to higher-acuity patients.