Abstract 19872: Safety and Efficacy of Digital Symptom Triage Tool Developed for Decreasing Emergency Department Overutilization in Patients With Chest Pain
Introduction: According to the CDC, >70% of the emergency department (ED) visits in 2013 were due to a non-emergent conditions. Chest pain accounts for one of the top reasons for such visits. We tested safety and efficacy of digital symptom triage tool (DSTT) designed to re-direct lower risk patients with chest pain into less expensive medical care setting.
Methods: Three hundred consecutive patients >18 years old who presented to a tertiary center ED with chest pain were evaluated retrospectively. DSTT was used to assign a risk score, defined as warning flag, to guide medical setting disposition. Actual outcomes were obtained from the medical records. Investigators were double blinded to the risk scores and the actual disposition.
Results: Average age was 51.7±17.1 years, 158 men (52.7%), and 142 women. Actual disposition was: 117 admitted (39%), and 183 (61%) discharged from ED. The DSTT risk score was 10.96±3.4 in the admitted group, and 5.46±3.0 in the discharged group (P<0.001). There was 65.7% agreement (Cohen’s kappa = 0.37) between the actual disposition, and the recommendations based on the DSTT risk score. Specifically, of the 117 patients admitted from the ED, 111 (94.9%) had a warning flag. The 6 admitted patients who were not flagged by the DSTT found to have musculoskeletal pain (2 patients), atrial fibrillation, pericarditis, non-anginal chest pain, and chronic obstructive coronary artery disease on angiography (1 patient each). Among 183 patients discharged, 97 (53%) had a warning flag, and 86 (47%) did not.
Conclusion: DSTT was more conservative than ED physicians in re-directing lower risk patients, providing a sizable safety margin while diverting patients to lower cost setting. A prospective investigation is currently in progress, and will utilize outcome-adjusted adaptive algorithm to maximize risk fit and cost savings.
Author Disclosures: B. Vettichira: None. M. Goyfman: None. J. Asheld: None. R. Druz: Ownership Interest; Significant; Owns 5% or more of shares in entity. S. Kort: None.
- © 2016 by American Heart Association, Inc.