Differences in diagnostic evaluation and clinical outcomes in the care of patients with chest pain based on admitting service: The benefits of a dedicated chest pain unit

Somekh, Nir N.; Rachko, Maurice; Husk, Gregg; Friedmann, Patricia; Bergmann, Steven R.
March 2008
Journal of Nuclear Cardiology;Mar2008, Vol. 15 Issue 2, p186
Academic Journal
Background: Chest pain is one of the most common complaints of patients presenting at emergency departments. However, the most appropriate diagnostic evaluation for patients with chest pain but without acute coronary syndrome remains controversial, and differs greatly among institutions and physicians. At our institution, patients with chest pain can be admitted to an internist-run hospitalist service, a private attending service, or a cardiologist-run Chest Pain Unit. The goal of the present study was to compare the management and outcomes of patients admitted with chest pain based on admitting service. Methods: The charts of 750 patients (250 consecutive patients per service) with a discharge diagnosis of chest pain were studied retrospectively. Results: Patients admitted to the Chest Pain Unit were younger and had a lower prevalence of known coronary artery disease, hypertension, or diabetes, but a similar prevalence of other risk factors compared with the other groups. Sixty percent of the patients in the Chest Pain Unit underwent stress myocardial perfusion imaging as their primary diagnostic modality (vs 22% and 12% of patients in the hospitalist and private services, respectively; P < .001). In contrast, 35% of the patients admitted to the hospitalist service underwent rest echocardiography (vs 8% and 17% of patients in the Chest Pain Unit and private services, respectively; P < .001). Finally, 47% of the patients in the private service underwent coronary angiography as their primary diagnostic modality (vs 6% and 10% of patients in the Chest Pain Unit and hospitalist services, respectively; P < .001). The length of stay was shortest for patients in the Chest Pain Unit (1.4 ± 1.2 days vs 3.9 ± 3.4 days and 3.5 ± 3.6 days in the hospitalist and private services, respectively; P < .001), even when corrected for patient age and number of risk factors. Readmission within 6 months was lowest for patients in the Chest Pain Unit (4.4% vs 17.6% and 15.2% in the hospitalist and private services, respectively; P < .001). Conclusions: The results of this study demonstrate that a highly protocolized chest pain unit, using myocardial perfusion imaging as primary diagnostic modality, results in a decreased length of stay and readmission rate.


Related Articles

  • ED patients prefer to board in inpatient hall while waiting for room.  // H&HN: Hospitals & Health Networks;Jun2007, Vol. 81 Issue 6, p72 

    The article discusses the study published online in the "Annals of Emergency Medicine" concerning the location preference of emergency department (ED) patients in the U.S. Patients who are admitted to the hospital but waiting for rooms to open up prefer to wait in inpatient hallways rather than...

  • Injury in China: a systematic review of injury surveillance studies conducted in Chinese hospital emergency departments.  // BMC Emergency Medicine;2011, Vol. 11 Issue 1, p18 

    The article presents information about the systematic review of injury surveillance studies conducted in the hospital emergency departments in China. In the study, five single centre studies were identified, with the patient sample size ranging from 5436 to 13 008 patients with all being three...

  • Be careful with triage in emergency departments: interobserver agreement on 1,578 patients in France.  // BMC Emergency Medicine;2011, Vol. 11 Issue 1, p19 

    The article presents a study on the overcrowding of emergency departments (EDs) due to nonurgent patients in France. A multicentric cross-sectional study was conducted over a 3-day period in April 2007, in a sample of EDs located in the Provence- Alpes-Cote d'Azur (PACA) region, in France. The...

  • Patients now spend average of four hours in ED; talking to them about delays eases their anger.  // H&HN: Hospitals & Health Networks;Aug2007, Vol. 81 Issue 8, p57 

    The article reports that the top priority for emergency departments in the U.S. is improving communication to patients about delays. According to a report released in June 2007 by Press Ganey, while the total time spent in the ED does have a strong impact on overall satisfaction, how well...

  • Emergency departments post wait times on the web.  // ED Management;Jan2010, Vol. 22 Issue 1, p10 

    The article reports on the positive attributes of wait times posted by the two emergency departments of Sacred Heart Medical Center in Eugene, Oregon on their home page. It notes that the idea, which was started by the marketing department of the hospital, increases patient satisfaction from 96...

  • REGULAR ATTENDERS AT A&E. Baston, Simon // Emergency Nurse;Sep2005, Vol. 13 Issue 5, p20 

    Focuses on the analysis and identification of regular attenders at the accident and emergency (A&E) department of the Northern General Hospital in Sheffield, England. Summary of the distribution of patients in terms of primary reasons for attending A&E; Objectives in the analysis of regular...

  • Achieving full potential. Cronin, Camille // Emergency Nurse;Jun2007, Vol. 15 Issue 3, p8 

    The article discusses changes related to the provision of emergency medical services in England. Such changes have been identified in the "Reforming Emergency Care" document which form the basis for a ten-year program of reform. The document's strategy aims to ensure that patients are seen at...

  • Meeting Canadian Emergency Department Triage and Acuity Scale benchmarks in a rural emergency department. Vlahaki, Dean; Milne, W. Ken // Canadian Journal of Rural Medicine;Summer2009, Vol. 14 Issue 3, p101 

    Introduction: The Canadian Emergency Department Triage and Acuity Scale (CTAS) was implemented in 1999. The CTAS aims to more accurately define patients' needs for timely care and provide operating objectives to standardize this care. These objectives are not being met across Ontario. The...

  • Readmissions in the Emergency Department. Mouridsen, Mads Strunk; Forberg, Jakob Lundager; Barfod, Charlotte // Scandinavian Journal of Trauma, Resuscitation & Emergency Medici;2012 Supplement 2, Vol. 19 Issue Suppl 2, p4 

    The article presents a study on the readmissions of patients in the emergency department (ED) at Hilleroed Hospital in Denmark. The patients with frequent admissions within a limited period of time may represent a group of patients, where readmissions could be prevented. The study showed that...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics