title: Design and implementation of a stand-alone chest pain evaluation center within an academic emergency department.
abstract: Chest pain is a common presenting symptom for emergency department (ED) patients; however, a thorough cardiac evaluation can be difficult to complete within the ED setting. Implementation of a stand-alone unit for the evaluation of chest pain may improve care for patients with chest pain. We designed a protocol for identifying patients without an acute coronary syndrome and with low-to-intermediate likelihood of obstructive coronary artery disease (CAD). These patients were monitored in a stand-alone chest pain evaluation center (CPEC) staffed with a small group of providers and tested for CAD, if necessary. In the first 6 weeks of operation, 181 patients were evaluated in the CPEC. The prevalence of CAD risk factors was low. Of the 181 patients, 159 (88%) were discharged home and 22 (12%) required admission to the hospital for further care. We compared the number of chest pain evaluations and admissions for first 6 weeks of operation to the same 6-week period from the 2 previous years. Whereas ED chest pain evaluations increased 66% over the 2-year time frame, the proportion admitted to the hospital decreased from 53% to 42% (P < 0.0001). In conclusion, evidence-based evaluation of chest pain in patients without acute coronary syndrome and with low-to-intermediate likelihood of obstructive CAD can result in the significant majority of patients being discharged from the ED. Creation of a stand-alone CPEC in an academic hospital was associated with a significant reduction in hospital admissions.
authors: Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville, 32610-0277, USA. dwinches@ufl.edu
authors: David E
authors: DE
authors: Winchester
authors: Dhane
authors: D
authors: Stomp
authors: Roger Y
authors: RY
authors: Shifrin
authors: Preeti
authors: P
authors: Jois
mesh_terms: D000046:Academic Medical Centers / Q000379:methods; D054058:Acute Coronary Syndrome / Q000150:complications / Q000175:diagnosis*; D000328:Adult; D002637:Chest Pain / Q000175:diagnosis* / Q000209:etiology; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis*; D019091:Critical Pathways; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D055416:Evidence-Based Emergency Medicine / Q000379:methods*; D005080:Exercise Test; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data; D018570:Risk Assessment; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D014218:Triage / Q000379:methods