Standardizing Emergency Work-ups Around Risk Data

Chest pain is the second leading reason for emergency department (ED) visits in the United
States. Resource utilization for this ED subpopulation is particularly high, in part due to a
dearth of accepted standardized clinical approaches and general overestimation of risk on the
part of both providers and patients. This prospective observational cohort study seeks to
address this issue by providing externally validated risk scores for major adverse cardiac
events using a web-based clinical decision support platform (RISTRA) embedded within the
electronic health record at 13 Kaiser Permanente Northern California (KPNC) EDs over a
12-month period. The decision support will provide risk estimates specific to the KPNC
patient population. This studies hypothesis is that the provision of more accurate risk
estimation for major adverse cardiac events will improve informed decision making by both
providers and patients, resulting in less provocative testing and lower ED lengths of stay
amongst low risk patients, as well as improving medical management among non-low risk
patients and decreasing future rates of major adverse cardiac events.