Structure, process and outcomes of chest pain units established in the ESCAPE Trial

Use or Abuse? A Qualitative Study of Emergency Physicians' Views on Use of Observation Stays at Three Hospitals in the United States and England

“…[7][8][9][10] Similarly, in England, research finds that observation can reduce unnecessary inpatient admissions, inappropriate emergency department (ED) discharges, and length of stay. [11][12][13][14][15] However, others are critical of observation stays. In the US, studies have found that observation is used for a much wider range of diagnoses than indicated by the Centers for Medicare and Medicaid Services (CMS), and often for more than 48 hours, 16 with dubious clinical or cost benefit, and potential negative consequences for patients.…”

Discharge of Non–Acute Coronary Syndrome Chest Pain Patients From Emergency Care to an Advanced Nurse Practitioner–Led Chest Pain Clinic

“…Across Europe chest pain assessment units linked to ED provide a common route to manage the patient who presents with chest pain 8,9 focusing on prompt diagnosis and management of ACS. Whilst there is evidence of the benefits of the role of the chest pain unit reducing overall hospital admissions, 8,9 this option still has cost implications related to staffing, equipment and space within the ED setting, a setting renowned for its stresses. 8 Recently specific protocols and practices have been developed to facilitate direct discharge from the ED.…”

“…Whilst there is evidence of the benefits of the role of the chest pain unit reducing overall hospital admissions, 8,9 this option still has cost implications related to staffing, equipment and space within the ED setting, a setting renowned for its stresses. 8 Recently specific protocols and practices have been developed to facilitate direct discharge from the ED. These range from; a two-hour accelerated diagnostic protocol (ADP) 10,11 a chest pain diagnostic algorithm facilitating discharge followed by outpatient stress testing within 48 hours 12 the New Vancouver chest pain prediction rule 13,14 ; and chest pain patients discharged from ED who underwent exercise stress testing within one week of discharge.…”

Implementation of a Dedicated Cardiovascular and Stroke Unit in a Crowded Emergency Department of a Tertiary Public Hospital in Brazil: Effect on Mortality Rates

“…9 It is adjacent to the ED and functions as a "crowding-proof" area to allow better quality of care. As the management of acute vascular syndromes is time-dependent, delays associated with ED structure and health care system inefficiencies are unacceptable.…”