STUDY OBJECTIVE: We evaluate a program designed to safely reduce avoidable emergency department (ED) admissions for chest pain using peer feedback. METHODS: We analyzed data from August 1, 2020, to December 31, 2022, comparing clinical protocols, education, and feedback starting in July 2021 at 16 EDs in a Mountain-region state (state A) and 22 in a Southwestern state (state B), compared with 70 controls with protocols and education alone. Difference-in-difference analyses compared temporal changes in admission rates in intervention versus control EDs. RESULTS: The study included 368,730 visits for chest pain. After implementation, feedback was not associated with a significant overall relative improvement in ED admission rates for chest pain. However, among baseline high-admitting clinicians, chest pain admissions declined in state A by 14.3% (95% confidence interval -21.7% to -6.9%) and in state B by 5.6% (95% confidence interval -10.5% to -0.8%), relative to high-admitting clinicians in control states. We estimate that 4 admissions in every 100 chest pain visits could have been avoided if feedback had the same effect in control EDs as it did in state A. CONCLUSION: Adding peer feedback to clinical protocols and education was associated with reduced admissions for chest pain among baseline high-admitting clinicians.
Oskvarek et al. (Mon,) studied this question.