Lessons learned from a community hospital chest pain center.
The iterative lessons from our studies suggest that creation of a chest pain center alone will not change the practice of chest pain management by most physicians. In 1993 we established a chest pain center; in mid-1995 we established a patient management algorithm directing intermediate-risk patients to the chest pain center rather than admit them to the hospital. The creation of a chest pain center did not reduce the rate of chest pain admission by mid-1995. After the patient management algorithm was created, admittances dropped by a rate of 21% (p <0.001) and chest pain center usage increased by +1,726% (p <0.001). Among the 473 patients treated and discharged in the chest pain center after mid-1995, 333 (70%) were considered intermediate risk. No patient died after discharge from the chest pain center and there was 1 non-Q-wave myocardial infarction. We conclude that a chest pain management algorithm in a chest pain center can be safe, yet effective, for identifying high-risk patients for admission and low-risk patients for discharge.
Stomel
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Botsford General Hospital, Farmington Hills, Michigan, USA.
Grant
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Eagle
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KA
D000368:Aged; D002637:Chest Pain / Q000175:diagnosis* / Q000191:economics; D003365:Costs and Cost Analysis; D019091:Critical Pathways; D004562:Electrocardiography; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006757:Hospital Units / Q000191:economics / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006764:Hospitals, Community / Q000191:economics; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000628:therapy; D010351:Patient Discharge; D012307:Risk Factors