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Background Rapid Access Chest Pain Clinics (RACPCs) play a central role in the assessment of patients with suspected stable coronary artery disease, yet increasing referral volumes, variable investigation strategies, and rising diagnostic costs place significant strain on services. National reviews have highlighted inconsistency in pathway implementation and called for greater use of digital solutions to standardise triage and improve efficiency.Objective To develop and evaluate a clinician-designed digital chest pain assessment and decision-support tool (eChestPain) and assess its feasibility, pathway concordance, safety, and service impact across multiple National Health Service (NHS) RACPCs.Methods We conducted a prospective, multi-centre service evaluation across four NHS RACPCs. Adult patients referred with suspected stable chest pain completed the eChestPain assessment independently prior to clinical consultation. The tool captured structured symptom data and generated an angina categorisation and investigation recommendation aligned with National Institute for Health and Care Excellence (NICE) guidance.Clinicians were blinded to the digital output until completion of routine assessment. Concordance between app-generated and clinician-selected investigations was assessed descriptively. Patient and staff feedback, and service metrics were collected to evaluate usability and workflow impact.Results Sixty-five patients were evaluated (East of England n=42; London Southeast n=23). Across East of England sites, the eChestPain tool recommended CT coronary angiography (CTCA) more frequently than standard clinical assessment (25 vs 20 cases), with fewer recommendations for invasive angiography (0 vs 4 cases) and slightly fewer no investigation outcomes (12 vs 13 cases). Functional testing recommendations were identical between approaches ( table 1).Summary of investigation outcomes across East of England (EoE) sites and Queen Elizabeth Hospital (QEH), comparing app-generated recommendations with investigations selected during routine Rapid Access Chest Pain Clinic (RACPC) assessment. Differences represent app minus real-world clinical decisions.At Queen Elizabeth Hospital, similar patterns were observed, with increased CTCA recommendations by the app compared with routine assessment (15 vs 10 cases), elimination of angiography recommendations (0 vs 4 cases), and comparable rates of functional testing and no investigation (table 1).The app eliminated invasive angiography recommendations and directed more patients toward CTCA, reflecting guideline-aligned redistribution rather than increased testing burden. Patient-reported usability and satisfaction were high across all domains. Staff reported good overall acceptability, with greatest confidence in usability.The average wait from referral to clinic appointment resulting in investigations and decision making of the standard pathway was 11 days. Mean patient completion time of the eChestPain app was 3 minutes 48 seconds. Automation of referral triage and first-appointment data capture through the eChestPain pathway could yield a potential time saving equivalent to approximately 0.69 full-time equivalent staff, representing an estimated £70,300 employer annual saving. Further service modelling suggested additional potential efficiency gains through reduced administrative workload, improved referral quality and reduced estates and facilities usageConclusions A clinician-designed digital chest pain assessment tool can be safely and feasibly integrated into RACPC workflows, producing investigation recommendations broadly concordant with routine care while supporting guideline-aligned, non-invasive testing strategies. The eChestPain tool demonstrates high patient and staff acceptability and substantial potential for service-level efficiencies.Abstract 367 Table 1Comparison of investigation recommendations generated by the eChestPain tool and routine clinical assessmentOutcomeEoE AppEoE RealEoE DifferenceQEH AppQEH RealQEH DifferenceCTCA2020+51510+5Functional test550110Angiogram04-404-4None1213-178-1