ArticleEClinicalMedicine2019
Clinical Transformation Through Change Management Case Study: Chest Pain in the Emergency Department.
Article in EClinicalMedicine, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed, 11 citations in OpenAlex.
- An Australian experience of the Rapid Access Chest Pain Assessment Clinic.Scientific reports · 2025Observational
- Implementation of High-Sensitivity Troponin for Early Rule-Out of Acute Myocardial Infarction in Emergency Department.American journal of medicine open · 2025Article
- Multicenter Study Evaluating Impact of Patient and Sonographer Demographics on Quality of Focused Cardiac Ultrasounds.The western journal of emergency medicine · 2025Article
- Uncommon cause of chest pain: Case report of esophageal foreign body diagnosed by chest computed tomography scan.Radiology case reports · 2025Article
- Change management for services redesign in healthcare: a conceptual framework.Journal of preventive medicine and hygiene · 2024Article
- Change Management in Medical Contexts, especially in Medical Education: A Systematized Review.Journal of advances in medical education & professionalism · 2022Review
- The effect of batched patient-physician assignment on patient length of stay in the emergency department.Journal of the American College of Emergency Physicians open · 2022Article
- Implementation of Integrated Behavioral Health Care in a Large Medical Center: Benefits, Challenges, and Recommendations.The journal of behavioral health services & research · 2021Article
- Where Do Models for Change Management, Improvement and Implementation Meet? A Systematic Review of the Applications of Change Management Models in Healthcare.Journal of healthcare leadership · 2021Review
Corrections and comments
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Authors and funding
6 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
INTRODUCTION/
backgroundAdults with chest pain presenting to an emergency department are high-risk and high-volume. A methodology which gathers practicing physicians together to review evidence and share practice experience to formulate a written algorithm with key decision points and measures is discussed with implementation, based on change management principles, and results.
methodsA methodology was followed to "establish the standard-of-care". Literature and data were reviewed, a written consensus algorithm was designed with ability to track adherence and deviations. We performed a before and after analysis of a performance improvement intervention in adult patients with undifferentiated chest pain in our nine-campus hospital system in Florida between January 1st, 2014 and December 31st, 2018.
resultsA total of 200,691 patients were identified as adults with chest pain and the algorithm was used. A dramatic change in the disposition decision rate was noted. When the 'Baseline-Year' was compared with the 'Performance-Year', chest pain patients discharged from the ED increased by 99%, those going to the 'Observation' status decreased by 20%, and inpatient admissions decreased by 63% (
conclusionsFor successful clinical transformation through change management, we learned: select strategic topics, get active physicians together, write a consensus algorithm with freedom to deviate, identify and remove barriers, communicate vision, pilot with feedback, implement, sustain by "hard wiring" into the electronic medical record and measure outputs.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.