Implementation of a rapid chest pain protocol in the emergency department: A quality improvement project

J Am Assoc Nurse Pract. 2016 Feb;28(2):75-83. doi: 10.1002/2327-6924.12260. Epub 2015 May 5.


Purpose: The purpose of this quality improvement (QI) project is to compare the effectiveness of a rapid 90-min chest pain screening and evaluation protocol to a 120-min screening and evaluation protocol in determining patient readiness for hospital admission or discharge home.

Data sources: The existing chest pain protocol utilized in the emergency department (ED) was revised based on a review of current research changing initial screening and reevaluation times from 120 to 90 min. A prospective comparative study of patients presenting to the ED with chest pain was performed comparing the existing chest pain protocol of 120 min (standard care) with a rapid screening evaluation protocol of 90 min. A total of 128 patients presenting to an ED in Texas with chest pain comprised the sample for this study.

Conclusions: There was a significant difference in the number of minutes between the groups for readiness for disposition. The average time from chest pain evaluation to readiness for disposition home, observation, or admission decreased from an average of 191 min in the standard care group to an average of 118 min in the rapid screening group.

Implications for practice: Use of the rapid screening and evaluation protocol decreased the time to disposition by an average of 73 min, which enhanced ED flow without influencing disposition and patient safety.

Keywords: Emergency department; cardiac biomarkers; chest pain; protocol; quality improvement; screening.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Chest Pain / therapy*
  • Clinical Protocols / standards*
  • Emergency Service, Hospital / legislation & jurisprudence
  • Emergency Service, Hospital / standards*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Program Development / methods*
  • Prospective Studies
  • Quality Improvement / trends
  • Risk Assessment
  • Time Factors*