title: Resource Utilization Reduction for Evaluation of Chest Pain in Pediatrics Using a Novel Standardized Clinical Assessment and Management Plan (SCAMP).
abstract: BACKGROUND
  Chest pain is a common reason for referral to pediatric cardiologists. Although pediatric chest pain is rarely attributable to serious cardiac pathology, extensive and costly evaluation is often performed. We have implemented a standardized approach to pediatric chest pain in our pediatric cardiology clinics as part of a broader quality improvement initiative termed Standardized Clinical Assessment and Management Plans (SCAMPs). In this study, we evaluate the impact of a SCAMP for chest pain on practice variation and resource utilization.
  
  
  RESULTS
  We compared demographic variables, clinical characteristics, and cardiac testing in a historical cohort (n=406) of patients presenting to our outpatient division for initial evaluation of chest pain in the most recent pre-SCAMP calendar year (2009) to patients enrolled in the chest pain SCAMP (n=364). Demographic variables including age at presentation, sex, and clinical characteristics were similar between groups. Adherence to the SCAMP algorithm for echocardiography was 84%. Practice variation decreased significantly after implementation of the SCAMP (P<0.001). The number of exercise stress tests obtained was significantly lower in the SCAMP-enrolled patients compared with the historic cohort (∼3% of patients versus 29%, respectively; P<0.001). Similarly, there was a 66% decrease in utilization of Holter monitors and 75% decrease in the use of long-term event monitors after implementation of the chest pain SCAMP (P=0.003 and P<0.001, respectively). The number of echocardiograms obtained was similar between groups.
  
  
  CONCLUSIONS
  Implementation of a SCAMP for evaluation of pediatric chest pain has lead to a decrease in practice variation and resource utilization. (J Am Heart Assoc. 2012;1:jah3-e000349 doi: 10.1161/JAHA.111.000349.).
authors.affiliation: Department of Cardiology, Children's Hospital Boston and the Department of Pediatrics, Harvard Medical School Boston, MA.
authors.forename: George R
authors.initials: GR
authors.lastname: Verghese
authors.forename: Kevin G
authors.initials: KG
authors.lastname: Friedman
authors.forename: Rahul H
authors.initials: RH
authors.lastname: Rathod
authors.forename: Amir
authors.initials: A
authors.lastname: Meiri
authors.forename: Susan F
authors.initials: SF
authors.lastname: Saleeb
authors.forename: Dionne A
authors.initials: DA
authors.lastname: Graham
authors.forename: Robert L
authors.initials: RL
authors.lastname: Geggel
authors.forename: David R
authors.initials: DR
authors.lastname: Fulton
keywords: chest pain; pediatrics; quality improvement; resource utilization