Improving resource utilization in a teaching hospital: development of a nonteaching service for chest pain admissions.
OBJECTIVE
Exclusion of acute coronary syndrome frequently prompts a brief hospital admission for a large proportion of patients presenting to the emergency department with chest pain. At hospitals with residency programs, the volume of such patients creates pressures on these programs because of the limit on the number of patients a resident can accept in a given period. These restrictions have been instituted by the Accreditation Council for Graduate Medical Education (ACGME). The authors hypothesized that a nonteaching service designed to identify and admit low-risk chest pain patients should reduce those pressures.


METHODS
A hospitalist-directed nonteaching service (NTS) was created to admit low-risk chest pain patients at the Hospital of the University of Pennsylvania. Patients' admission service was based upon the thrombolysis in myocardial infarction (TIMI) risk score. From September 2003 to June 2004, patients (n = 113) with scores of 0 or 1 (showing low risk) were admitted to the NTS. Simultaneously, a similar group of low-risk chest pain patients (n = 205) were admitted to a traditional internal medicine resident-based service (RBS).


RESULTS
The NTS patients had a lower median length of stay (23 hours versus 33 hours; p < .0001) and lower median hospital charges ($8,545 versus $14,150; p < .0001) when compared with the low-risk patients on the RBS.


CONCLUSIONS
The development of an NTS for chest pain admissions can assist residency programs in their efforts to meet the ACGME program requirements. The TIMI risk score can be used as a tool to assist in the identification of low-risk chest pain patients.
Myers
Jennifer S
JS
Division of General Internal Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA. jennifer.myers@uphs.upenn.edu
Bellini
Lisa M
LM
Rohrbach
Jeff
J
Shofer
Frances S
FS
Hollander
Judd E
JE
D000068:Accreditation / Q000592:standards; D000789:Angina, Unstable / Q000150:complications; D002637:Chest Pain / Q000145:classification* / Q000209:etiology; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data; D020445:Hospitalists; D006785:Hospitals, University / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications; D009722:Nurse Practitioners; D019982:Organizational Case Studies; D010343:Patient Admission / Q000592:standards*; D015143:Philadelphia; D011379:Prognosis; D016730:Program Development; D018570:Risk Assessment; D012307:Risk Factors; D014218:Triage / Q000458:organization & administration*