A chest pain clinic to improve the follow-up of patients released from an urban university teaching hospital emergency department

Rouan, Gregory W.; Hedges, Jerris R.; Toltzis, Robert J.; Goldstein-Wayne, Beth; Brand, Donald A.; Goldman, Lee

doi:10.1016/s0196-0644(87)80474-2

Cited by 78 publications

(16 citation statements)

References 18 publications

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“…Acute non-traumatic chest pain in all age groups is the reason for about 2% of all attendances in accident and emergency departments (Rouan et al, 1987). Thirty to fifty-eight percent of patients over the age of 30 years with acute chest pain are hospitalized (Lee et al, 1987;Rouan et al, 1987).…”

Section: Discussionmentioning

confidence: 99%

“…Such problems may be characterized by means of Internal Audit, which looks at a group of patients sharing some characteristic (Shaw, 1980). Chest pain of spontaneous onset is a frequent reason for presentation to accident and emergency departments (Lee et al, 1985;Rouan et al, 1987). Although the vast majority of patients with non-traumatic chest pain have no serious underlying pathology, many are extensively investigated and/or are hospitalized, primarily because of physicians' anxiety lest they miss important but subclinical cardiac events.…”

Section: Introductionmentioning

confidence: 99%

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Non-traumatic chest pain in young adults: a medical audit.

Luke

Cusack

Smith

et al. 1990

Emergency Medicine Journal

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SUMMARYFour hundred consecutive young patients who attended an accident and emergency department with non-traumatic chest pain as their primary complaint were reviewed. They represented 0.7% of total new attendances. Most were self-referrals, but ambulance transport was requested for over 25%. The majority of investigations (mainly chest radiography and electrocardiography) performed in this group of patients were normal; however, almost one in six investigations was judged to be abnormal. Although this group of patients is at low risk for serious cardiorespiratory disease, a small but significant number of underlying (mainly non-cardiac) disorders was found and 22-5% (90) required in-patient admission. In contrast, almost onefifth of patients received no specific diagnosis, while almost 40% were deemed to require no follow-up.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Non-traumatic chest pain in young adults: a medical audit.

Luke

Cusack

Smith

et al. 1990

Emergency Medicine Journal

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“…Up to 7% of emergency department (ED) visits in the USA and Europe are patients presenting with chest pain [4][5][6][7]. About 10% to 15% of those patients are eventually diagnosed with an acute myocardial infarction (AMI) [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

The Role of Nurses in a Chest Pain Unit

Siebens

Moons

Geest

et al. 2007

European Journal of Cardiovascular Nursing

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The chest pain unit (CPU) provides a service for patients at moderate-to-low risk for acute coronary syndrome (ACS). Although the number of CPUs has continued to grow worldwide, little has been written on the specific role and contribution of nursing in CPUs. The stay of patients in the CPU can be divided into six stages: triage, diagnosis, treatment, observation/monitoring, discharge, and follow-up. CPU nurses are in a unique position to promote evidence-based practice during all of these stages. Deeper insight into the unique role of nurses in CPUs will promote understanding of what type of knowledge, skills, and attitudes are required to provide the services that will contribute to improved quality of care for chest pain patients.

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“…About 60% of these patients are admitted, in many cases to cardiac care units (CCU), for "rule-out" of myocardial infarction. Only 10-15% of these patients ultimately have acute myocardial infarction [2][3][4][5] (only 30% of those admitted to an intensive care unit [6]), and as many as 19% of those admitted with a diagnosis of unstable angina have no significant coronary artery disease [7]. This diagnostic inaccuracy generates an estimated 1.6 million unnecessary hospital days ~and $600 million in hospital costs annually for rule-out of myocardial infarction [1].…”

Section: Introductionmentioning

confidence: 99%

“…This diagnostic inaccuracy generates an estimated 1.6 million unnecessary hospital days ~and $600 million in hospital costs annually for rule-out of myocardial infarction [1]. Equally problematic, previous studies have suggested that 2-10% of chest pain patients sent home from the emergency department had acute myocardial infarction undetected on initial evaluation, up to 23% of which were fatal [2,4,5,8]. The medicolegal consequences of missed myocardial infarctions are substantial, accounting for >20% of the malpractice awards against emergency department physicians [9].…”

Section: Introductionmentioning

confidence: 99%

Identifying patient risk: The basis for rational discharge planning after acute myocardial infarction

Newby

Califf

1996

J Thromb Thrombol

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Variations in the management of patients with chest pain and acute myocardial infarction (MI) can significantly affect hospital length of stay and cost. Risk stratification of such patients, combined with data about effective therapies, provides the basis for developing rational guidelines for patient care that can improve efficiency while maintaining quality of care. Such standardized management approaches are often referred to as pathways or CareMaps. To be most effective in guiding hospital course and early discharge planning, risk stratification strategies must be applied early in a patient's course with continuous updating. The process of identifying risk in a patient with acute chest pain occurs in two segments: assessing the risk of acute MI at presentation, and subsequently assessing the morbidity and mortality risk of patients diagnosed with acute MI. Identification of patient risk at presentation has been the subject of intense investigation. The history, physical exam, initial electrocardiogram, and cardiac enzymes are the mainstays of the process, but because of inherent weaknesses in this approach (~25% of acute MIs missed at the initial screening), several risk stratification models have been developed. To date these models have not been widely employed, however. Very sensitive early cardiac markers, such as troponin T, and the use of diagnostic echocardiography or cardiolite perfusion imaging during pain are also being investigated. Chest pain observation units are an alternate strategy and have obviated the need to admit many low-to moderate-risk chest pain patients. In these protocol-driven units, continuous physiologic monitoring and serial cardiac enzymes and electrocardiography over a 9-12 hour period refine the risk assessment. For the majority who "rule out," the risk of subsequent MI or death is very low. Cost savings due to reduced length of stay and more efficient resource utilization are 63-76% compared with conventional ward or cardiac care unit management. For patients with acute MI, baseline characteristics, complications, and laboratory and diagnostic testing help define the risk of morbidity and mortality and guide management through the immediate post-MI phase and long term. Many models incorporating these features have been proposed for risk stratification after acute MI, and they have implications for both timing of discharge and necessary diagnostic testing. Savings by employing risk stratification to guide hospital course and discharge planning could be 30-44% in some patient groups. In conclusion, risk stratification models can facilitate early discharge planning, potentially reducing hospital stay, improving resource utilization, and reducing costs.Key Words. risk stratification, discharge planning, care pathway, chest pain unit Changes in the health care industry are prompting re-evaluation of the management of patients with coronary artery disease and clear or potential acute coronary syndromes. As the effort to control costs becomes increasingly important, reduction in hos...

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A chest pain clinic to improve the follow-up of patients released from an urban university teaching hospital emergency department

Cited by 78 publications

References 18 publications

Non-traumatic chest pain in young adults: a medical audit.

Non-traumatic chest pain in young adults: a medical audit.

The Role of Nurses in a Chest Pain Unit

Identifying patient risk: The basis for rational discharge planning after acute myocardial infarction

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