The Statewide ACRE Project
www.health.qld.gov.au/caru/html/acre.asp
Accelerated Chest pain Risk Evaluation
Statewide Outcome Report
June 2016
Summary
Statewide Outcome Snapshot
The ACRE Project is a state wide clinical redesign
initiative to improve the assessment of chest pain
patients in hospital Emergency Departments (EDs).
For all possible cardiac chest
By implementing an accelerated diagnostic protocol
(ADP) described in the ADAPT1 trial, the project aims to
safely fast track assessment of one in five chest pain
patients. This is expected to lead to reduced ED and
admitted lengths of stay (LOS), and fewer admissions to
await diagnostic testing.
pain presentations:
 Median hospital LOS
 Admission rate
from 69%
30%
to 52%
 19 hospitals implemented
Outcomes
At this stage 19 hospitals across Queensland have
implemented the ADAPT-ADP, as shown on the map. At
implemented sites to 31st May 2016, 12792 patients, or
24% of the 53374 patients presenting with possible
cardiac chest pain had been managed using the ADAPTADP. Monthly presentation numbers, ADAPT-ADP
uptake, and no. of sites implemented and included in
data collation are shown on the graph below.
3500
18
Total Cardiac Chest Pain
16
Total ACRE-ADP
2500
14
12
2000
10
1500
8
6
1000
4
500
Number of Sites Implemented
3000
Implemented
2
May-16
Mar-16
Jan-16
Nov-15
Sep-15
Jul-15
May-15
Mar-15
Jan-15
Nov-14
Sep-14
0
Jul-14
0
May-14
Number of presentations
20
No of sites
1. Than M, Cullen L, Aldous S, Parsonage WA, Reid CM, Greenslade J, et al. 2-Hour Accelerated Diagnostic Protocol to Assess
Patients With Chest Pain Symptoms Using Contemporary Troponins as the Only Biomarker: The ADAPT Trial. J Am Coll Cardiol.
2012;59(23):2091-8. Epub 2012/05/15
Reduced by 30%, from 1167 to 815
minutes. This represents the most
significant impact of the ACRE Project
to date, and a very substantial
improvement for a cohort of patients
traditionally requiring prolonged
assessment and waits for diagnostic
testing.
1400
Median total hospital LOS (mins)
Total Hospital LOS
1000
1199
1167
800
815
600
400
317
200
0
Pre-implementation
Admissions
Post-implementation
ACRE Pathway
Non-ACRE Pathway
80%
70%
% patients admitted
Only 18% of patients assessed using
the ADAPT-ADP were admitted. This
compares favourably to 63% for non
ADAPT-ADP patients, which has also
dropped slightly from the preimplementation rate likely due to
other factors. The improved rate for
ACRE/ADAPT-ADP patients enabled
the overall post-implementation rate
to drop to 52%.
1200
60%
69%
50%
63%
52%
40%
30%
20%
18%
10%
0%
Pre-implementation
Post-implementation
ACRE Pathway
Non-ACRE Pathway
240
Median ED Length of Stay
Median ED LOS (mins)
Reduced from 228 to 213 mins,
demonstrating a median saving of
15 minutes (7%). While modest in
isolation, the impact of this
reduction is substantial when
scaled across all chest pain patients
across all ACRE Project sites.
228
180
224
213
184
120
60
0
Pre-implementation
Post-implementation
ACRE Pathway
Non-ACRE Pathway
90%
NEAT (National Emergency
% patients meeting NEAT
Access Target)
Cardiac chest pain patients showed
improvement from 56% to 63%
following ACRE Project
implementation. ACRE/ADAPT-ADP
patients performed significantly
better than other cardiac chest
pain.
80%
70%
77%
60%
50%
56%
63%
59%
40%
30%
20%
10%
0%
Pre-implementation
Post-implementation
ACRE Pathway
Non-ACRE Pathway