title: New Guidelines for the Management of Chest Pain: Lessons From a Recent Audit in Tauranga, New Zealand.
abstract: BACKGROUND
  Protocol based care is known to improve the outcomes of patients admitted with recent onset chest pain. The aim of this clinical review was to investigate chest pain management, using newly published guidance from NICE, in the emergency department of a regional hospital in New Zealand.
  
  
  METHODS
  All admissions with chest pain during the period of September-October 2010 were identified retrospectively (n = 599), and a sufficiently powered random sample (n = 120) taken. Relevant data was identified from patient notes, including basic demographics and specific management details.
  
  
  RESULTS
  One hundred and eighteen patients were analysed (M = 65, F = 53), 99.2% received an ECG on admission, yet only 59.3% of patients had documented evidence of a repeat ECG, with admissions during the day less likely to receive one compared to those admitted overnight (51.5% vs 69.2%, P = 0.04). Younger patients (< 39 years) appeared less likely to receive aspirin than older patients (38.9% vs 80.0%, P = 0.06), 21.3% of patients failed to receive 300 mg aspirin, and 45.6% of patients received oxygen despite normal saturations.
  
  
  CONCLUSIONS
  Despite good performance in a number of areas, this clinical review has highlighted that some standards, such as repeat ECGs, administration of aspirin therapy and appropriate use of oxygen are not being met in all patients with chest pain. A chest pain management pathway is to be implemented for all relevant admissions, to ensure that essential aspects of care are not missed. Timely dissemination and implementation of new clinical guidelines remains a challenge in clinical practice.
authors.affiliation: Highland Heartbeat Centre, Raigmore Hospital, Inverness, IV2 3UJ, UK.
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Chapman
authors.affiliation: Highland Heartbeat Centre, Raigmore Hospital, Inverness, IV2 3UJ, UK.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Leslie
authors.affiliation: Tauranga Emergency Department, Cameron Road, Tauranga 3110, New Zealand.
authors.forename: Derek K
authors.initials: DK
authors.lastname: Sage
keywords: Chest pain; Medical audit; Oxygen therapy