Development and evaluation of the clinical pathway for suspected acute coronary syndrome in emergency department

Author

• Nur Aimimastura Berahim @ Abd Wahab, Universiti Malaya

Date of Award

4-20-2026

Thesis Type

PhD

Document Type

Thesis

Divisions

Faculty of Medicine

Department

Department of Social and Preventive Medicine

Institution

Universiti Malaya

Abstract

Introduction: Variations in medical practice and resource utilisation in managing suspected Acute Coronary Syndrome (ACS) in Emergency Departments (EDs) lead to inconsistencies in care and inefficiencies. Standardised clinical pathways (CPs) aim to promote evidence-based, consistent management. This study aimed to develop, implement, and evaluate CPs for ACS cases in the ED. Methods: A three-phase quasi-experimental before-and-after design was conducted over 18 months. Phase 1 established baseline practice. Phase 2 involved multidisciplinary CP development. Phase 3 comprised a one-month trial and four-month full implementation. The framework evaluated process indicators (utilisation rate, variances documentation), quality indicators, resource utilisation and costs via top-down and bottom-up activity-based costing (ABC). Results: Implementation findings showed a 14.4% utilisation rate. Despite these challenges, quality indicators improved significantly: non-essential testing dropped from 100% to 22.2% (p=0.047), and Ticagrelor utilisation rose from 4.7% to 38.9% (p< 0.001). Cost comparison revealed actual costs were higher than baseline across all diagnoses, with mean differences ranging from RM 16.91 (non-thrombolysis STEMI) to RM 188.24 (stable angina). This increase was driven by enforced adherence to potent antiplatelets and mandatory diagnostic panels. Conclusion: Standardising ACS pathways improves consistency and reduces diagnostic waste. Although direct ED costs increased, this represents a strategic quality investment to align local practice with evidence-based standards. Addressing implementation barriers through digitalisation is essential for long-term sustainability and reduced provider burden.

Initial

khm

Additional Information

Thesis (PhD) – Faculty of Medicine, Universiti Malaya, 2026.

Recommended Citation

Berahim @ Abd Wahab, Nur Aimimastura, "Development and evaluation of the clinical pathway for suspected acute coronary syndrome in emergency department" (2026). Student Works (2020-2029). 1984.
https://knova.um.edu.my/student_works_2020s/1984

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.