Impact of a Clinical Decision Rule on Hospital Triage of Patients With Suspected Acute Cardiac Ischemia in the Emergency Department

Abstract

Use of the clinical decision rule had a favorable impact on physicians' hospital triage decisions. Efficiency improved without compromising safety.

New methods for improved evaluation of patients with suspected acute coronary syndrome in the emergency department

“…The model deals with clinically important events, recommends specific action and, most importantly, is well validated 14. The model postulates that only patients with ECG evidence of ischaemia and at least two of three “urgent factors” (rales above both lung bases, systolic blood pressure <100 mm Hg and specified symptoms of unstable ischaemic heart disease) need admission to a coronary care unit.…”

Technical Feasibility of an Online Decision Support System for Acute Coronary Syndromes

“…Decision support tools were effective in identifying low-risk patients eligible for discharge from the ED 12,13 This suggests that DSS might achieve comparable success in identifying low-risk patients reporting chest pain by telephone who are eligible for outpatient evaluation. Indeed, the 50% of patients discharged home from the ED after evaluation of chest pain subsequently have a low rate of adverse clinical events.…”

“…[11][12][13] The decision support rule developed and validated by Goldman et al 11 focused largely on the prediction of cardiac complications within 72 hours among patients hospitalized with acute MI. Goldman's decision support rule was based on ECG findings and the presence or absence of 3 clinical predictors.…”

“…In their critique of new methods to improve evaluation of patients presenting to the ED with suspected ACS, Ekelund et al 16 emphasized the need to expand the present focus on acute MI to include the broader category of ACS. However, despite the favorable influence of prediction rules on the care provided to patients presenting to the ED with chest pain, [11][12][13] formal approaches to the triage of such patients have yet to be systematically implemented in clinical practice. 14 Katz et al 14 have suggested that better integration of guidelines into the clinical work flow, including the use of health information technology tools, could increase ED physicians' use of the ACC/AHA guidelines.…”

Coronary CT angiography in emergency department patients with acute chest pain: triple rule-out protocol versus dedicated coronary CT angiography

“…Low to intermediate risk patients are those with nonspecific or negative ECG change and normal initial serum cardiac biomarkers without evidence of cardiac failure. In these patients, the risk of a short term major adverse cardiac event (MACE) is relatively low [3,13]. Many of these patients are admitted to dedicated cardiac units to rule out ACS, and the conventional management protocol includes serial ECGs, serum cardiac biomarkers over 12-24 h and radionuclide perfusion imaging, often with single photon emission computed tomography (SPECT) or less frequently, positron emission tomography (PET).…”