title: Chest pain unit in an internal medicine department: comparison of a year with the facility to a year without.
abstract: BACKGROUND
  Chest pain is one of the most common reasons for emergency department visits and hospital admissions. Chest pain units (CPU) are being incorporated in tertiary hospitals for rapid and effective management of patients with chest pain. In Israel prior to 2010, only one chest pain unit existed in a tertiary hospital.
  
  
  OBJECTIVE
  To report our first year experience with a CPU located in an internal medicine department as compared to the year before establishment of the CPU.
  
  
  METHODS
  We retrospectively evaluated the medical records of consecutive patients who were admitted to our internal medicine department for the investigation of chest pain for 2 different years: a year before and a year after the establishment of the CPU in the department. We focused on the patients' characteristics and the impact of the CPU regarding the investigational modalities used and the length of in-hospital stay.
  
  
  RESULTS
  In the year before establishment of the CPU, 258 patients were admitted to our department with chest pain, compared to 417 patients admitted to the CPU in the first year of its operation. All patients were followed for serial electrocardiographic and cardiac enzyme testing. All CPU patients (100%) underwent investigation compared to only 171 patients (66%) in the pre-CPU year. During the year pre-CPU, 164 non-invasive tests were performed (0.64 tests per patient) compared to 506 tests (1.2 tests/patient) in the CPU population. Coronary arteriography was performed in 35 patients (14%) during the pre-CPU year, mostly as the first test performed, compared to 61 patients (15%) during the CPU year, mostly as a second test, with only 5 procedures (1.1%) being the first test performed. The length of hospitalization was significantly shorter during the CPU year, 37.8 +/- 29.4 hours compared to 66.8 +/- 46 hours in the pre-CPU year.
  
  
  CONCLUSIONS
  Establishment of a CPU in an internal medicine department significantly decreased the need for invasive coronary arteriography as the first modality for investigating patients admitted with chest pain, significantly decreased the need for invasive procedures (especially where no intervention was performed), and significantly shortened the hospitalization period. CPU is an effective facility for rapid and effective investigation of patients admitted with chest pain.
authors.affiliation: Department of Internal Medicine E, Rambam Health Care Campus, Haifa, Israel. s_hamoud@rambam.health.gov.il
authors.forename: Shadi
authors.initials: S
authors.lastname: Hamoud
authors.forename: Riad
authors.initials: R
authors.lastname: Mahamid
authors.forename: Majdi
authors.initials: M
authors.lastname: Halabi
authors.forename: Jonathan
authors.initials: J
authors.lastname: Lessick
authors.forename: Sobhi
authors.initials: S
authors.lastname: Abbadi
authors.forename: Roni
authors.initials: R
authors.lastname: Shreter
authors.forename: Zohar
authors.initials: Z
authors.lastname: Keidar
authors.forename: Doron
authors.initials: D
authors.lastname: Aronson
authors.forename: Haim
authors.initials: H
authors.lastname: Hammerman
authors.forename: Tony
authors.initials: T
authors.lastname: Hayek
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000032:analysis; D002637:Chest Pain / Q000209:etiology*; D015897:Comorbidity; D003952:Diagnostic Imaging; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006757:Hospital Units / Q000458:organization & administration*; D006801:Humans; D007388:Internal Medicine; D007557:Israel; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D015415:Biomarkers