THE INVESTIGATION OF CHEST PAIN - AUDIT AND INTERVENTION

Objective: To examine the patterns of tests requested for patients adm itted with chest pain, and to monitor the effects on those patterns of issuing a set of guidelines formulated by an expert panel. Setting: T ertiary referral hospital (teaching). Design: A retrospective audit of the patterns of testing of patients with chest pain compared with tes ting recommended by an expert panel, followed by comparison with patte rns of testing after guidelines were issued. Intervention: Practice gu idelines, based on the expert committee's recommendations, were drawn up for use in the cardiology unit. Outcome measures: Tests per admissi on, bed days per admission, emergency readmission rate. Patients: Sixt y-seven patients with diagnosis at the time of admission of chest pain and a discharge diagnosis of ''Intermediate coronary syndrome''. Resu lts: The major finding of the audit was the excessive use of ''biochem istry test profiles'' instead of targeted tests as recommended by the expert committee. Intervention led to a decrease in the number of test s per admission in the cardiology unit from an average of 22.9 tests i n the six months before intervention to 9.7 in the six months after (P < 0.001). There was no effect on bed days per admission or emergency readmission rates. Conclusion: Audit and intervention in a specialised unit of patients with a specified diagnosis led to more cost effectiv e use of the resources of the Royal Melbourne Hospital Department of B iochemistry.