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Abstract
Aims, Objectives and Background We implemented a novel ambulatory computed tomography coronary angiography (CTCA) pathway as an alternative to inpatient stay when resolving uncertainty surrounding acute coronary syndrome diagnosis in ‘moderate risk’ patients. Eligible patients were identified automatically, and recommendations ‘pushed’ to the clinician. This novel pathway aimed to reduce the length of stay and pressure on hospital resources. We investigated the uptake of this service and its effects on patient outcomes including length of stay and the use of percutaneous coronary intervention (PCI).
Method and Design We conducted a retrospective, single-centre service evaluation. Patients were eligible for CTCA if they were moderate risk with T-MACS; troponin <99th percentile; no acute electrocardiogram ischaemia.
Data were collected contemporaneously using the T-MACS app as part of routine clinical care for consecutive moderate-risk patients pre- (June 2016 – December 2018) and post-implementation (January 2018 – October 2020) of ambulatory CTCA. The primary outcome was adherence (eligible patients who received an ambulatory CTCA). Secondary outcomes included location and length of stay, time to CTCA, and PCI. We summarised data using descriptive statistics.
Results and Conclusion We identified 1,341 patients eligible for ambulatory CTCA (524 pre-implementation of pathway; 817 post-implementation; 820 [61%] male; mean age 57 [SD 14]). Pre-implementation, 46.6% (n=244) of these patients were admitted to the Ambulatory Care Unit (ACU). Post-implementation, 32% (n=258) were admitted to the ACU; only 7 (1.3%) eligible patients received ambulatory CTCA after implementation of the service. A further 25 ‘moderate risk’ patients received an inpatient CTCA. The median time to ambulatory CTCA from admission was 1 (IQR 0.75–3) day. Five (71.4%) ambulatory CTCAs were abnormal, identifying coronary artery disease. Three patients with abnormal CTCA underwent PCI; only one followed the ambulatory CTCA pathway.
Conclusions Clinicians continued to admit patients to inpatient areas, indicating suboptimal utilisation of the pathway. Future work should focus on identifying barriers to adherence.