Eight to ten million patients visit the emergency department (ED) with chest pain (CP) annually (Smulowitz et al., 2017). Additional testing in the low-risk population is not beneficial and leads to increased mortality (Smulowitz et al., 2017). The HEART (History, ECG, Age, Risk Factors, Troponin) score risk stratification tool assists with the identification of a patient’s 30-day risk for a major adverse cardiac event (MACE; Ras et al., 2017). Lack of education on use of the HEART score leads to incorrect use of the tool and inappropriate management of patients with CP. The aim of this quality improvement project is to enhance use and application of the risk stratification tool thus leading to consistent care and improved patient outcomes.

Emergency department observation unit (EDOU) providers indicated they received no structured training on use of the HEART score and many did not understand all components of the risk stratification tool. All EDOU providers at a county hospital system in Dallas County participated in this project to ensure best practice measures for the management of CP. Current evidence supports the use of educational videos and PowerPoint presentations to review the five components of the HEART score in addition to pre- and post-assessment quizzes. Providers practiced use of the HEART score with model patients created by the project leader. The scores were then compared to identify measures required to maintain sustainability. Expected outcomes based on current evidence are a 15% increase in post-test scores when compared to pre-test scores and the allocation of similar HEART scores to model patients from one provider to the next. Measures for sustainability include annual HEART score training for current EDOU providers and training at the time of hire for new employees.

Date of publication

Spring 4-29-2022

Document Type

DNP Scholarly Project



Persistent identifier


Committee members

Dr. Cheryl Parker; Dr. Lauri John; Dr. Chilton


Doctor of Nursing Practice