title: Introduction of an accelerated diagnostic protocol in the assessment of emergency department patients with possible acute coronary syndrome: the Nambour Short Low-Intermediate Chest pain project.
abstract: Emergency physicians can feel pressured by opposing forces of clinical reality and the need to publish successful key performance indicators in an environment of increasing demands and cost containment. This is particularly relevant to management of patients with undifferentiated chest pain and possible acute coronary syndrome. Unreliability of clinical assessment and high risk of adverse outcomes for all concerned exist, yet national guidelines are at odds with efforts to reduce ED crowding and access block. We report findings from the Nambour Short Low-Intermediate Chest pain risk trial, which safely introduced an accelerated diagnostic protocol with reduced ED length of stay and high patient acceptability. Over a 7-month period, there were no major adverse cardiac events by 30 days in 19% of undifferentiated chest pain presentations with possible acute coronary syndrome discharged after normal sensitive cardiac troponin taken 2 h after presentation and scheduled to return for outpatient exercise stress test.
authors.affiliation: Department of Emergency Medicine, Nambour General Hospital, Nambour, Queensland, Australia. terry_george@health.qld.gov.au
authors.forename: Terry
authors.initials: T
authors.lastname: George
authors.forename: Sarah
authors.initials: S
authors.lastname: Ashover
authors.forename: Louise
authors.initials: L
authors.lastname: Cullen
authors.forename: Peter
authors.initials: P
authors.lastname: Larsen
authors.forename: Jason
authors.initials: J
authors.lastname: Gibson
authors.forename: Jennifer
authors.initials: J
authors.lastname: Bilesky
authors.forename: Steven
authors.initials: S
authors.lastname: Coverdale
authors.forename: William
authors.initials: W
authors.lastname: Parsonage
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis*; D015415:Biomarkers / Q000097:blood; D002637:Chest Pain / Q000175:diagnosis*; D002985:Clinical Protocols / Q000592:standards*; D017023:Coronary Angiography / Q000379:methods; D004636:Emergency Service, Hospital; D005080:Exercise Test; D006801:Humans; D007902:Length of Stay; D010043:Outcome and Process Assessment, Health Care; D017060:Patient Satisfaction; D011793:Queensland; D019210:Troponin I / Q000097:blood
chemical_list: D015415:Biomarkers; D019210:Troponin I
keywords: acute coronary syndrome; chest pain; length of stay; risk assessment; troponin