Optimising chest pain pathways that ensure earlier access to definitive care for patients in remote and rural communities

A new model of care in remote/rural communities to ensure earlier access to definitive care for high-risk patients with chest pain, reducing poor outcomes, and streamlining care for low-risk patients, minimising delays, and pressure on the overburdened emergency care system. The new model will involve a prehospital blood test (to identify any heart damage and if the patient needs immediate transport to a capable hospital), a smartphone-based prehospital risk score assessment that determines the likelihood of serious cardiac and non-cardiac conditions based on patient characteristics and symptoms, and a virtual ED. We will establish effectiveness of the model by conducting a trial in Victoria before implementing it in other Australian ambulance services.

Chief Investigators

Prof Dion Stub, Dr Ziad Nehme, Prof Louise Cullen, Prof Derek Chew, A/Prof Sarah Zaman, Dr Jocasta Ball, Prof Clara Chow, Prof David Kaye, Prof Thomas Briffa, Prof Peter Cameron, Dr Shane Nanayakkara, Prof Janet Bray, Prof Judith Finn, Dr Susan Cartledge, Prof Christopher Reid

Funding source

The Medical Research Future Fund (MRFF)

Estimated completed date

December 2028

Background

Chest pain is a common symptom for many serious health conditions and is the leading cause of ambulance attendance, with over 470,000 presentations to Australian Emergency Departments (ED) every year. We have demonstrated that 26% of chest patients live in remote/rural communities and have disparate outcomes compared to their metropolitan counterparts due in part to their distance from and access to definitive care, in addition to limited care capability in many local regional hospitals. In Victoria, mean annual costs for chest pain transported via ambulance from remote/rural communities is ~$100 million. Current prehospital practice is that all patients with chest pain are transported to the nearest ED for further assessment regardless of hospital capability. However, 50% are found to be at low-risk and are discharged from ED without a specific diagnosis, at an annual cost of up to $35 million in remote/rural communities. Chest pain, therefore, represents a major public health concern in these communities.

Aim

We aim to assess the clinical safety and impact on health service efficiency of a novel prehospital chest pain model of care within remote and rural communities.