Tasmanian Health Service - RHH RACPAC Team

Andrew Black Picture.jpg

The Royal Hobart Hospital Rapid Access Chest Pain Clinic (RACPAC) was established in 2014 as a partnership between General Medicine and Cardiology and has now seen over 3,000 new referrals.

The clinic was designed to streamline the outpatient assessment of patients with new onset chest pain, as well as to provide certainty of timely follow up for patients being discharged from the Emergency Department.  Patients are offered an appointment within 2 weeks of referral, with expedited investigation where required.  Follow up is via telephone, minimising unnecessary additional clinic appointments.  90% of patients have non cardiac chest pain, and can be rapidly discharged from the service.  Patients with a history of previous cardiac disease are still seen in the general cardiology clinic due to the need for ongoing review.

A review of outcomes from the RACPAC compared to a historical comparison group from the traditional cardiology clinic appears in the current edition of the Medical Journal of Australia.  This study of 1,914 patients is the first and largest study of its kind and demonstrates a substantial reduction in wait times and the number of clinic appointments required to complete assessment.

Most importantly, unplanned Emergency Department re-attendance was cut by 64% and 56% at 30 days and 12 months respectively.  This was achieved at no cost in terms of safety, with a low rate of major adverse cardiovascular events in the RACPAC cohort at 12 months (0.2% vs 1.4% in comparison group; adjusted odds ratio 0.36 [0.19-0.67]).

This study also highlights the high prevalence of cardiovascular risk factors in a chest pain clinic population.  A key focus of the RHH RACPAC is the assessment and management of modifiable risk factors, and this is the subject of an ongoing clinical trial due for completion later this year.  The RHH RACPAC team, in collaboration with The Menzies Research Institute, are also conducting an economic analysis of the clinic, as well as qualitative research exploring patient and referrer experience with the new clinic model.

The research has been funded by grants from the Tasmanian Community Fund, virtual Academic Health Sciences Precinct and Royal Hobart Hospital Research Foundation (article reproduced with permission from Andrew Black, Staff Specialist, Cardiology Department, Royal Hobart Hospital).