Clinical features in the emergency department can identify patients with suspected acute coronary syndromes who are safe for care in unmonitored hospital beds.
BACKGROUND
Standard practice for patients requiring hospital admission with suspected acute coronary syndromes (ACS) is admission to a monitored cardiology bed. The Western Hospital Chest Pain Protocol was developed to identify a subset of these patients who could be safely managed in an unmonitored bed.


OBJECTIVE
The objective of this prospective study of chest pain patients classified as 'high' or 'intermediate' risk by the Agency for Health Care Policy and Research/National Health and Medical Research Council guidelines was to further evaluate the safety of this protocol.


METHODS
This study was a prospective, observational, cohort study investigating the outcomes of patients admitted to hospital with suspected ACS. The primary outcome of interest was death or life-threatening arrhythmia within 24 h of hospital admission.


RESULTS
If the Western Hospital Chest Pain Protocol had been strictly applied, there would have been one death in the group assigned to unmonitored beds (1/750; 0.13%, 95% confidence interval 0.01-0.85%) and no other life-threatening arrhythmias.


CONCLUSIONS
There is a subgroup of patients with suspected ACS who require hospital admission who can, based on clinical and biochemical features in the emergency department, be safely assigned to unmonitored beds.
Kelly
A-M
AM
Joseph Epstein Centre for Emergency Medicine Research, Western Hospital and The University of Melbourne, Melbourne, Victoria 3011, Australia. Anne-Maree.Kelly@wh.org.au
Kerr
D
D
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002637:Chest Pain / Q000175:diagnosis* / Q000628:therapy; D015331:Cohort Studies; D003327:Coronary Disease / Q000175:diagnosis* / Q000628:therapy; D004562:Electrocardiography; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization; D006764:Hospitals, Community / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D017751:Safety Management; D013577:Syndrome; D013686:Telemetry