Design and Implementation of a Stand-alone Chest Pain Evaluation Center Within an Academic Emergency Department
Critical Pathways in Cardiology, 08/02/2012
Evidence Based Medicine
Winchester DE et al. - Evidence-based evaluation of chest pain in patients without acute coronary syndrome and with low-to-intermediate likelihood of obstructive coronary artery disease (CAD) can result in the significant majority of patients being discharged from the emergency department (ED). Creation of a stand-alone chest pain evaluation center (CPEC) in an academic hospital was associated with a significant reduction in hospital admissions.
- Chest pain is a common presenting symptom for emergency department (ED) patients; however, a thorough cardiac evaluation can be difficult to complete within the ED setting.
- Implementation of a stand-alone unit for the evaluation of chest pain may improve care for patients with chest pain.
- The authors designed a protocol for identifying patients without an acute coronary syndrome and with low-to-intermediate likelihood of obstructive coronary artery disease (CAD).
- These patients were monitored in a stand-alone chest pain evaluation center (CPEC) staffed with a small group of providers and tested for CAD, if necessary.
- In the first 6 weeks of operation, 181 patients were evaluated in the CPEC.
- The prevalence of CAD risk factors was low.
- Of the 181 patients, 159 (88%) were discharged home and 22 (12%) required admission to the hospital for further care.
- The authors compared the number of chest pain evaluations and admissions for first 6 weeks of operation to the same 6-week period from the 2 previous years.
- Whereas ED chest pain evaluations increased 66% over the 2-year time frame, the proportion admitted to the hospital decreased from 53% to 42% (P < 0.0001).