Application of Diagnosis-Related Group (DRG) in Measuring the Impact of Clinical Pathway on Resource Utilization for Patients Suspected With Acute Coronary Syndrome in the Emergency Department

OBJECTIVES: Effective Acute Coronary Syndrome (ACS) management in the emergency department (ED) is crucial for patient outcomes, although it often requires significant resource utilisation. Variability in clinical practices can lead to inefficiencies and inconsistent care. To address these issues, we developed and implemented a standardised clinical pathway (CP) specifically designed for patients suspected of ACS. This study aims to describe the clinical pathway's development and implementation process and evaluate its effectiveness in optimising resource utilisation in the ED.

METHODS: We developed a CP and evaluated its effectiveness in a prospective study with controls on patients presented to the Emergency Department, University Malaya Medical Centre (UMMC). Patients were identified through the diagnosis-related group (DRG) coding. Patients who were presented between June 2023 and October 2023 were prospectively recruited into the CP group. Non-CP controls were obtained from randomised case records of patients presented between June 2022 and September 2022. Outcomes were evaluated by comparing resource utilisation which include investigations and medications used.

RESULTS: 203 patients were enrolled in the CP group, while 86 were in the non-CP group. Both groups were similar, with no significant differences in age, sex, gender, and triage zone (p-value ranging from p=0.347 to p=0.636). We observed a significant decrease in non-ACS-related investigations performed and other medications prescribed. The proportion of non-ACS-related investigations sent was reduced from 100.0% in non-CP compared to 15.6% in the with-CP group (χ2 = 3.935, p = 0.047). Similarly, the proportion of prescriptions of other medications reduced from 88.4% in non-CP compared to 78.3% in the with-CP group (χ2 = 4.013, p = 0.045).

CONCLUSIONS: The implementation of CP has shown promising results, significantly reducing non-ACS-related investigations and other medication prescribed to patients suspected of ACS in the Emergency Department. This is a positive step towards more efficient and targeted patient care.