Funding flashback: Funding generates improved process for heart patients in ED

Published: 9 April 2025

A change in the way patients with chest pain are treated when they arrive at the Emergency Department at Christchurch Hospital is the work of Professor Martin Than, an emergency department doctor and a Heart Foundation research grant recipient in 2017.

Professor Martin Than’s research looked at patients who are assessed on arrival at hospital as not having an immediate heart attack but who may need further investigation to establish the underlying cause of their chest pain.

The first investigation is often an exercise stress test, performed a few days later. This is usually organised after a specialist’s (e.g. cardiologist) review of the case. An exercise stress test is undertaken on a treadmill and shows how the heart copes when working harder.

“Each careful patient case review takes time, and when many patients need review that adds up to a significant amount of work. This research project was able to demonstrate that a decision based on guidance given by the cardiologists can be safely and effectively replicated by staff working in the emergency department,” he says.

Martin and his team of doctors wanted to evaluate a change of process. Instead of the decision about who gets a test being made a few days later by a cardiologist, they trialled the decision being made by emergency department (ED) doctors while the patient is still in ED. 

Results of the research showed that the latter process was efficient and resulted in the same rate of exercise stress tests with similar outcomes.

“Cardiologists are a limited resource and there are other patients who would benefit from their review. This project has shown that it is possible to free up precious cardiologist time for other patients while empowering doctors in the emergency department to order tests in a similar manner.”

“I am personally very pleased to be able to demonstrate a way of using our limited resources more efficiently,” he says.

 Heart Foundation Medical Director Dr Gerry Devlin says there has long been a need for an improved process and tools to assess a person who presents at an ED with chest pain. 

“This research, led by Professor Than and the emergency doctors at Christchurch Hospital, is improving our ability to not only provide care but also reassure New Zealanders presenting with chest pain in a timely manner. It also gives confidence for the ongoing use of ED doctors for their decision making.”

While this new diagnostic pathway is currently only being used at Christchurch hospital, there is hope it will be used in other hospitals in future, widening the impact of this successful research project.