The PAIN Pathway as a Tool to Bridge the Gap between Evidence and Management of Acute Coronary Syndrome

Clinical guidelines on the management of Acute Coronary Syndrome (ACS) have consistently shown a major gap between the guidelines and their application in the actual management of ACS. In an attempt to achieve the goal of bridging the gap between these evidence-based guidelines and patient management, we have reorganized the pathway for the management of ACS at our institution. The pathway has been designated with the acronym of PAIN (Priority risk, Advanced risk, Intermediate risk, and Negative/Low risk), to reflect patients risk stratification upon admission. Along with the pathway comes a single detailed order sheet and a single discharge form which are color-coded according to the patient's risk stratification. This model is designed to mandate and, thus, markedly improve adherence to the published American Heart Association/American College of Cardiology guidelines for the management of ACS.