1. Development of Clinical Pathways to Streamline Care for Patients Presenting with Suspected Cardiac Chest Pain Background The National Heart Foundation recommends fostering a system of care where there is clinical leadership and collaboration across traditional service delivery boundaries and activation of a system of care. Early diagnosis and appropriate intervention, together with systems to minimise delay and prioritise catheterisation laboratory access for patients with ST Elevation Myocardial Infarction (STEMI) is currently best practice. In late 2011 the Emergency Care Network formed the Cardiac Chest Pain Working Group (CCPWG). This group consisted of clinicians from diverse disciplines around the state including Ambulance, Emergency Departments, Cardiology Departments, Coronary Angiography suites, Cardiology wards, General Medicine, Nuclear Medicine, Pathology, General Practice and a representative from the Heart Foundation. This group agreed there was a need for a more streamlined and consistent approach to the care of patients presenting to the Emergency Department with suspected cardiac chest pain. Following an initial literature review in January 2012, the group agreed to focus on the development of a suite of chest pain pathways to guide decision making and documentation. These pathways were developed in accordance with the National Heart Foundation Acute Coronary Syndrome Treatment Algorithm and the 2011 Addendum to the National Heart Foundation of Australia/Cardiac Society of Australia and New Zealand Guidelines for the Management of Acute Coronary Syndromes (ACS) 2006. One of the current management gaps identified through the literature review was that risk stratification for patients with ACS was not streamlined and therefore not regularly undertaken. The group agreed to develop clinical pathways to incorporate risk stratification and clarify and streamline referral processes. Method A sub-group of the CCPWG was formed to evaluate examples of pathways from other jurisdictions and to review current practices around Tasmania. With the knowledge gained from this Cardiac Chest Pain Pathways were developed. This significant body of work contained a suite of five documents which were presented to the CCPWG for feedback. Whilst the focus of the documentation is on care in the Emergency Department, the intention is to improve the entire patient journey by ensuring each person is directed into and follows the correct pathway. In addition, during development the group structured the current paper pathways to be easily modified to an electronic version which is envisaged will be more user-friendly for clinicians. As part of the process for forms approval input was provided by Safety and Quality, Pharmacy, and Medical Records. A six month trial was commenced at the Royal Hobart Hospital in June 2013. Improvements to Care The process of developing the pathways has resulted in the team identifying and rectifying barriers to timely and consistent evidence-based care. It has removed non- value steps and provided a means of audit and review of all patients presenting to the ED with chest pain and commenced on the pathways. This audit process provides real data to assess care and determine improvements in timeliness of interventions. By building the pathways around the patient experience the team were able to streamline discharge processes to facilitate timely and appropriate outpatient care. The Pathways assist in meeting National Safety and Quality Health Service (NSQHS) Standards, by having consistent and well known processes for patient management and medication administration. This also aids in the handover process as staff are familiar with the pathway and what should have occurred in each step. Next Steps Review of the trial will take place in the coming months, and feedback will be used to revise the pathways. Further consultation will occur with the other public hospitals around Tasmania to promote a statewide consistent approach to the management of suspected cardiac chest pain. Further funding (or award funds) would enable the purchase of quality handout literature for patients to improve their understanding of cardiovascular disease and the lifestyle adjustments necessary to prevent a major cardiac event. Submitted by Melinda Rose on behalf of Cardiac Chest Pain Working Group – Emergency Care Network 2013