Table 4. Barriers to implementing new diagnostic and discharge pathways in the emergency department and potential strategies to overcome them.

Implementation Barrier	Potential strategy
Limited knowledge in updated literature	Offer targeted in-person or virtual educational sessions for all clinicians to improve understanding of latest chest pain evaluation data and guidelines.
Lack of familiarity with updated protocol	Email reminders, question and answer sessions and educators on shift can help clinicians improve access and improve understanding of the updated protocol.
Resistance to change current practices	Protocol development leaders need to conduct multidisciplinary meetings to demonstrate pathway benefits through pilot studies after implementation.
EMR documentation limitations	Collaborate with EMR developers to integrate prompts or “hard stops” to document critical items such as HEART score
Disruption to current workflows	Automated EMR order sets based on initial troponin and documented HEART score may assist nursing workflow. Consultants and additional staff involvement in workflow also need training on protocol updates.

Notes.

EMR

electronic medical record