The SAEM GRACE program addresses the best practices for the care of the most common chief complaints that can be seen on the tracking board of any emergency department in the country, based upon research and expert consensus. These guidelines are designed with de-implementation as a guiding principle to reasonably reduce wasteful testing, provide explicit criteria to reduce foreseeable risk, and define sensible and prudent medical care.
In addition to GRACE for chest pain, SAEM research and writing teams will create guidelines for recurrent abdominal pain, acute dizziness, and non-opioid substance dependence.
GRACE-1 - Recurrent, Low Risk Chest Pain
Chest pain is the second most common chief complaint in the emergency department (ED), with only five percent of patients diagnosed with an acute, life-threatening condition. There are significant physician and institutional variations in diagnostic testing and admission of these patients, creating a need for clinical practice guidelines to aid in the evaluation and treatment specific to the ED population. The first SAEM GRACE team was assembled to address this critical need for evidence-based and expert-driven recommendations for the care of complaints associated with recurrent chest pain.
A multidisciplinary panel of experts assessed the certainty of evidence and strength of recommendations regarding eight priority questions for adults presenting to the ED with recurrent, low-risk chest pain. They then developed guidelines for testing, treatment, hospital admission, and screening tools and referrals for mental health management. To write this clinical practice guideline, the panel used Grading of Recommendations Assessment Development and Evaluation (GRADE) methodology, a framework for rating the quality of the best available evidence and developing clinical practice recommendations.
In GRACE-Recurrent, Low-risk Chest Pain: A User’s Guide, to be published alongside
the Musey et al. GRACE article in AEM, Courtney et al. summarize what emergency medicine physicians can take to the patient bedside and its possible effect in the ED,
“It is not recommended to employ further routine stress testing to reduce subsequent 30-day major adverse cardiac events (MACE). In our opinion the other important statement is that there is insufficient evidence to recommend hospitalization (either inpatient admission or observation) versus discharge. Further recommendations including screening and referral for anxiety and depression, previously unexplored topics in the context of chest pain, should also be noted in this novel work.”
“Endorsement and dissemination by multi-stakeholder organizations could catapult these recommendations into decision support within electronic health records and implementation for millions of chest pain ED visits across the US and beyond.”
CREDIT: Mark Ramzy, DO, Critical Care and Ultrasound Fellow, University of Pittsburgh Medical Center Department of Critical Care
Upcoming GRACE Guidelines:
GRACE-2: Acute Abdominal Pain in the ED (2022)
GRACE-3: Acute Dizziness in the ED (2023)
GRACE-4: Non-opioid Substance Dependence in the ED (2024)