Rapid rule out of acute coronary syndrome (ACS)

Erin O’Callaghan1, Marianne Griffen1

1 Emergency Clinical Care Network, Melbourne VIC

Assessment of risk is part of the chest pain assessment process within Emergency Departments. In 2016, the National Heart Foundation and Cardiac Society released guidelines advising that selected patients requiring rule out of Acute Coronary Syndrome in the Emergency Department can have a shorter assessment process. This project aimed to provide Emergency Departments across Victoria with guidance about how to combine clinical risk stratification, ECG and troponin testing; along with structure on how to guide patient management in a clear clinical pathway documentation process.

Background: The Emergency Care Clinical Network actively engages with emergency clinicians in creating and building sustainable improvements and innovation in the delivery of emergency care in Victoria. A key focus is to enhance the use of evidence-based care to reduce variation in clinical practise and improve patient care. Within this project: patients were considered eligible for the rapid rule out pathway if they had no high risk features, a modified TIMI score of 0 or 1, depending on the troponin assay used and a normal or unchanged ECG. Implementation of rapid rule out Acute Coronary Syndrome pathway for eligible patients would be in parallel with ‘standard’ practice for other patients.

Results: In 2016, a similar project was conducted; the median change in length of stay for the rapid rule out group over nine months was 96 minutes. The median change in length of stay was 58 minutes. This year the project aims to build on those, with results due November 2017.

Findings: The rapid rule out pathway reduced the average length of stay for patients in the Emergency Department using evidence based practice to guide clinicians. Extended benefits included clear discharge planning and patient education which improved patient centred care.

Summary: Implementation of the rapid rule out pathway in the Emergency Department enhances patient care by reducing variation in clinical practice based on evidence resulting in reduced length of stay and improved patient centred care.


 Erin O’Callaghan is an Emergency Clinical Nurse Specialist and Associate Nurse Unit Manager. She works at a large tertiary Emergency Department (ED) and concurrently a smaller private ED in Melbourne. Erin also holds the position of  a Teaching Associate with Monash University.  Erin has a Master of Nursing (emergency). As part of this, Erin completed a research thesis titled ‘Compassion Fatigue in Emergency Nurses’ in 2015.  Erin has experience in homeless youth outreach and mental health case management. 
Erin is currently on secondment to Safer Care Victoria the Victorian Department of Health and Human Services, working within the Emergency Clinical Care Network (part of Safer Care Victoria). As a Senior Project Officer/ Nursing advisor. Erin’s role is to implement sustainable and innovative evidence based projects that reduce variation in clinical practice and improve quality of care across Victorian Emergency Departments.