FEASIBILITY OF A RAPID DIAGNOSTIC PROTOCOL FOR AN EMERGENCY DEPARTMENT CHEST PAIN UNIT

Study objective: To evaluate the applicability of a short-stay protoco l for exclusion of acute ischemic heart disease without hospital admis sion and to analyze these results in the context of a conceptual model . Methods: An observational study of patients who presented with chest pain to the emergency department of an 886-bed inner-city municipal h ospital and who needed hospital admission to rule out acute myocardial infarction (AMI). Patients were assessed by ED attending physicians t o determine eligibility for an alternative, 12-hour protocol in an ED chest pain observation unit (CPOU) followed by immediate exercise test ing. Outcome measures were proportion of patients eligible for the sho rt-stay protocol, risk factor profile, and reasons for exclusion. Resu lts: Of 500 patients screened, 446 had sufficient data points to deter mine protocol eligibility. Of these, 238 (53.3%; 95% confidence interv al [CI], 48.7% to 57.9%) were found to have low probability for AMI. A fter study exclusion criteria were applied to the patient cohort, 63 p atients (14.1%; 95% CI, 10.9% to 17.3%) were eligible for the protocol . The most common reasons for exclusion were history of coronary arter y disease (46%) and inability to perform an interpretable exercise tol erance test (42%). Conclusion: Although most admitted patients with ch est pain (53%) were at low probability for AMI, only a minority (14%) were eligible for a short-stay protocol that required patients to be f ree of known coronary artery disease and able to perform an exercise t olerance test. Factors affecting the operations and efficiency of a CP OU include clinical characteristics of the target patient population, protocol tests used, and hospital occupancy and reimbursement patterns .