[AVBC 2025] Utilisation of a Chest Pain Protocol to Reduce Testing in Low-Risk Patients with Stable Chest Pain
Care Process & Redesign
Appropriate & Value-based Care Conference
SingHealth
27 November 2025
The study aims to evaluate whether the use of a chest pain protocol with structured risk assessment can reduce the rate of. The protocol group had lower rates of advanced cardiac testing (p0.001) and higher rates of patients with no tests ordered (p0.001).
Year Submitted: 2025
Published Date: 27 November 2025
Tags: Care Process ＆ Redesign, Quality Improvement, Workflow Redesign, Productivity, Cost Saving, Value Based Care, Risk Management, Safe Care
About this Content
Aims
The study aims to evaluate whether the use of a chest pain protocol with structured risk assessment can reduce the rate of unnecessary testing in low-risk patients with stable chest pain.
Background
Chest pain is a common presentation in outpatient cardiology clinics, and the majority of patients are low-risk. Excessive use of advanced cardiac testing in low-risk patients generates unnecessary cost and increased strain on cardiac laboratories.
Methods
A chest pain protocol incorporating the locally validated PRECISE risk score was utilized to guide management for 407 patients with chest pain (protocol group) in National Heart Centre Singapore (NHCS) and NHCS@Sengkang General. The protocol recommends avoiding testing in low-risk patients and offering primary prevention advice. Rates of investigations ordered in low-risk patients in the protocol group were compared with a similar low-risk cohort receiving standard care in other NHCS clinics.
Results
The use of the chest pain protocol effectively led to a three-fold reduction in cardiac investigations in low-risk patients, and more than twice the number of patients avoided testing altogether. This resulted in substantial cost savings by reducing unnecessary cardiac investigations. Importantly, the protocol was shown to be safe despite the reduction in testing, there was no increase in 1-year adverse outcomes.
Conclusion
The protocol group had lower rates of advanced cardiac testing (p0.001) and higher rates of patients with no tests ordered (p0.001). Estimated cost savings were $114,372 (n = 353), averaging $324 per patient.
Lessons Learnt
The protocol group had lower rates of advanced cardiac testing and higher rates of patients with no tests ordered, indicating the protocol's effectiveness in reducing unnecessary testing.
Keywords
Chest Pain, Protocol, Cardiac Testing, Cost Savings
Innovators' Details
Innovators' Details
Healthcare Cluster(s) | SingHealth |
Organization(s) Involved | National Heart Centre Singapore |
Platform(s) | Appropriate & Value-based Care Conference |
Healthcare Professional Group(s) | Medical |
Applicable Specialty or Discipline | Cardiology |
Project Lead(s) | Donovan Koh Song Yang |
Project Member(s) | Amelia Kuan Xin Yan |
Connect with this contributor!
Donovan Koh Song Yang - e1053702@u.nus.edu