How Shared Decision Making In The Emergency Department Can Improve Value

From Health Affairs:

The ‘Chest Pain Choice’ Decision Aid

The “Chest Pain Choice” decision aid is a visual representation of a patient’s risk of ACS within 45 days of their ED visit. Assessment tools are used to calculate risk based on patient information collected during their ED visit, including:

  • Age
  • Gender
  • If chest pain is made worse when manual pressure is applied to the chest area
  • If there is a history of coronary artery disease
  • If the chest pain causes perspiration
  • Findings on electrocardiograms (electronic tracings of the heart)
  • Initial cardiac troponin result

Once the probability that a patient will experience ACS within 45 days of his or her ED visit is calculated, the patient is presented with a decision aid that is tailored to his or her personal risk profile. Clinicians were directed to be conservative in determining the level of risk to communicate to patients. For instance, if a patient’s risk is 0.9 to 1.7 percent, clinicians would use a decision aid indicating a 2 percent risk.

The decision aid is an 11×14 piece of paper that communicates to patients the results of initial tests indicating that they are not having a heart attack, their personalized 45-day risk for a heart attack, and the available management options, including staying in the ED observation unit for cardiac stress testing, following up in the next 72 hours, or having the physician make the decision on their behalf.

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