Implementing change: evaluating the Accelerated Chest pain Risk Evaluation (ACRE) project

William A Parsonage, Tanya Milburn, Sarah Ashover, Wade Skoien, Jaimi H Greenslade, Louise McCormack and Louise Cullen
Med J Aust 2017; 207 (5): 201-205. || doi: 10.5694/mja16.01479


Objective: To evaluate hospital length of stay (LOS) and admission rates before and after implementation of an evidence-based, accelerated diagnostic protocol (ADP) for patients presenting to emergency departments (EDs) with chest pain.

Design: Quasi-experimental design, with interrupted time series analysis for the period October 2013 – November 2015.

Setting, participants: Adults presenting with chest pain to EDs of 16 public hospitals in Queensland.

Intervention: Implementation of the ADP by structured clinical re-design.

Main outcome measures: Primary outcome: hospital LOS. Secondary outcomes: ED LOS, hospital admission rate, proportion of patients identified as being at low risk of an acute coronary syndrome (ACS).

Results: Outcomes were recorded for 30 769 patients presenting before and 23 699 presenting after implementation of the ADP. Following implementation, 21.3% of patients were identified by the ADP as being at low risk for an ACS. Following implementation of the ADP, mean hospital LOS fell from 57.7 to 47.3 hours (rate ratio [RR], 0.82; 95% CI, 0.74–0.91) and mean ED LOS for all patients presenting with chest pain fell from 292 to 256 minutes (RR, 0.80; 95% CI, 0.72–0.89). The hospital admission rate fell from 68.3% (95% CI, 59.3–78.5%) to 54.9% (95% CI, 44.7–67.6%; P < 0.01). The estimated release in financial capacity amounted to $2.3 million as the result of reduced ED LOS and $11.2 million through fewer hospital admissions.

Conclusions: Implementing an evidence-based ADP for assessing patients with chest pain was feasible across a range of hospital types, and achieved a substantial release of health service capacity through reductions in hospital admissions and ED LOS.

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  • William A Parsonage1,2
  • Tanya Milburn1
  • Sarah Ashover1
  • Wade Skoien1
  • Jaimi H Greenslade1,3
  • Louise McCormack1
  • Louise Cullen1,2,3

  • 1 Royal Brisbane and Women's Hospital, Brisbane, QLD
  • 2 Queensland University of Technology, Brisbane, QLD
  • 3 The University of Queensland, Brisbane, QLD



The ACRE Project was funded by the Queensland Government Department of Health. We acknowledge the support of the Healthcare Improvement Unit, Queensland Department of Health. We thank the Queensland Research Linkage Group of the Department of Health for assistance with linking data from the emergency department and inpatient datasets. We also gratefully acknowledge the contributions of former project officers Jennifer Bilesky, Jo Sippel and Vandana Bettens in the early development of the project, and the staff of the participating hospitals.

Competing interests:

No relevant disclosures.

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